HomeMy WebLinkAboutPermits - 93 ROCKY BROOK ROAD 5/29/2018 Commonwealth of Massachusetts etap-Black-1"t
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090 Ao0513A
BOARD OF HEALTH
Per�ttt Na
North Andover BHP-2018-0155-_.
P.I. _ FEE
F.1. $175.00
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Bateson Enterprises
to(Construct)an Individual Sewage Disposal System.
at No 93 ROCKY BROOK ROAD
-----------------------------------------------
as
----- -------- ---as shown on the application for Disposal Works Construction Permit No BHP 2018- Dated ay
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. .. ..... --- --------
Issued On; May-24-2018 BOARD OF HEALTH
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pp at�on for e ► c Disposal !. stem
TaoA
YS DATE
Constructidn. Permit — TOWN OF
$.2501.00—Full Repair
NORTH :AN OVER . A 01845 $125.00-component
Apiplication Is herobv made for a Penn it to:
❑construct a new on-site sewage disposal system*
❑Repair Or replace an existing on-site sewage disposal'system*
UR6pair.or replace an existing system component—What?
A. Facility Information.
Address or Lot# m roAxIED
City/Town 1Vd
2.- 'TYPE OF SEPTI YSTEM*:
Pump y(
➢ ❑ Pum ravit choose one)
**'*Ifpump system attach copy of electrical permit to application**' -�
> g n,ventional System (pipe and stone system)
➢ ❑ Infiltrator or Blodiffuser(Gravel-Less)(Attach a copy of your certifrcalion to install this type of system.)
➢ ❑Pressure Distribution S.A.S.(No D-Box)
➢ ❑ Pressure Dosed(D-Box Present)S.A.S.
A ❑ Does the system require an effluent filter"? Yes No
If yes, does plan specify make and model of ffiter? YES=(no further info. needed)
'NO=(installer must specify brand of filter before DWC Issuance)
What is the Makc? What is the Modch� ,_._.
2. Owner Information
Name
Address(if different from above)
CitylTown State r , zip Code
Telephone Number
3. Installer Information
Name Name of Company
Address ( ow vninwv it 6
Cityrrown
State Zip Code
Telephone Number(Cell Phone#if passible please)
DesianetJ lnft rrnation
Name Name of Company 4
Address
City/T0: Skate Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
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P I ility arts atio -co" inued
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R. Agreement
The undersigned. agrees to ensure:.the eopstrg0tlon;and maintenance of the af.Qrerc/e..scrlbOd
an-ito sewage afisposaiy `t�m:ln actrardant;t with the pro.vlslorfs ofltle 5 of the
rr Envl►`aniriaitta%Cade,as will
,as fhb L,ai*a�Subsctrf ce Disposal Regulations for the Town of
,' North Andover, and not to place.;the system fn�p.eretlbn unfl!a CertJflcato of Com$O)lc6:has
been Issued OW this Board of Health.
f '
Name r--- Dite
' •
AppIle Ap d By ( and of Health°RepresentOtive)
24
Name C3ate
Applleatlon Disapproved,for the following reasons:
For O ae.Use Qnivt
1. "Fee Attachedp Yes
/ Na_
2, Frojcatll "Ogee Oh gadorr Forni Attached? A'
3.: ,b.S`vstem;� Ifso�Atta�h�F 'lam trx`cal P rft . 'cs N
4. Foundatx`on.rlss•Bur' P(hew construcflon'ronly); No,
(`Same scaIe as app, ovedplan) ;
5. FloorP,(jwsp•(hew'-o'onstruOtlon'on Not
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