HomeMy WebLinkAboutPermits - 60 DEER MEADOW ROAD 6/20/2018 r •
r I Commonwealth of Massachusetts Map-Block-Lot
104.B01 18
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BOARD OF HEALTH ------------
Pennit N
North Andover BHP-2017-1096
P.I.
1`fil✓
F.I. $350.00
DISPOSAL, WORKS CONSTRUCTION PERMIT
Permission is hereby granted Peter Breen
to(Construct)an Individual Sewage Disposal System.
at No 60 DEER MEADOW ROAD
as shown on the application for Disposal Works Construction Permit No. BH13-2017-109 Date November 09,_2017
�
Issucd On: BOARD OF HEALTH
i
Application for Septic Disposal System 9/12/2017
TODAY'S DATE
Construction Permit - TOWN OF
$360.00 -Full Repair
NORTH ANDOVER. MA 01845 $175.00 -Component
Important: Application is hereby made for a permit to:
When filling out Construct a new on-site sewage disposal system*
forms on the
computer,use F-1 Repair or replace an existing on-site sewage disposal system*
only the tab key
to move your El Repair or replace an existing system component-What?
cursor-do not
use the return A. Facility Information
key. 60 Deer Meadow Road- 104.13/118 RECEUVED—
Address or Lot#
VQ North Andover
City/Town 'rOWN OF NORTH ANDOVER
2.-*TYPE OF SEPTIC-SYSTEM*: HEALTH DEPARTMENT
> F-1 Pump W3 Gravity(choose one)
***If pump system, attach copy of electrical permit to application—
> Z Conventional System (pipe and stone system)
> n Infiltrator or Blodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.)
> n Pressure Distribution S.A.S.(No D-Box)
> F1 Pressure Dosed(D-Box Present)S.A.S.
> M 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)
Miat is the What is the Model?
2. Owner Information
-Sumeeta&Sunit Mukherj-ee
Name
60 Deer Meadow Road
Address(if different from above)
North Andover MA01845
City/Town -State -- Zip Code
sumeetam@comcast.net 978-387-3147
Email address Telephone Number
3. Installer Information
..........
Name Name of Company
A Vdres
Cityfrown State Zip Code
Telephone Number(Cel Phone#if possible please)
4. Designer Information,
Greg J. Hochmuth —------ Williams&Sparages, LLC
Name-- Name of Company
189 North Main Street
Address
Middleton MA 01949
Cltyfrown State Zip Code
978-539-8088
AI,-)C, /Y)u Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
7 Application for Septic Disposal System
TODAY'S DATE
Construction Permit - TOWN OF
$350.00 -Full Repair
NORTH ANDOVER, MA 01845 $175.00 -Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building: ®Residential Dwelling or FICommercial
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, the installed system is not approved.
X, ldll'yrn
/IN14ilne Date
A d By: (Board of Health Representative)
T!,!/;`01�I p ..
N��e �' Dale
Application Disapproved for the following reasons:
For Office Use Only:
L Fee Attached. Yes V/. No
2. Project Manager Obligation Form Attached? Yeses
No
3. y Pump S
- - w ? If so,Attach copy ofElectrical Permit Yes No—
Applicant received copy of
"Electrical Inspection Notes for Septic Systems" Yes No
Handout?
4. Reviewed approval letter, allpaperworkreceived? Yes No
5. Foundation As-Built?(new construction only): Yes No
(Same scale as approved plan)
& Floor Plans?(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 thepr.operty at:
561y)
(Address of septic system) For plans by S 2 Leda
Relative to the application of (Engineer)
(Installer's name) And dated � - //" ' c)
(Unginal date)
Dated 9 With revisions dated
(I'oday's date) —z�b 1-3 - 0_�_)
(bast 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 prior to
performing any work on a site. I must have the approved plans and the permit on site when any work is
jx1ing 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
itern three shall be applicable.
3. As the installer, Iainxequjied to have the necessary work completed prior to the applicable inspections as
indicated below. 1 understand that out completion of the items in accordance
wide Title 5 and the Board of Health RegWations inay result in,a$50.00 fine being levied against me and/or
my company,
a. Bottom of Bed--Generally, flais is the first (1") inspection unless there is areah-iing 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: he,,t.lthdept@no-tthandoverina.gov) from the engineer must be
submitted to the Board of Health, after which installer:calls for an inspection tirrie. Installer must be
present for this inspection. With a pump system, all electrical,work:must beready and able to cause
pump to work and alarm to ffinction.
c. Final GradeInstaller must request inspection when all grading is complete. Installer does not
have to be or.L-site.
4. As the installer,1.understand that only I may perforin the work (other than simple excavation,?and I anirccluired
to complete the installation of the system identified in the attached application.for installation. I further
-understand that work done bv others unlicensed to install se tic systeins in North Andover can constitute
reasons for denial of the Syit_qm_a_n_d_/o c—at-ion or suspension of gW license to operate in the Town of
North AndQvgt,significant fines to all Mrsqn
_q 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. Deternzhiation that theproperelcvadoii ofthe excavation has been-reached,
b, Inspection of the sand and stoiw to he used.
c. Final inspection by Board ofl-lealt/7 staffof copsultant.
d Installation oftatik, D-Box,pipes, stone, ve-ot,pianp chamber, retaining wall and other
co,trponents.
6. As the installer, I understand that Iain solv temonsible f.bx the installation of the system as per the
APP—roved Plans. No instructions by the homeowner, general contractor or ggy clttl'qt_-'ersons shall absolve
me of this obligation,
Undersigned Licensed Septic Installer: (1 (Today's Date)
Dc"- ,
Print)_ Vain&—Signed)