HomeMy WebLinkAboutPermits - 25 HOLLOW TREE LANE 8/6/2018 Commonwealth of Massachusetts Map-Block-Lot
104.A0084
BOARD OF HEALTH ----
.
Permit No
North Andover BHP-2018.0246
FEE
« $175.00
DISPOSAL, WORKS CONSTRUCTION PERMIT
Permission is hereby granted Bateson Ent
to(Constrict)an Individual Sewage Disposal System.
at No 25 HOLLOW TREE LANE
as shown on the application for Disposal Works Construction Permit No. BHP-2018-0 6 atedtVt ,
Issued On: Aug-02-2018
BOARD OF HEALTH
AApp��c�3t on for AdIt I��.�i.w7Q' System
TODAYS DATE
ConstrLrcfiDn. Pe rn1t - TO WN OF
epair
NORTH A VER MA 0.1$45 �2501.09— o oneorientnt
y $�'4ZS»00�-Cmp.
Apof ication Is hereby made for a permit to:
�}Cons#ruct a clew on-alto sewage disposal system*
❑Repalr:.Or replace an existing on-site sewage disposat system*
UA-eipair or replace an existing system component—What?
i .. v C�
A. Facility information. C "d, �''6 My
rid,.� /-/,�//���. `"i�•- .. .��, ,
Address or Lot#
C4frown T ,n✓j y? AU G 0 �tl. �,0 tl B
2.-*TYPE OF SEPTIC SYSTEM`:
❑ Pump. ravity.(choose one) fi( G
ANDOVER
*IfPuP system,attach caPY of electrical to application* LTH DE ,i1E
`i`
-Conventional
System (pipe and stone system)
➢ ❑ Infiltrator or Blodiffuser(Gravel-Less)(Attach a copy of yourcertifrcaffon to install this type ofsystem.)
D ❑Pressure Distribution S.A.S.(No D-Box)
D Q 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)
Whatis the Maker' What is theModehit
2. Owner Information
,,t9 r f
Name
Address(if different from above)
CityfTown State /� Zip Code
Telephone Number
3. Installer Information
ZA-r - _ "
Name Name of 1V 1rN R ,
RpRlscS,1C
/ A-. f/14 -_IV
Address 111 Ar,gilla Road
_ /kQ /�'l.f C '/c� Andover MA 01510
Cityfrown, State (y Zip Code
�y y
Telephone Number(Gell Phone#if passible please)
a. Designer--,Information
Name Name of Company
Address
Cityffown State Zip Code'
Telephone Number(Best#to Roach)
Application for Disposal System Construction Permit-Page 1 of 2
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A. Fad.ili ,.In. 6,,rmatio,n,cootin.ued,...
5. Tm2.- f S.ulld,ln-q,:,Efgesidentfal.Dw6lilhj or 00ommerclal
B. Agr :..emenf
Me Undersfgnecl'agrees-to ensura:.the cortstruOtlon;and malntenance of the a!'prscrlb.Od
on alta sewage disposal System:ln ac crdance wlfh the.pro.vlslorrs:of 5 of
ffie
EnvlronmeWal Coa►oe, yrs wellas th6 LocalSubsurf�ce Disposal RegulatJons forthe Town of
North Andover, and rrat to place,fhe system tri op.er tlo» until a Cedmflcate of complla ice:has
} been issue y this Beef d of Neatfh,
tJariee a C
rate
• f ,
Appl�i�catlphy APraved
o
Health eres ntat! }Y
t
ami �,
Pate
Application Disapproved for the following reasons:"
For Offfee Use Only:
I 'Fee Amt had? Yes °
NO
2,• Ptolcctll�artaget Ohhgsdoa Foc iAtt a d? Yes
NO
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01
Town of North Andover
HEALTH DEPARTMENT
CHECK#: DATE:
LOCATION:
1-1/0 NAME: .....
CONTRACTOR NAME: —6 '°�w-,-
Type of Permit or License: (Check box)
• Animal
• Body Art Establishment
• Body Art Practitioner
0 Dumpster
0 Food Set-vice-Type•.......
11 Funeral Directors
* Massage Establishment
* Massage Practice
* Offal(Septic)Hauler
* Recreational Camp
0 Sun tanning
• Swimming Pool
• Tobacco
• Trash/Solid Waste Hauler $
• Well Construction $
SEPTIC System.
• Septic-Soil'Testing
• Septic-Design Approval
Septic Disposal Works Cotistruction(DWQ $
13 Septic Disposal Works Installers(DWI) $
0 Title 5 Inspector
0 Title 5 Report
0 Other. (Indicate)— $
Healih"'A"' gent Initialsi
White Applicant Yellow-Health Pink-Treasurer