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HomeMy WebLinkAboutHealth Permit # 12/8/2017 i lv]s�p-si"� Commonwealth of Massachusetts -�t BOARD OF HEALTH Perm,tNo -------- North Andover BHP-2017-1094 P.1. _....— FEE F.I. $175.00 --------------- DISPOSAL, WORKS CONSTRUCTION PERMIT Permission is hereby granted Bateson Enterprises -- - ------ -- _-------- -------- - ---- to(Construct)an Individual Sewage Disposal System. �">C�'.. j° �: �'- /6) °171c, at No 185 BRIDGESLADE ...' P , 2017 pp p' --- as shown an thea application for Disposal Works Construction Permit Na. HHI 20 7"=1O�I'.... , at�� November 09=.----- ---. - -- _ Issued On:Nov-09-2017 ... BOARD OF HEALTH a Application for .ep is DispOsal System £ a„� # cam. Constru'ctionPerinit — TOWN OF TDDArS DATE W. - Repair NOR H ANDOVER MA 41845 50-com Application Is hereby made for a permit to; D construct a new on-site sewage disposal system* ❑Repair.or replace lace an existing on-site sewage dis osat system* tem 1 � � p g 9 P Y * 0-Viepair or replace an existing system component–What? „° ti,r .. ' ” ? - ' W k A. Facility Information Address or Lot# CityfTOwn 2.-*TYPE OF SEPT ..SYSTEM*. -rOWN Or-NORTH ANDOVER ➢ ❑ Pump -[Gravity(choose one) HEALTH DEPARTMENT "*If pump system, attach copy of electrical permit to application*** ❑Conventional System (pipe and stone system) ➢ n Infiltrator or Blodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Bax) ➢ ❑ 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 DWG issuance) What is the Make? What is the Modcli 2. Owner Information Name - Address(if different from above) l ._.... p City/Town State Zip Code ��� _ Telephone Number 3. Installer Information Name Name of Cor+lP anY ","HISM0,INC, "f 1 t AR( -A[-,ioAD ANDOVER. MA Address � Cityfl*owrn State Zi p Code Telephone Number(Cell Phone#if possible please) 4. Designer-Information Name Name of Company Address City/town State Zip Code 'telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 A 11caf loci,.for.Se tic DIs osal stern :.,. .. O 4Qi1S 1 V� '"' '�� oDAY'S AAT s ' 1A 018 ,,.► .t' �:25Q.00 Pull Rpalr 4 S�(25.0p::Component RAG> Z OF 2 t A. Faciilly,informa#iOn :C©ntinued. .. S. Type`of Building; Residential Dweliing or 00omrnercial B. Agreement rhe unders/gned agrees to ensure the constructlon and maintenance of the afore:described on-slt`e sewage dlsposal ikstem,ln accordance with the provisidns of title 5 of the Envlronmenta7 Code,as,welj as the Local Subsurface Disposal Regulatlons for the Town of North Andover, and not to place,ttha system In Operatla»Wilts Certificate of Compliance has been Is a d� y t • s s Board ofHealth, Name, Application Approved By: (Board of Health Representative) Name Date Application Disapproved,for the following reasons:-, ' For 9MIce Use Only: -------------- X "Fee1 Attsched? : .` Yes—L// No 2., Pro1ectMaxt2ger Ohhgr atl'on Form Attached? 1Vo l-ma, �`+u'_t=? .rfsq Attac1"�=v rlrir. 1Pcrmlr No ,.y 4. FOunda ' ' tro�rAs,Bur'!t?,(Few construcflor�•ronl}r): .nWy' . (Same Mde as approvedplau) 5. Floot PZws?thew ddlistrutrtiori'only). Appj6atfdn'dar.platppsal.yysteci: or�strUctfcrri Psrmtt Rsae 2�r • r . ► �. . , , . 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