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HomeMy WebLinkAboutHealth Permit # 11/15/2016 • , Commonwealth of Massachusetts Map Block Lot 106.00082 • BOARD OF HEALTH Perm3tNo North Andover ------zo1s-0472 FEF $175.00 DISPOSALS WORKS CONSTRUCTION PERMIT 3 Permission is hereby granted Todd Bateson - - - ----------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal Syl± m.' } at No 151 CARLTON LANE t as shown on the application for Disposal Works Construction Permit No. BHP-2016-047 Dated November 15,2016 ---------------- __ ---- ----------- -----------------------------------------------` Issued On:Nov-15-2016 'BOARD Op'�ht�'J H r i ion for Septic Disposal System Application Construction Permit — TOWN OF TODAYS DATE 60 $2501. - u Repair NORTH ANDOVER, MA 01845 $1 0 Compon n-A Application Is hereby made for a permit Construct a new on-site sewage disposal system* Rep ir or replace an existing on-site sewage disposal system* p Zpair or replace an existirif 7ysT ante What. _m(fompoir 69 A. Facility Information 4e/4"C-L Address or Lot# RECEIVED- 2.-*TYPE OF SER11C SYSTEM*: NOV 1 ,5 Z016 > ❑ Pump ff Gravity(choose one) 'TOWN OF NORTH ANDOVER ­If pump system, attach copy of electrical permit to application' > [:]Conventional System (pipe and stone system) HEALTH DEPARTMENT > ❑ Infiltrator or Blodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) E] ➢ Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. , 0�) ➢ ❑ Does the system require an effluent filter? Yes No L-`­ !f yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of filter before DWG issuance) Wlha t is the Make? What is the modlch ____ 2. Owner Information game IS-1 Address(if different from above) e5, t ------------- City/Town State Zip Code Telephone Number 3. Installer Information Name '7'1r)r11STFr,, IN Name of ComV6hV"-' T17— 111 1�OAIJ (A T­ AN[)ovrr�, IWA 0 1 8i 0 Address Cityrrown State Zip Code Telephone Number(Coll Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(bes_tWfoo Reach) Application for Disposal System Construction Permit Page 1 of 2 MdNrH Ap;plication..for Septic Disposal . stem, v _. 3 rya sE^�,� w� ice+ h 'C.onstrl.�ction 'Perrrtt - 1'V . Q,L 7UpAY'S DATE F * '►� •�'� (JR."T' ,NDR MA 01$45 $.zsa.00 Fall Repair �qas,•• - - Component ACHU s $125.00.Co .-PAGS 2 OF 2 A. Facility information continued,... S. T.ype'of Building: lKesidential Dwelling or ElOommercial B. Agreement The undersigned agrees to ensure the construct/on and maintenance of the afore-described on-site sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code,as well as the Local Subsuifice,Disposal Regulations for the Town of North Andover, and not to place the system In operation until a Certificate of Compliance has been Issu d� th, oard of Health. Namur' Date A llcatf %�i�� r'4e y� pp 9 �po : (Board of Health Representative Name Date Application Dia�approved,for the following reasons; For Office Use Ono.. I ' Fee Attaecbedr' Yes 2,• Frojectl4laaager©bligatron Attacbedr' Yes 31: Purnn�S' tcm? If,sai h f rmr °„ 'es No 4. Fvwndatlo'rAs Built.?(flew constrcuctlon, n1y)r Yes No (Sarre scale as approved plan) 5. F1oorPlaxsP(J�rew cairn#ruction'onl.Y): 3 AppliI' tidn,fior'0005ai 4ystbM-:0dn*Uctlod Pemmn Racae 2 er 9 SH .`IC SYST Aa4 N 1luc3avrr ic=cd iataallet£gr44,0 trq6ft fda.t6leptic 6y6 •for.the�Pmvettyat, (Ad4rm e[tepdt apt* -.Ycm pUm by Reue"to tke apomdm of _ l(MVWWG:unse AM dMW DaW klaaa.-T;A WSft mvi Eow dtted (L=t mosed date) I uadwtated the followIng olbugstiotm for mmgmeut ofibb project; 1. Aa the fat i i a.ob]rgsated#p abut ellpe Baal Bb d of ulth�W �pum ►g any:wotk ciat. edte, plmpdz to 2. 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