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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 NT catio, faricfIs, .mm. :ts's'I: tem r kM►QIstI;U�G' latt P. ` �t r' 7A � t)AY'S AAT ��YA+.r.rz` � :250,Ob PU11 Rpalr A . x1845 s`f25 n'e:nt PAGS 2 QF 2 ' 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 PumtrS=? Iffso)Attach ca,nyofp'/P=r 4. Fbu dazl'o&.els-Bur*R(now const* cdory•ronly). Ye& Aro-4 ('Same scide as approyedp4m) A FloorPlansp'(he.w�eonstruOtlon'only).. f'es NO p{ft tldn'for,pfsp"gsal. ystQrkt`06M ruet'laO POrmtt Rase 2 rif 2 . . � � rrb • �,m � a 11 1Y • i r •4 • 1 1• M " .k• ": • 1• , • 1 .n ♦ 1 . Y•i. • ••i • • . • • r 1 Td I, ♦ ! 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M r J , .r r , ., J Nr, , ♦ ay p r •' y ; Y 4 r r a •, tf li 1 (wA ITOM r.T.1".r.ri I D m RM. ¢' 7171 1 6,�• ♦ !• Ik n' j • s r s M1 .1I. !r/a a.1 ! .1 Igiy"♦.,4 . „7k ,,• k• •� aft tJ! •y' rk k •k.".•t:'!!J!. 'x+A! •!Y. .U• .�' •14ry. • ..kt' ♦ a ►.7R,•f#.• "!; t.T�' - N ♦ Ir o• =y • i k 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