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Home My WebLink AboutPermits - 851 FOREST STREET 7/18/2018 • Commonwealth of Massachusetts Map-Block-Lot ///%l�l� o/,�• 106 DO162 • � �� BOARD OF HEALTH Permit No 018-0 North Andover , BNP ------o71--- P.I. FEE F.I. $350.00 ----------------------- DISPOSAL, WORKS CONSTRUCTION PERMIT Permission is hereby granted Wane-n Pe-arce Jr. to(Construct)an Individual Sewage Disposal System. at No 851 FOREST STREET (R-1)--- - ----- -- - as shown on the application for Disposal Works Construction Permit No. BI IP-201Date A 18 ------------ -- ---- ---------- � I --- ---- ------------ Issued On;Apr-19-201$ 136AIW OF HEALTH 1 1 i i i I Application for Septic Disposal System firm ° TODAY'S DATE Construction Permit — TOWN OF $350.00-Full Repair NORTH ANDOVER, MA 01845 $175.00-Component Important: fora permit to: When filling out Construct a now 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 El Repair or replace an existing system component—What? to move your cursor-do not 111 "0 j wo use the return A. Facility Informat,pp key. Address or Lot# 421— City/Town 2.- Wif _�T_ OF SEPTIC SYSTEM*:_ - > [:] Pump N Gravity(choose one) ***If pump system, attach copy of electrical permit to application"* > Q Conventional System (pipe and stone system) > F1 Infiltrator or Biodiffuser(Gravel-Loss)(Attach a copy of your certification to install this type of system.) > ❑ 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) What is the Ma1Ce?___.____ What is the 2. Owner Information Name Address(if different from above) J VL/t City/Town State Zip Code ---------- Pmail address Telephone Number 3. Insller Information (__111P cc Name Name of Company Addr7R., V\I\ bt? -4- City/Town State Zip Code -Telephone Number(Cell Phone Wif possible please) 4. Designer Information --- Uvc�om)qh Name Name of Company 14 Is Addrepsr-4) wo(�V) . U 11(9 State Zip Qd _C71ty1Tcwn 7e7%) ........... Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page I 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 ofBuilding: S31/esidential Dwelling or FICornmercial 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, thVinstalled system is not approved. L Name Date A tion Approved as of H lth Representative) )L T, me Date Application Disapproved for the following reasons: For Office Use Only: 1. FecAttaclied? Yes No Z. PfoiectMai2agei,Obligation Form Attached? Yes.1 No_ 3. Pain y ofEleettical Permit Yes J2 System? If so,Attach con Applicant received copy of "Ejecoical Inspection Notes foxSeptic Systems" Yes— No— I-Jandoixt? 4. I?evievvedappfovallettei, all papenvotk-t-eceived? Yeses Na Missing. .5. Foun(ladonAs-Built?(new construction only): Yes No (Same scale as approved plan) G. 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: (Address of septic system) Forplansby (Engineer) Relative to the applicatiorl of And dated 112111c) LA � �e / IC (Onginal date) Dated (1—OT-Aycrate Wiffi 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 Flealth approved plans prior to the 1. t on site when any work is performing any work on a site. I must have the a roved plans and being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person riot associated with my company schedules an inspection and the system is not ready, then item three shall.be applicable. 3. As the installer,1. am required to have the necessary work completed prior to the applicable inspections as indicated below. I understandthat;requesting without thout completion of the items in accordance - __L . with_Title 5 and the Board offlealthRegulations may resulting 5 50.00j5q( L)(,,ijqglevied afainstinean(icit: my corn j2agy. a. Bottom of Bed--Generally, this is the first (V� 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: heal,thdel?t@northandov(;i.-tna.gav) from the engineer must be submitted to the Board of flealth, 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 1 may perform the work (other than simple ex6mation)and I am required 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 septic systemsiii,North Andover can. constitute reasons for denial of-h' t- _c'system and/or revocation or suspension of my license to operate in the Town of North Andover:,significant:Ones to all p tqgns 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. Determination that thepl-oper elevation of the excavation has been reached, b, insP ection of the sand and stone to be used. c, Final inspection by Board of Health staffor consultant. d. -Installation of tank,D-Box,pipes, stotic, vent,pump clmaiber, retabVng walland other co,triponents. 6. As the itistallm I understand that I an_solely temonsible for the installation of the systern as per the ---------- app -AeJ roved plans. No instructiQgs-Ay horneowngr. general contractor. or any otlxer lxersons shall absolve me of this ob] Undersigned Licensed Septic Installer: (Today's Date) i n a me__ Irent} ame—Signed) 13 4/9/2018 DIG SAFE SYSTEM,INC.-Create Now Quick Ticket Request Number. 20181503224 Date 04/09/2018 Times 14 56 . -- Longitude: State: a u o: State:MASSACHUSETTS XMunicipality:4NORTH ANDOVER .. M m. ._..M. S �ft [Address/ intorsection: 851 FORESl'ST Nearest Cross Street 1 LACONIA CIE Nearest Cross Street 2: LACY ST Additional(ntormatlan: __.__..._ _. ... .._.__._... ..._ .._._ ....._,,,_ ,.,._.._...,.,_,_._._.._...._..._.._. _..,..m,....._......�.. ,, ._ ..._ .... .... ....,..,.,.. ,._M.___....__..._._., Nature Of Work INSTALL SEPTIC SYSTEM Area Of Work: ENTIRE YARD Area Is Premarked Y Start Bate 04/19/2018 Start Time: 05:00 FCaller: JENNIFER ALLAIRE Title Return Cali ANY E Phone#:*978-664-52 64 Fax : 978.664 9886 Alt.Phonei�W Email Address: PEARCECON@AOL.COM 111 Contractor: PEARCE CONST COX� .�_...,��......M_...___..__.._ PARK ST City: NORTH READING State: MA Zip: 01864 [Address.,,196 _[E-1 tl�mm�9matar Datn _.. .w.w.-ARC m .w_...,..rv_®_�._.__.....�.._,...�_....._..m_....._ av g Work PE C CONSTRUCTION _...m ._._.,w,......_. _....,_..._ ,_. Member...__.___ Utility List Gado Abbreviation Name CMAOAS pCOLUMBIA GASOFMASSACHUSETTS NGRDELNATIONAL GRID ELECTRIC-MASS CLEC SD ALGGAS ALGONQUIN GAS 1 SPECTRA ENERGY _ l VERI2ON.....__--___ ._...._.._... m ... _....._ _J COMCAS COMCAST TVF7L ._.___ ON ONTARG ON TARGET LOCATING wRJ7 VERIZN VERIZON a There may be non-member utilities in the area that you need to noti a Electric and other companies may not mark lies they don't own or maintain. You may want to contact them for more information. e The excavator is responsible to maintain markings placed by member utilities. * You are required by law to call 911 if pipeline damage r ult in a gas release. IMG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL http://digsafeform.digsafe.cam/cgi-bin/diGgi.exe 1/2 a +wd0L M � Torn of North Andover � '•°. ,«�: . °" ° HEALTH DEPARTMENT T � sACNUSkh CHECK#: DATE: ., LOCATION: ` ` H/O NAME: CONTRACTOR NAME ( Type of Permit e:car License: (Check box) �...� s ❑ Animal - ❑ Body Art Establishment ❑ Body Art Practitioner $.. ❑ Dumpster _ — ❑ Food Service ❑ Funeral Directors --. ❑ Massage Establishment $ ❑ Massage Practice ❑ Offal(Septic)Hauler $ ❑ Recreational Camp - ❑ Sun tanning ❑ Swimming Pool _ ❑ Tobacco — ❑ TrasIVSolid Waste Hauler _ ❑ Well Construction SEPTIC Systems: ❑ Septic-Soil Testing pp g ❑ Se tic-Des n.Approval $ P " ,Al p Disposal tic Dis anal Works construction(DWC) $�mm ❑ Septic Disposal Works Installers(DW[) $ ❑ Title 5 Inspector ❑ Title 5 Deport ❑ Other:(Indicate)_ ._ � r He Wth.Agent initials White-d Applicant Yellow-Ifealth Fink-Treasurer