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HomeMy WebLinkAboutPermits - 594 BOXFORD STREET 7/16/2018 f Commonwealth of Massachusetts Map-Block-Lot � 105.Cp079 BOARD OF HEALTH ['ermit No a PHP 2018-0205 North Andover �� ����� P.1. FFE _. _....— $350.00 DISPOSAL, WORKS CONSTRUCTION PERMIT Permission is hereby granted David Chandler to(Construct)an Individual Sewage Disposal System. at No 594 BOXFORD S TREET as shown on the application for Disposat Works Construction Permit Na I3HP-201 - ecI -3�ine --- --- - Issued -- Jun-19-2018 BOARD OF ---PMALTH Application for Septic Disposal System May 2018 __._. _.. _...__. � ^^ TODAY'S DATE Construction Permit — TOWN OF p,1 $350.00 -Full Repair NORTH ANDOVER, NIA 01845 $175.00 -Component Important: 4t7iication is hereby made for—a permit to: RECEIVED when filling out © Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key ❑ Repair or replace an existing system component—What? to move your cursor-do not rowN OF NO TN i ANDOVER use the return A. Facility Information EAS'H DEPARTMENT key. 594 Boxford Street Address or Lot# VQ _........ _ _, _ North Andover City/Town 2. *TYPE OF SEPTIC SYSTEM*: Y El Pump P Gravity(choose one) ***If pump system, attach copy of electrical permit to application*** Y P Conventional System (pipe and stone system) Y ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.) Y ❑ Pressure Distribution S.A.S.(No D-Bax) ➢ ❑ Pressure Dosed (D-Bax Present)S.A.S. Y ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES =(no further info. needed) NO =(installer must specify brand of filter before DWC issuance) Wliatis the Make? _._Wbatis the Model?__,-_ _ 2. Owner Information Melmark New England Name 461 River Road Address(if different from above) Andover MA 01810 CityiTown State Zip Code sbriley@melmarkne.org 978-654--4374 Email address Telephone Number 3. Installer Information Name Name of Company 't + dress City/Town State Qt1e Telephone Number(Cell Phone#if possible please) 4. Designer Information Richard Williams Williams &Sparages, LLC Name Name of Company 189 North Main Street Address Middleton MA 01949 City/Town State Zip Code 978-539-8088 __ _ - Telephone Number(best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 May 2s, ���$ Application for Septic Disposal System ; Construction Permit — TOWN OF TODAY'S DATE $350.00-Full Repair NORTH ANDOVER, MA 01845 $175.00 -component PAGE 2-ciF 2 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 t Board of Health, the installed system is not approved. Name Date licat' By: (Board of Health Representative) Date forthe following reasons: For Office Use Only: 1. Fee Attached. Yes No 2. Project Manager Obligation Form Attached? Yes r No 3. Pump Systerm? Xfso,Attach copy ofElectrical Permit Yes No Applicant received copy of "Electrical Inspection Notes for Septic Systems" Yes _ No Ilandout? 4. Reviewed approval letter, all paperwork received? Yes No Missing: - - 5. Foundation As-Built?(new construction only): Yes.__..Y. No_ (Same scale as approved plan) 6. 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 the property at: 6/-ex') S,7z (AddFor plans byress of septic system) (Engineer) Relative to the application of (installer's name) And dated Dated (I oday's date) With revisions dated (Last 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:i. to performing any work on a site. I must have the approyed t — on when any wort 9 being --j — done. 2. As the installer, I must call for any and all inspecttons. If homeowner, contractor,project manager, or any other person not associated with nay company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I aturequired to have the necessary work,completed prior. to the applicable inspections as indicated below. I understand that requestlngan inspection,without completion o:E the items in accordance with Title 5 and the Board of Health Regulations may—result in_g 150,�00fine�bein ievi�cda against me�and ot my cornparry. a. Bottom of Be — Generally, this is the first (15) inspection unless there is aretairung 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: healt.hdeptC&,northandovej:ma.gov) from the engineer inust be subinitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump systern, 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 (otber lban siwple excavation)and.I an.1required 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 SyStetnand�®r re�y_o North Andover,_srgnrfic ant fines to all persons involved are also passible. 5. As the installer, I understand that 1". must be on-site during the performance of the following construction steps: a. De tettnina tion that the proper-elevation of the excavation 1-708been teached. b. Inspection of the sand and stone to be used. c. Fin al in s p e c tion by Board of Health staff of consultant. d. Installation of tan1c, D-Box,pipes, stone, vent,pzinip chamber; ietaining•wallandot/le-t. Components. G. As the installer,I understand that I am solely responsible four the installation of.the system as per the appr wecLpja ns. No instructions by the hoateowner, general contractor, or any other persons shall absolve me of this mbl ation. Undersigned Licensed Septic Installer: (-roday's Date) nre Signe lame c—�rin (j 4 of. Town of North Andover HEALTH DEPARTMENT O CHECK lt DATE: LOCATION: H/O NAME: CONTRACTOR NAME: ilbq //4-),( T,Vpe of Permit or License: (Check box) 0 Animal 13 Body Art Establishment • Body Art Practitioner • Dunipster 0 Food Service- • Funeral Directors • Massage Establishment • Massage Practice • Offal(Septic)Hauler • Recreational Carnp • Sun tanning [I Swininjing Poo I 0 Tobacco 0 Trash/Solid Waste Hauler 0 Well Construction SEPTIC S sterns: 0 Septic-Soil Testing 0 Septic-Design Approval 0 Septic Disposal Works Construction(DWQ ASeptic Disposal Works Installers(DWI) * Title 5 Inspector * Title 5 Report * Other:(Indicate).---- Heats Agent,initial White-Applicant Yellow-Health Pink-Treasurer