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HomeMy WebLinkAboutHealth Permit # 11/29/2017 I I T Commonwealth of Massachusetts Map-Block-Lot 106 C0090 BOARD OF HEALTH + Permit No North Andover BHP-2015-0083---------- FEE $125.00 ------------ DISPOSAL WORKS CONSTRUCTION P'ERMI'T" Pei-mission is hereby granted Todd Bateson. to(Construct)an Individual Sewage Disposal System. r at NO 49CAttL'TONI;,ANE- '- . ...'` 1_ .... ------- as shown on the application for Disposal Works Construction Permit No, 13HP-20157008 Dated March 31,2015 �.._ Issued On: Mar-31-2015 BOARD OF HEALTH i 1, I Application for Septic Disposal Svstem, TODAY'S DAM Construction Permit - TOWN OF $2501.00'—Full Repair NORTH ANDOVER. MA 01845 $125.00-Component Important: Application is hereby made for a permit to: When filling out F1 Construct a new on-site sewage disposal system* forms on the computer,use ❑Repair or replace an existing on-site sewage disposal system* only the tab key to move your 04e-p ir or replace an existing system component—What? cursor-do not use the return A. Facility Information key. Address or Lot# it yfrow� 2.--*TYPE-6F S'E'—P'jj"—YSTEM*: > E] pump ER-iTravity(choose one) ***If pump rim, attach copy of electrical permit to applicatio >MP SYSO 9,17 onventional System (pipe and stone system) 1-ex)c-(--- > ❑infiltrator or Biodiff user(Gravel-Loss)(Attach a copy of your certificiffio-n to install this type of system.) > ❑ Pressure Distribution S.A.S.(No D-Box) > ❑ Pressure Dosed(D-Box Present)S.A.S. > F1 Does the system require an effluent filter? Yes�— N ....... If yes, does plan specify make and model of filter? YES =(no furth r info. needed) NO=(installer must specify brand of filter before DWC issuance) What is the Make?— What is the Mod'c4hM 3 12015 2. Owner Information °° e 40t- e r- t;'V Name { /Y Address(if dlfferentfroriWabove) Cityrrown State Zip Code Telephone Number 3. Installer Information Name Name of Cqmpany -I e 10,ATSON r7-NTE,71PRISE S, INC. Address A4- el?)0 ANDOVER, IVIA 0 181 U CityrTown State Zip Code -feTephone Number(Cell Phone#if possible please) 4. Designer Information NameNameName Of Company ---------- CityfFown State Zip Code Felephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 Application..for Septic Dlspo.sai .S stem .� * . • °c � TODAY'S ..DATE Construction �Permrit — TO'R'N. +0►,F " $.258.00--FullRepair $hCYNUS ©RT14 ANDOVER, MA 01.845 $125.00 Component PAGE 2OF2 A. Faciii .Information continued.... 5. Type,of Building: esidential Dwelling or OCommercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-slte sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulatlons for the Town of North Andover, and not to place the system In operation until a Certificate of Compliance has been Issued his Board of Health, f .. Name Date lira n Apprciye y� oard Health Representative) __ ,. I .- m Date Application Disapproved or the following reasons: For Offloa Use Only: 1 Fee Attached? Yes No 2, PrajectMadager Obligation Form Attached? Yes N ' A: Pum_,�S ,�,rv? Ifsoj Attach ca,Qv ofMectrrcal Pernrrt Na 4. Foundation As-Built.?(new construction-ronly), Yes, , No (Same scale as approved plan) a A FlootPlans?(hew construction,only). Yes .No AppEfcatfon for pfsppaai Systerrt.0bnMract1on Permit-Page 2 Of 2 An fl%*.Nqrth An&vtrjic=SCd &ijmUer fo XtH*.W�trtlCilwftlho. I septic F6r plans by Roative to tht'APPIlmdon of - ots SOM-ey—,­ Atd dated Dated wah NI le I the instaR04 r Q= -Obligated t'* 6bt& Aff pej=ts and Bbard o lOf`HC;Rlth approved pIgns to f Othmilug =y.'Wolk Oa it mite, 2. As &�intyftj, snint'"n for my and aul"PeWbnS, leholgemmet. cOntmctOpTojeCtmwgV, Or any 4erpenon flot *040cfkted With my'dompiny g��- -an oa and tho qatc6l js not rcgd7, th, As *A whiclz but do. der hwe tq b4 prqiift:� gag for eTev d thee, -etc, babaaaiAx�b­ to 414141 dk--(6i i-m4tb? iu fr6m the aria r• MCgUShMia U4 bmd I r*mzm � . - r gxtxst 'o 46,jhA"e,.,f :1� for iiii 6pectipn time 1�6ii� . , qtjU& be . pu4t'4' t&r"-fi"Pecdcm, W'th*'Pu6Pqftlft)2,- CIteftical �mu.st' bc. $Ad, able to MUM P.Oj�p 46 1��& jf4d�a1ax�;to firm - C. VAdlaili catpplete,. tmtaet 'does u'Ot hive to keon"fite-, Arthe in wam .1. utlti dt*t only Fpsyptob= to ?npjeteth4jnstihtjWu of *e mte� 'M�ndj�djq ONMAW61) 4.:hd 1, OT*ed A-I &t inlStdIAHOni'llaffer 6�.insr M-er I . n SECPS., hg,,60ep rc&chcd 66 to be used, Q F!qdZVpccab&.6 d' Undmimird UcosgsgoHL jt -