HomeMy WebLinkAboutPermits - 87 FOSTER STREET 7/16/2018 • '
Commonwealth of Massachusetts Map-Block-Lot
% p •„ 104D0048
BOARD OF HEALTH _ _
Perrrat No
North Andover ----ants-o-
P.L ......._.---- rpt;
F.I. $350.00
DISPOSAL WORKS CONSTRUCTION PERMIT"
Permission is hereby granted Waken Pearce Jr.
to(Construct)an individual Sewage Disposal System.
at No 87 FOSTER STREET
-- ----_. .. ------ ---.... . . .._-
as shown on the application for Disposal Works Construction Permit No BHP 20 Date ., :57
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Issued On:Apr-19-2018 BOARD OF HEALTH I'H
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Application for Septic Disposal System
Construction Permit — TOWN OF TO DAY'S DATE
NORTH ANDOVER, MA 01845 $175.$350.00-gull Repair
00-Component
Important: Applicatio0s hereby made fora permit to:
When filling out VI Construct a new on-site sewage disposal system*
forms on the
computer,USO El Repair or replace an existing on-site sewage disposal system*
only the tab key n Repair or replace an existing system component-What?
to move your
cursor-do not 10
use the return A. Facilit Information
key.
Address or LotiN
ray .............
C) VIA over --__
City/Town
2.-*TYPE OF SEPTIC SYSTEM*:
)-, El Pump .® Gravity(choose one)
`If pump system, 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.)
➢ El Pressure Distribution S.A.S.(No D-Box)
> [:] 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)
IV])at is t/1 0 Make? What is the Models
2. Owner Information
Name
Address(if different from bove) ——-----------
M414 )�A q ,
City/Town State
LX1-
Email address Telephone Number
3. Installer Information
k A )n,rcp o Pectrr�) A
Name - ' ' - � Name of Company C,r,
Addresf,,,)
Cit /Town State 1P olk-
ckl-f= .62k�
Z, C
T
��phon UUM�r_;
1'elephonq -ell Phone#_ii�posslble please)
4. Designer Information
n GM Qh
,
Name Name of Company
Address
04 W State Zi ode
-------------
'ieiephone Number(Best#E to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
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 FCornmercial
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.
(A,)Pt .11.c .....a('
Name Date
!ic6ti n Approve ealth Representative)
amen Date
Application Disapproved for the following reasons:
For Office Use Only:
1. Fee Attached? yes No
2. Project Manager Obligation FotfnAttached? YesG No
3. Pump.5 ? If so,Attach copy of Electrical Pejinit Yes No
- �rA
Applicant iv ceived copy of
"Electrical Inspection Notes for Septic Systems Yes No
Handout?
4. Reviewed apptovallettei; all papei-wo-rkreceived. Yes Nq_-,
Missing.—___ ----------
5. Foundation As-Built?(new construction only): Yes No
(Slime scale as approved plan)
6. TYoor_1-j11ans?(new construction only): Yes No
Application for Disposal System Construction Permit-Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGE,MENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
ITI qt&c �3A_
(Address of septic system) Forplansby
Relative to the application of GUUNen 'Pleur_a�_ if (Engineer) (J
(Installer's name) And dated -7 / /5
4/06 IVK
- (Original date
Dated )
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 p
a; _riot to
performing any work on.a site. 'I must have t11t_approved plans and the permit oil site when.-aby-work is
being
2. As thCiuStallcr, 1,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 reqiic:_S_tj IQ 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 against me and/or
my c2g.Wany.
a. Bottom of Bed-Generally, this is the first (1't) inspection unless there is a retaining wall,which
should be done lirst. The installer must request the inspection but does not have to be present.
b. Final Constructio.n.-Insvection—Engineer must first do their,inspection for elevations, ties, etc.
As-built of verbal OK (or e-.mail to: healthdept@rioi-thaii.dov-cnna.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
purnp to work and al-arm 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 perforin the work (other than siiai
ple exeawfion)and I am required
to complete the installation of the system.identified in the attached application for installation. I further
understand that work doge b
otfjqj_s_unlicensed to install septic systems i:ti North Andover can constitute
reasons for denial of the pieta and/or revocation or suspension of my license to operate in the Town of
North Andover, sjgLifLjgaatfines to all trersons involved are-_a-I-so possible.
5. As the installer, I understand that I must be on site during the performance of the following construction
steps:
a. Detamnination that the proper elevation) of t/le excavatio-u has beet)reached
b. Inspection ofthe sand and stone to be used.
c, Final inspection bj,Board ofHealth staff or consultant.
d. Ihstallation of tank, D-Box,pipes, stone, vent,puinp chamber, retainiog-wall and other
components,
6. As the installer. I understand that I am solely espnsible for the installation of the systern as per the
-----------
Approved plans. No instructions by the homeowner-general contractor, any other Det.-sons shall absolve
me of this 2hlt�padQn.
Undersigned.Licensed Septic Installer: ("Today's Date) 4/15) 1t _
,10o0en �6K.e
arne---Print) ame -Signe
4/12/2016 DIG SAFE SYSTEM,INC.-Create New Quick Ticket
Request Number 20161513041 Date 04/12/2018 Time 14:18
Latitude Longitude
(State MASSACHUSETTS Municipality NORTH.._._. ANDOVER
Address/Intersection: 87 FOSTER ST
Nearest Cross Street 1 m BOKFORD ST Nearest Cross Street 2: BRIDGES LN I
Additional Information JJJ
[Nature Of WUorI INSTALL SEPTIC SYSTEM
Area Of Work ENTIRE YARD
[Area Is Premarked Y Start Date 04/18/2016 Start Time 14:20
Caller JENNIFER ALLAIRE Title Return Call: ANY
F
hone#. 978-664-6264 Fax# 978-664-9886 Alt Phone#
�"', _,,_,_____,-,--_,__,_,_,_,_.._ _7__ _-
F-E-Mall Address PEAR CECO Nc@AOL COM
Contractor: PEARCE CONST COM Y nITITN tl
Address 196 PARK ST Ci NORTH READING State MA Zip. 01 6
Excavator Doing Work: PEARCE CONSTRUCTION µ MM
l
Me mber Utility list
Code Abbreviation Name
EG mN CMAGAS COLUMBIA GAS OF MASSACh
MG NGRDELN NATIONAL GRID ELECTRIC MASS CLEC mmT MM1
F T- 71 _.._. VCRIZ.N.._
1,F ONTARG ON TARGET LOCATING.._. . .._ ............
_�.�_ ..__t ._._ VER4ZN__ _ YVERI7ON _._... _.. _
* There may be non-member utilities in the area that you bead to noti
Electric and other companies may not mark limes they don't own or maintain. 'oar
may want to contact tiers for more information.
* The excavator is responsible to maintain m rkin placed by member utilities.
* You are required by law to call 911 it pipeline damage results in a gas release.
DIG SAFE ENCOURAGES PY OF THIS ELECTRONIC TICKET T Odd SITE AT ALL
TIME So
http://digsafeform.digsafe.com/cgi-bin/dlcgi.oxe 112
Town of North Andover
14 o
HEALTH DEPAIITMENT
CHECK 4: DATE:
LOCATION:.��- 5 Je, r,-
H/O NAME: .
CONTRACTOR NAME:
Type of Permit or. License: (Check box)
0 Animal
• Body Art Establishment
• Body Art Practitioner
0 Dunipster
• Food Service-Type:-------
• Funeral Directors
• Massage Establishment $
• Massage Practice
• Offal(Septic)Hauler
• Recreational Camp
• Sun tanning
• Swimming Pool
0 Tobacco
0 Trash/Solid Waste Hauler $
0 Well Construction
SEPTIC Slistems:
0 Septic-Soil Testing
[I Septic-Design Approval C $
Septic Disposal Works Construction(DWC) $3LL0=-,
0 Septic Disposal Works Installers(DW) $
LJ Title 5 Inspector $
0 Title 5 Report
0 Other. (Indicate)_._...._ — $
th Agent initials
White-Applicant Yellow--Health Pink-Treasurer