HomeMy WebLinkAboutHealth Permit # 3/21/2006 Commonwealth of Massachusetts Map-Block-Lot
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105----0064-
Board of Health
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ermit No
BHP-2006-0068
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North Andover ------------------ ----
I � P.I. FEE
RC�a,sq � F.I.
$125.00
Disposal Works Construction Permit
Permission is hereby granted Peter Breen
to(Repair)an Individual Sewage Disposal System.
at No 94 SHERWOOD DRIVE
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as shown on the application for Disposal Works Construction Permit No. BHP-2006-006 Dated - March 21,2006
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Issued On: Mar-21-2006 Board of Health
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No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BARD OF HEALTH
Town North Andover
OF
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( ) Repair (X) Upgrade ( ) Abandon ( ) - []Complete System [T Individual Components
94 Sherwood Drive Jian Wen & Judy Hou
Location Owner's Name
Map 105C, Parcel 64 94 Sherwood Drive, N. Andover 01825
Map/Parcel# Address -
978 973-9074
Lot# Telephone#
The N ve—Mo i n Grntr-, T nr
Installer's Name Designer's Name
447 Boston Street , Topsfi d , ML-( 1983
Address Address
978 887-8586
Telephone# Telephone#
Type of Building: Residential Lot Size 59 ,022 Sq.feet
Dwelling—No.of Bedrooms 4 Garbage Grinder (NO
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) 440 gpd Calculated design flow 41x0 gpd Design flow provided 449__._.�pd
Plan: Date 1/2 0/06 Number of sheets 1 Revision Date None
Title Plan of Land in North Andover, Mass. Showing "Septic Tank Repair"
Description ofSoil(s) SIM(KxlA zK N/A PrePar Nano 47 a }_nen
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑Complete System
The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( )
by:
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built
plans relating to application No. dated Approved Design Flow (gpd)
Installer
Designer: Inspector Date
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96