HomeMy WebLinkAboutPermits - 800 JOHNSON STREET 5/30/2018 I
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��I"NOWI �• Commonwealth of Massachusetts Msr-»lack-i..ot
BOARD OF HEALTH ---�0a.co-3s
Permit No
North Andover BHP-2018-0063
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$350.00
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DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Tim Quinlan.
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to(Construct)an.Individual Sewage Disposal System.
at Na 800 Johnson Street 10
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as shown on thea application for Disposal works Construction Permit No BHP 2018-0063
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Dated April 12,2018 I
Issued On:Apr-1.2-2018
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BOARD OF HEALTH t
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Application for Sept,ic isposal �st� Tod,��~� 2,S
DATE
Construction Permit — TOWN OF
$350.00-Full Repair
NORTH A. DC3VER3 MA 01845 $175.00-Component �
Important: Application is hereby made for a permit to:
When filming out 14,Construct a new on-site sewage disposal system*
forms on the
computer,use ❑ Repair or replace an existing on-site sewage disposal system*
only the tab key ❑ Repair or replace an existing system component—What? f ,.
to move your
cursor-do enot ,
use the return A. Facility Information p
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Address or Lot#
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City/Town _
2.-*TYPE CIF SEPTIC SYSTEM*:
➢ ❑ Pump N Gravity(choose one)
***If pump system, attach copy of electrical permit to application***
Y ® Conventional System (pipe and stone system)
❑ Infiltrator or Blodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.)
Y ❑ Pressure Distribution S.A.S.(No D-Box)
9 ❑ Pressure Dosed (D-Box Present)S.A.S.
Y ❑ 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 Modela
2. Owner Information
Name
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Address(if ifferen __ --_._
t from above
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City/Town State Zip Code
Ernail address Telephone Number
3. Installer Information
Name
Name of Company
Address
City/Town State Zip Code
Telephone Number(Cell Phone#if possible please)
4. Designer Information
IN Name of Compan
IL
i Address
(c.),5C,r _ -Citi
y/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
. � pplication for Septic Disposal System
TODAY'S DATE `
Construction Permit - TOWN OF
$350.00-Full Repair
NORTH ANDOVER, A 01845 $175.00-Component �
PAGE 2OF2
A. Facility Information continued....
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5. Type of Building: Wesidential Dwelling or❑Commercial 1
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B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover. 1 understand that until a final Certificate of Compliance has been issued by
this oard of Heal , t insta,(l ed system is not approved.
ame Date
A li ion Approved Board of Health Representative)
pp� pep �d �� ( p )
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Nam _- Date
Application Disapproved for the following reasons:
For Office Use Only:
1. Fee Attaclied? Yes No
2. Project Manager Obligation Form Attached? Yes cow' r No
3. Puxnta Sy_stetn? If so.,Attach copy ofElectrical Permit Yes_ No.
Applicant received copy of
"Mectrzcallnspection Notes for Septic Systems" Y _.----
Handout?
4. Reviewed approvalletter; all paperwork received? Yes t1l No
Missing.• _
5. Foundation As-Built?(new construction only): Yes�~` No
(Same scale as approvedplan)
G. Floor Plans?(new construction only): Yes V No
car''/ �;`/�, cwv�(i'+��. Cr.��'✓��;� C,.�..Q.,O-
Application for Disposal System Construction Permit•Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction. for the septic system for. the property at:
P300 ?)k r%,sd)i ",_TtreeA___
(Address of septic system) For plans by
(En,neer)
Relative to the application of 'T xo \
(Installer's name,) And dated TL," z I , ?0 17
rigin-al
Dated 2112 With revisions dated (udate)
(I oday-s date)
q.,ast revised date)
I understand the following obligations for management of this project:
1. As the installer, I am obligated to obtain all permits and Board of Health approved plans p jor to
performing any work on a site. I must have the @pRLoved dansacid _pstmit on site when any_work is
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being done,
2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any
other person not associated with my company schedules an inspection and the system is not ready, then
item three shall be applicable.
3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspection,without completion of the items in accordance
with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied a),ainst rne and or
my coriapa!2T.
a. Bottom of Bed---- Generally, this is the first (Vinspection unless there is a retail-ling wall,which
should be done first. 'the installer must request the inspection but does not have to be present.
b. Final. Construction Insi)ection Engineer must first do their.inspection for elevations, tics, etc.
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As-built of verbal OK (or e-mail to: licalthdel)t@northandovetina.gov) from the engineer must be
submitted to the Board of Health, after which installer calls for an inspection time. Installer must be
present for this inspection. With a pump system, all electrical work must be ready and able to cause
pump to work and alarm to function. Installer does not
c. Final Grade—Installer must request inspection when all grading is complete. Iti
have to be on-.site.
4. As the installer, I understand that only I may perform the work, (otber tban simple excavation)and I arri required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others unlicensed to install septic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of M license to operate in the Town of
North Andover, significant fines to all persons involved are also possible.
5. As the installer, I understand that I must be on--site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been i-eached.
b. Inspection of the sand and stone to be used.
c. Final inspection by Boatil ofHealth staff of consultant.
d Installation of tan1c, D-Box,pipes, stone, vent,pump chambet, retaining wall and other
components.
6. As the installer, I understand that I am solely res vonsible for the installation of the system as per the
approved plans. No instructions by the horileo"er, general contractor, or any other persons shall absolve
me of this obligation.
"Undersigned Licensed Septic Installer: (I'oday's, Date)
Y,
(Name Fruit) (Name—SrOcdf