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HomeMy WebLinkAboutPermits - 130 WINDKIST FARM ROAD 6/20/2018 Commonwealth of Massachusetts Map-Block-Lot 108 00139 BOARD OF HEALTH - ... PermitNo North Andover BHP---- 0574 FEL; $350.00 DISPOSAL WORKS CONSTRUCTION PERMIT Pei mission is hereby granted Dean Dynan to(Construct)an Individual sewage Disposal System. at No130 Windkist Farm Road as shown on the applicatton for Disposal Works 11 Construction Permit No BHP-20 Dated ct 017 Issued On: Oct-02-2017 BOARD OF HEALTH • r Commonwealth of Massachusetts Map-Block-Lot �/%i�%���ir' f% '• 108 00139 BOARD OF HEALTH Permit No • BHP-2017-0 North Andover 574 P.I. FEL F.1. $350.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted. Dean Dynatl to(Construct)an Individual Sewage Disposal System. at No 130 Windkist Farm Road - - .. as shown on the application for Disposal Works Construction Permit Na BHP 2017- at ed. Issued On: Oct-02-2017 BOARD OF I-I1 AL'rII �.i lir: 9 tion for Septic Disposal System � � Application _ TODAY'S DATE E Construction Permit — TOWN OF $350.00-Full Repair NORTH ANDOVER, MA01845 $175.00-Component Important: Application 's hereby made for a permit to: f. When filling out 5, onstruct 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 [:1 Repair or replace an existing system component—What? to move your cursor-do not use the return A. Facility Information key. f �< Ar-------------- Address or Lot# 2.-*TYPE (j'-F'--S-'-EPTIC-SYSTE- -- --- M--*: --- Pumprravity(choose one) ach ***If pump s M, a c copy of electrical permit to application' Upconventional System (pipe and stone system) 0 Infiltrator or Biodiff user(Gravel-Less) (Attach a copy ol'your certification to install this type ofsystem.) > F-1 Pressure Distribution S.A.S.(No D-Box) >- �Zssure Dosed,(D-Box Present)S.A.S-.- > oes the system require an effluent filter? Yes.yNo ........ P If yes, does plan specify make and model of filter? YES =(no further info. needed) NO =(installer must specify brand of filter before DWC issuynce) What is the Mo del? Wha t is the Make? 2. Owner Information Name ------ if different from above) ress i i eren b�'�S' -- City/Town State Zi fade trn_­ ail address Telephone Number 3. Installer Information __Veq__ .............. Name Name of Company A dress City/Ifown State �VC Cad el�,ep 6or '11 Phan; Tele ell Phc n;#ff XsAble please) 4. Desiciner Information, Name Name of Company Addres5 CitylTawnStat�L A Code 7e!!Ie!;p�humber(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 el_5 ry F Application for Septic Disposal System 1 TODAY'S DATE qWConstruction Permit — TOWN OF NORTH ANDOVER MA 01845 $ -Full Repair $175.005.p0-Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: Residential Dwelling or❑Commercial 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. I understand that until a final Certificate of Compliance has been issued by this rd of Health, the installed system is not approved. C' Dat - -- App' on pr ed By: (Board of Health Representative) Nam f ..._ Date Application Disapproved for the following reasons; For Office Use Onl : 1. Fee Attached.? Yes No 2. Project Matrager•Obligation Form Attached? Yes�I� Nra_-___..__ 3. Puxnp S,stem? If`so,Attach copy ofl?,lecttzcal Permit Yes No Appltcatztreceived copy of ° "Mlecuicallnspecti©n Notes Jot•Septic Systenxs" Yes No Handout? 4. Reviewed approvallettet, aUpaper•worlr received? Yes No Mlsuing;' 5. Foutldadon As-Built?(new construction only): Yes .No_-.._-__- (Same scale as approvedplan) 6. Floot Plans?(new construction only): Yes No Application for Disposal System Construction Permit-Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANA.GEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the Property at: Z� f6L- (Address of septic system) For plans by (F-11p,incer) Relative to the application of &(Installer's ona e) And dated rignia ate Dated o ay s ate With revisions dated 'Last revised date) 1. 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 prior to performing any work on a site. I must have the approyedT 'I ___ plans and�thc permit n site ite wlen any work is 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, lien item three shall be applicable. 3. As the installer,I an-irequired to have the -.necessary work completed prior to the applicable inspections as indicated below. I iii-idersitalaidd that requestix _gt in _an mspection,wLt .hggt compj ion of the items J accordance with Tide,5 and the Board of HeaUll:K.eg _a�50.00�fine b -i_ )ej1gJ_cvied.,against me and/or a. Bottorn of Bed—Generally, this is the first (1') inspection-unless there is aretaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—.Engineer must first do their inspection for elevations, ties, etc. As--built of verbal OK (or e-mail to: healtlidept(& -imust engineer st be ,no.tdiandovertna.gov) from d 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. c. Final Grade---Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system.identified 111 the attached-application for installation. I ffirther 'understand that,work done by others unlicensed to install _se systems kLNc?rth An oAndover can constitute reasons for denial.of the system Town of North Andov r. significant fines Q d are also possible. CT ,W" j -4,11-personsin-mlye 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 reached. b, Inspection of the sand and stone to be zzsed, c. Final inspection by Board ofHealth staff 0,t consultant, d, 1"ostal - lation of tank, D-Box,pipes, stone,-�, vent,pump chaixibeyretalhing-wall and other coinponents. 6. As the installer,I understand that I am solely responsible for the installation of the.-systern asper the approved plans. Na instrp- the homeowi�ae _ =al contractor, or any other persons shall absolve me of this 01"94—ti-01-1. Undersigned Licensed Septic Installer: (Foday's Date) .2 c c -Igmec 16 Jown of North Andover ....... HEALTH DEPARTMENT S CKUS CHECK V DATE: ( 2 LOCATION: 43o H/ONAME: CONTRACTOR NAME: Type of.L'e—rillit OKLIC( ase. (Check box) 0 Animal 0 Body Art Establishment o Body Art Practitioner 0 Dumpster 0 Food Service-'Type.-- 0 Funeral Directors C3 Massage Establishment 0 Massage Practice [3 offal(Septic)Hauler 0 Recreational Camp [I Sun tanning [I Swimming Pool 0 Tobacco tj TrashlSolid Waste Hauler [3 well Construction ----- SEPTIC �sty erns: [] Septic-Soil Testing 0 Septic-Design Approval 2 Septic Disposal Works collstructioij(DW0 D Septic Disposal Works Installers(DWI) 0 Title 5 inspector 0 Title 5 Report [I other. (Indicate) Health Agent Initials White-Applicant yjfflow-Health Nn—k--Treasurer