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HomeMy WebLinkAboutHealth Permit # 1/17/2018 I, - --- ... r • J Commonwealth of Massachusetts Map-Block-Lot 104 D0130 BOARD OF HEALTH PermitNo North Andover BHP-2018-0002 P.1. FEL F.I. $175.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Bateson Enterprises ----------------------------------------------------------------- to(Construct)an Individual Sewage Disposal. System. at No 111 CHRISTIAN WAY -..-------- --------------------------------------------------------- -- - as shown on the application for Disposal Works Construction Permit No BHP-2 Dat Ja 2018 ---- _a z,... .. .... Issued On: Jan-17-2018 BOARD OF HEALTH i I 1, { Application for Septic Disposal System �ry TODAY DATE Construction Permit -- TOWN OF $250:01Y—Fun Repair NORTH AN°DOTVER, MA. 41$45 $125.00_Component Application Is hereby made for a permit to: f F1 Construct a new on-site sewage disposal system* i ❑Repair or replace an existing on-site sewage disposal'system* 1 (�epair or replace an existing system component—What? ) s W J-)—P7 ::4_- _ A. Facility Information s ,�Iv 14//I- Address or Lot JAN 15 CityfTown ;/ 'e a vel"- NORTHTOWN OF ANDOVER 2.-*TYPE OF SEPTIC SYSTEM*:- DEPARTMENT ➢ ElPump cavity(choose one) "*If pump sys m, attach copy of electrical permit to application**" ➢ onventional System (pipe and stone system) ➢ ❑Infiitrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ [IPressure Distribution S.A.S.(No D-Box) El 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 Makes' What is the ModcA 2. Owner Information Name Address(if different from above) /V", IVA CityfTown State Zip Code Telephone Number 3. Installer Information Name Name o omp S PYARC:,11_1.A l',OAD Address Cityrrown state Zip Code Telephone Number(Cell Phone#If possible please) 4. Desislner4nforrrration Name Name of Company Address Cityrrown State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 N 11iH A F Il of ian,.for.SentIC Dis Q:Sai Sstem —/ AO. Onstr.U.0tio 1.=F!arm� a Toners 7E " ''• ` � ' ��.�.�7. AD, � 01845 �: n � all Repatr N, 5.254?. 0 F "I CHU� �-- ��t25 Op R Comp nQnt PAGE 2-OF 2 - 1 A. Fac111LNv lnf.ornnatlon continued,.� 5. Type,of Buildin ;. esldentlal Dwellln or Commercial B. Agreement The underslgned agrees to ensure the construotlon and malntenance of the afore:desGtibed on-site sewage disposal systam,ln acaoro'ance with tie,pr©vlslons of Title 5 of the Envlronirrental Code,as well as the Local SuhsuiaF*Oq Oisposal Reg'ulatlons for the Town of North Andover, and mot to placolhe system Inoperation until Certificate of Complla rca has been issued y this Board of Health. Name Date pp r d of Nealt`h.Represe-ntative) A fl�atlon rov d Bo .. Me Application Disapproved,for the following reasons."' ' For Office Use Only: I `Fee Attaclrcd?: Yes t No 2.• Pro)cct.l f",iger Oh#gadon Farm Attache'd? No A CSB =? Ifso)Attach co,��QfLr+'1,-�/YrralPetSm�r:. es -- No 4. F6rmda#otrAs-BW7t?(new construpdo,)•ronlj/): Yes Nil— (SIM e scale as approvedplaa) A Floor-PLwsr'(he:w donsteuotlonf only): P'es No • Applfaatldn'dar.pla'pOsaC Sy',sterll:�onstfiUcttari�?ermft�Raoe 2 o�a Aa 654•Npsth AAndavarliclimsed&iim9jt frig oiow t true OQII ft.*618eptia qVtCM'fat.&e (h�ot'gdc rytteac) -Oce ping by Reiit�5 b�theappil�doa of� /�i4 T�,� �� .. (ini� s ►te Abd dM Dtted y Wfth row dg ' . (I.a=r rcvls date} I the following bbllgatioos fat management ofi�ba pro cct< 1. As the farmer,I am.obligated to abtxiCt.AUperpits snd#p2rd 0 Meafffi gppwyc4 gIguaplia t'D �p�g At►p.'�aar3�cim.a ems• - 2. Ass' ,:I,�aabatlr -fo stt1 aad sdI'aptx cu ho sea�aatxe coacr�ct p aaM of sy odttpat rnx niat*040E PA•With stip&mpiap g&adu"Ia�ep�cm and the apaticia is ndt=ce thch •itrm thcce•sh�.h�,o�?pf�blc. .. � •' 3,'� h14.4ins xitx:.z to tom• # tpmtIffiatMAMMA— r a ra'i b n ua# t i ',spc a 4ut doll hs v tri prt$tet, 6. i r ,'teEpa�t foz#Icviosu�.t ,etc. t a 'vexb I OI£'(ar cpm •to: friam thee bamicci#ohc.Aoxd ofBatk `3 { , % tar's meat rpt~farx �� e Vie.`i#tst�]tes be PF,�tx, 'Ath gctt'evk, t be 'atuad .#z� orlcidrs .to ,, c. �- �tllrs mt� 'uxepsaa�'vfcp df� p �e Vinci mot haoe to bejite.' r� 4. As-the iastaltrt;'I uud d that o*low P�the c'pfur1&a • • riaen�p�CtetI�n�aat�.ttvfth��t�eft�entif�#k�.ie�e¢�►pl,J�at�a�'�3�at�t€aa; vnry 1411 Enor� Abthcfiaatie �r eider�tn a ste csa- + f tFb cotrstNciou ��. �E�C��'i1�d'��ItE,�¢• r •G��'PxT�Qti Q��tL`!'� r,• .: ,: . .• ' , b. ,las P�A� • oar,��•bcet,xc�ahed E . ptftra crftlresa�'�ead#eta cared CA 'Pfcrlrprcotvxr�y3oau#ot`. fpilt1 'arcaart d -TOOLD&A ar D'W av pp ri e pwro P=p. aht�bcr,xeftiwl ah''o ret lit t,th Mit that Um gal* ' , - TIN . . •' • ' ` , • • • - • , • •' t •. •' • • •. Und i44b=mdS lp ' A / �� i�