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HomeMy WebLinkAboutHealth Permit # 12/8/2017 i t Map-Block-Lot 107 A O09$ 1 Commonwealth of Massachusetts BOARD OF HEALTH PermitNo ' BHP-2017-1099 North Andover P.I. FLL F.1. ISPOSAL FORKS CONSTRUCTION PERMIT � � Permission is'hereby granted Bateson Ent to(Construct)an Individual Sewage Disposal Systean. at No 1370 JOHNSON STREET ____..,._ as shown on the application for Disposal Works Construction Permit No, BI-IP-2917 edove 2017. Issued On: Nov-I6-2017 BOARD OF HEALTH � roNmoo. ., Commonwealth of Massachusetts Map-Block-Lot °t 107.A009$8 BOARD OF HEALTH Permit No North Andover BHP-2x17-1099 FEE DISPOSAL WORKS CONSTRUCTION PERMIT' Permission is hereby granted Bateson-Ent.. to(Construct)an Individual Sewage Disposal System. at No 970 JOHNSON STREET ..._.._... as shown on the application for Disposal Works Construction Permit No BHP-2017-1 Dated ove 0-17 Issued On:Nov-I6-2017 BOARD OF HEALTH i a Application for Septic Disposal S ►stem Construction --Permit TOWN O TODArs DATE $MOM—Full Repair NORTH ANDOVER MA 01845 $'1'25.00°-Component Application Is hereby made for a permit to: 0 Construct a new on-site sewage disposal system* 1 ❑Repair or replace an existing on-site sewage disposal'system* .� c��'r°(.�.�. sTepair or replace an existing system component—What. C ''' ' i A. Facility Information RECEIVED Address or Lot# city/Town ION r-M(),2114 LN OIER 2.-*TYPE OF SEPTIC SYSTEM*: t,0011 DE.P i,TMEN ` ❑ Pump LBIGravity(choose one) "*If pump system,attach copy of electrical permit to application'' A ❑Conventional System (pipe and stone system) ➢ ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Bax 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 Modeh� 2. Owner Information Mame Address(if different from above 1 Cityrrown State Zip Code Telephone Number 3. Installer Information -- e lF f!r. �iij r ,nr.11 r.,.,),ING. .M^C." � ..- .°".s,,7t'K'""/ _..'1 i d A 1-'f✓' n e . n Name of Com a Name p - ) R�00V�-B f,,v,, 6,18 1 o //- hrI I (,q- L, -- Address 14114 Cityrrown State Zip Code Telephone Number(Cell Phone#ff possible please) 4. Desian6rInfoFination Name Name of Company Address _ CRtyfrown State Zip Code Telephone Number(Best#to Reach) Application for disposal System Construction Permit-Page 1 oft A ��� is Dis O.si ��'�tC�.�1..fOr �� alstem ©nstroOlon Permit TODAY'S PATE V.7 11% $,250.06,-pull Repair �sa c►utiE`' `...."" x"(25 00,-Component PAGE 2 O 2 A. Facilt ,tnformaton :confinued®.. �^`"�� r l ....,,,,�'' of w S. Type"of Suilding:.SAesidgntlal,D.wellfng or 00ommercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore.descrlbed on-ilia sewage d/sposal sysfe"hrin accordance with ithe.provisions of Title 5 of the Envlr'onMental Code,as.well as the local Subsurface Disposal Regulations for the town of North Andover, and not to place;th'asystem In operatlon.untfl a Certificate of Compllattce has been Issugo by this Board of Health. Nems Date Application Approved By: (Board of Health Representative) Name [3ate Application Disapproved for the following reasons:" ' For Oft a Use On#y: 1. "FeeAttachcd? Yes Na 2,• Prafect lartager ObLgatron Farni Attac-tzeds' Yes C Ncr ' Fum2 Svstem? Ifso) trach o, ;y of 1 cYectrlcal '�-rm ''; 'es No 4. Foutlda otr _._.. ., ' _ ...._ mm...... �, As Brultr'(new constructlori'ronl No (SM"O scslee os spprovcdp=) , 5. 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