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HomeMy WebLinkAboutHealth Permit # 12/8/2017 Commonwealth of Massachusetts Map-Block-Lot 104.D0094_ . .,. BOARD OF HEALTH *� Permit No North Andover BHP-20.17-1100. . .... .. . ........ P.1. PEE FJ. $175.00 DISPOSAL WORKS CONSTRUCTION PERMIT � Permission is herebyanted Bateson Ent � � ' 5 � € ' -- --- to(Construct)an Individual Sewage Disposal System. at No 197 VEST WAY -------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BI TP 201.7-1 10 ted Nove er 017 Issued On:Nov-16-2017 BOARD OF, HEALTI-I • Commonwealth of Massachusetts Map-Block-Lot /J1''� BOARD OF HEALTH 104 Doo94--------- * Permit No North Andover BHP-2017-1100 FEE $176.00 ............ DISPOSAL, WORKS CONSTRUCTION PERMIT Pet-mission is hereby granted Bateson Ent --- --------- ----------- to --------to(Construct)an Individual Sewage Disposal System. cSr✓c. at No 197 VEST WAY as shown on the application for Disposal Works Construction Permit No. BHP-2017-1 Dated e er 2017 Issued On:Nov-16-2017 BO, RD OFIILALTH l F Application for S:eptic Disposal Sster�n TODAY'S DATE Construction Permit - TOWN OF $250:00—Full Repair NORTH .Al`wTD OVA'R$ MA 01845 M5.011-Component Application is hereby made for a permit to: ❑Construct a new on-site sewage disposal system* ❑Repair or replace an existing on-site sewage disposal'system* _ U'#epair or replace an existing system component—What? Gf A. Facility Information '7 Address or Lot# CiifTown� _ .. , �` ✓1 ��..�s�s, 2.-*TYPE OF SEPT SYSTEM*'. A ❑ Pump ravity(choose one) "Tpump system, attach copy of electrical permit to application*** ❑Conventional System (pipe and stone system) ➢ ❑ Infiltrator or BiodifFuser(Gravel-Less)(Attach a copy of yourcertification to install this type ofsystem.) ❑ Pressure Distribution S.A.S.(No D-Bax) D ❑ Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info. needed) NO-(installer must specify brand of filter before DWC issuance) What is the Make? What is the Modeta 2. Owner Information Name Address(if different from above) Cityrrown State Zip Code 91 'fir ~ Telephone Number 3. Installer Information Name Y ! Name of Con(,' - .s INC. Address — L MA 0 16 io _ Cityfrown, State r Zip Code I —a 117 d Telephone Number(Cell Phone#ffpossible please) 4. Desianelrnformiation Name Name of Company Address - CitylTown _- State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 A ficatIO . •.far Se is his aj:,��afii stern . �r TODAYS DATE 1lliV1CY2sp.00:�Fufl epir Q4 '1Z5Compoytent -PAGE 2 OF 2 A. Facili ,:In.fofrmatio►n co flnued.... S. Typo-ofBujldinq; esidentlal,Dwelling or(DCommerclal B.Agreement The underslgned agrees to ensure:the constru0tlon and malntenance of the afore:deierlbed on-site sewage disposal system In accohdOnee with iffie.provIsl6ni of Title 5 of the Environmental Code,as well as the Local Subsurfeca Disposal Regulatlons for the Town of , North A»dov , and not t0 pJace;#he system In operation until o Certif/cate of Compllance:has been Issue y this oard of Health. Name Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved,for the following reasons;"' ' For Offfee Use Only: 1 "FeeAttached?� .• Yes, es7A2.• FfOctMadaget Ohhgtadon Form Attaab-d? .7- A: : Fumy vstem? Ifsa)Attachco v._ �. rmit Nb 4. FbundadaaAs•.B'ux'W(hew constructlon,ronly), Yes (Same scale as app. ovedpl&a) A FloorP.laas?'(he.w c©nstructlon.only): des Na �,pplrc kld�e�forpi( o$at . p ...Yst9r*06rtstrueticrri Permtk Raae 2 cit 7 r r � ►M I • 1 b • � * � ♦ � �r • 1 t•■ .ir . • #r , r I „ • rY. ww■, ■ a a• w r! _ ♦ r + �Itl • a r r•✓w " r r .r• Ir 1! 1♦ F 1. r ^ rY / • 1 * utajo, Visr 04 / 4 t a • a • i L'syl la< r , •w r a • a • •■ YI. 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