HomeMy WebLinkAboutPermits - 2211 TURNPIKE STREET 6/20/2018 i
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Commonwealth of Massachusetts Map -Block-Lot l
/fll ��l/101 f «• 108 Co058
BOARD OF HEALTH Pert
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North Andover BHP-2018-0163
FEE
$175.00
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DISPOSAL, WORKS CONSTRUCTION PERMIT
Permission is hereby granted James Currier
to(Construct)an Individual Sewage Disposal Systern.
at No 2211 TURNPIKE STI2-EETI'
as shown on the application for Disposal Works Construction Permit No. BI P-2018-01.6 Dated Jun 07
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Issued On: Jun-07-2018 OA OF HEAL"III
D
J le,
Application for Septic Disposal System
TODAY'S DATE
Construction Permit - TOWN OF
NORTH ANDOVER MA 01845 $350.00-Full Repair
$175.00-Component
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Important: Application is hereby made for a permit to:
When filling out El Construct a new on-site sewage disposal system*
forms on the
computer,use El Repair or replace an existing on-site sewage disposal system*
only the tab key Vx0pair or replace an existing system component--What?
to move your
cursor-do riot
use the return A. Facility Information
key.
Address or Lot#
Pa,
City/Town
2.-—*TYPE O F S E_DT I C S_Y--S_TE M—*:
> [I Pump [�rGravity(choose one)
***Ifpumps rstem, attach copy of electrical permit to application'
> Conventional System (pipe and stone system)
> ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.)
> F1 Pressure Distribution S.A.S.(No D-Box)
> -E] 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 Wqjq t is tb a Model? -------
2. Owner Information
0
Name
Address(if different from above)
7 7,0
CV9'1_5_'
D_
City/Town State Zip Code
Email address Telephone Number
3. Installer Information
elz ----------
_N a'mTe' _-Ae Company
--ldd W,,
A
V/YiALn—----------
City/Town State �ryZip Code
'9
Telephone Number(Cell Phone#if possible please)
4. Designer Information
Name Name of Company
Address "_'"
Cit /Town State Zip Code
-Tolophone (Best#to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
Application for Septic Disposal System TODAY'S DATE
Construction Permit — TOWN OF
NORTH ANDOVE,R,...MA 01845 $175$350.00-Full Repair 00-Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Buildincr [:!(Residential Dwelling or nCornmercial
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 Board of Health, Op installed system is not approved.
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-i�C me --------------- -Da
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re en ,,tive)
c A� r w .By: (B
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xdameDate
Application Disapproved for the following reasons:
For Office Use Only:
1. Fee Attached? yes No
2. Project MatiagYes OhAgation Foffn Attached? es-Z No
3. jrxnalr.S sy teal? lfsoAttaelicot)vofEYectricqlPettnit Yes No
AppEcan,t received copy of
"Electrical liispectic)p Notes for Septic Systems" Ycs.----- No
Handout?
4. Revieweclapprovallettei, all paperwo-y1creceived? yes No
Missirz
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5. Foundation As-Built?(new construction only): Yes No
(Sarre scale as approved plan)
G. FloorPlans?(new construction only): Yes No
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:
1/ rUrPbbl-4-P...
(Address of septic system) For plans by
(Engineer)
Relative to the application of e s
(Installer's najnc) And dated
(Original date)
l
Dated _
k 1 oda"y's elate With revisions dated
(Last revised date)
I understand the following obligations for management of this project:
1. As the installer,I ain obligated to obtain all permits and Board of Health approved plans.arior to
performing any work on a site. I must;have the approved plans and the pg.rxait c>n sj.te when aLy 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 cornpany 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 chat:re uestt'ag axz irzs pectic_>rx,without completion of the items in accordance
with Title 5 and the Board of Health_Regulalions may result in a$50.00 fine beim-levied against me and/or
rn co.txr an .
a. Bottom of Bed---Generally, this is the first (1") inspection unless there is a retaining 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 UIQ (or e-mail to: healthdept@northandoverma.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.
c. Final Grade—Installer must request inspection when all grading is complete. Installer does riot
have to be on-site.
4. As the installer,I understand that only I may perform the work (other thaia shvple excavatio)and I am requited
to complete the installation of the system identified.in the attached.applicationfor installation. T.fa"rtheg
understand that work done by others unlicensed to install septic systems in North Andover can constitute
reasons for--denial.of the systerri and/or revocation or suspension_nf my—license to operate in the Town of
North Andover, SiL,-nificant fines to all persons involved ate also t)ossible.,
5. As the installer, I understand that I must be on-site during the performance of the following construction
steps:
a. Detezmination that the ptopet-clevatlon of the excavation has bee-o reached
b. Inspectio-o of the sa.ncl and stone to be used
c. Eixnal lnspectiot) by Board ofl3ealth staff or consultant.
d Installation of tank, D-Box,pipes, stone, vent,pump charnbatr mta iVng wifl ancl other
compo17ents.
6. As the installer: I understand that I arxr soI.elyr:esp .rslle for the installation of the system as per the
approved plans. No instructions,bv the homeowner.�cneral contractor, o:r�any_gthet pctL is shall absolve
i
ane of this obligation.
Undersigned Licensed Septic Installer: � �../� (Today's Date)
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