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HomeMy WebLinkAboutPermits - 21 ASH STREET 8/7/2018 Commonwealth of Massachusetts Map-Block-Lot 106D0041 BOARD OF HEALTH ---- Permit No North Andover BHP-2018-0244 FEF, $175.00 - -------- - -.,... DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Bateson to(Construct)an Individual Sewage Disposal System. at No 21 ASH STREET _ ..-------.._ as shown on the application for Disposal Works Construction.Permit No. BHP-201*IDaed ssue On:Aug-U2-2U18 --- .... ---- .... - - -------- BOARD OF HEALTH i ?r4 Application for aC 'p , 0isposa 1 $�/steirrr TODAY'S DATE Constructibn! P it - TOWN OF NO►R H AN OVER., MA 01845 $,2501.01Y—Full Repair $'t25.00-Component Application is hereby made for a permit tot ©Construct a new on-site sewage disposal system* ❑Repair or replace an existing on-site sewage disposal"system* [repair or replace an existing system component--What? A. Facility Information. Address or Lot# ; > 4A City/Town 2.-*TYPE OF SEPTIC SYSTEM*: EAT �w d HEALTH T ANDOVER A ❑ Pump ravity(choose one) "'If pump sys em,attach copy of electrical pennit to application'** ➢ Conventional System (pipe and stone system) D ❑Infiltrator or Biodiffuser(Gravel-Loss)(Attach a copy of your cort(ficatfon to install_this type ofsystem.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) A ❑ Pressure Dosed(D-Box Present)S.A.S. D ❑Does the system require an effluent filter? Yes No if yes, does plan specify make and model of filter? YES=(no further Info:needed) NO=(installer must specify brand of filter before DWC issuance) What is the Make? Whatrs the Modc,� 2. Owner Information Mame Address(if different from above) City/Town State Zip Code Telephone Number 3, Installer Information BA'TESON ENTERPRISES,INC Name " ` Name of Comp*M Argilla head Andover MA 01810 Address Cityrrown. State Zip Code } Telephone Number(Cell Phone#If possible please) 4. Des i-00,;lnfeirmatlon Name Name of Company Address -----_.___ --_ City/Town -- State Zip Code' Telephone Number(Best#to Reach) Application for Disposal System Construction Pormit-Page 1 of 2 U11 tC ��:t��tl••for ��.,. ��fs D a sal s, e;m QIIIY • o14ADAI"S�A7E J'+.�rFul(ie air . . 01,g4J "125. p,e Cft 6':ent .''PAGE 2 DF2 A. 6111ty.Inf rminatlo Gort,.it-juec ,... S. T�rpo'of Buiiding: esld0ntial.Dwelllhj or(]Commercial II.Agrp.emant The u'nderslgnec/agrses to ensure:.the 4op#ru0f19n and rnalntenance of the afpre.q'escrlbecl on-site sewage dlspasalsysfOmIn accordance with the pro.vlslarfs of Tltle 5'ofthe . €nvlronmehtal Code,,ids well as the Loca7'Safsdrf�0e bispi sa!R090at ons for the Town of North Anclo ver, and Trot to place:the system M vperjtlon.until$ Certlflcate of Comp!!atfce:has bpen-Msuedbv this Boafd otNealth. • PJ�mr _ [lata �f� , ratio Appr& &i� 6 ,� alfh�e'Aresentative) , ami w. n2ta . Application Disapproved,for the following reasons:"' For O fk"ae.Use Qniv: 1 ,�FeeAttachedp ; Yes .No 2- Ptol�ctll429"Obligadotl Fo=Attachcd,? Yes t 1 No . 3.: ,fib Systcrnr� I,fsdi Attach cu E ofEYcrrr,��a1 No - t 4. Foutrdat*,As-B4W(now constM" 01dtt•ronly), Yes N ('Same scale as apptovedplau) 5. ,�aorPlans�lhew o©irsfrutlorr'vnlY), Yes No . � rAliplra'atfdn'tar;pla�ppsat yystQrYS:�onstrpc�tcrii�'eimft�t?a�ae�dr9 • •. tr♦1 rYC ar.�I � 1•�S IA /A 11 fi 11} M 4 •� ♦ ♦ �w 1 1-1 . Y♦ • !.. i" A i, • • Ir 11 • A•Y { f • • I 1 f• !1 4• /d + R• • M ' .�4 I• ► • .,. ♦ f •...•«•1 Y. 111 •• A • DWI • • i • / t ► i!! r• •.t7/.:/ •. ► , „ • •/C •R r 7ri!..) +;j"L ! •M Kyj.,! c.,.4• ..3 r • ► .7� ! f1 r /_ ♦♦ f•• � • • r " R. ! 1 / r1Y«r 1 / ••. .,t ,r • -+ •"M r •..'. f♦ Ir 1 r / ! r •/r w •,4h•► • ;Fr. •!• " I ♦ •1 ♦r ' rft/r►' .• MY ..•1 II 1 i .=NI • • • •• Mr1 M♦ ."r• 1 . 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"l K!«!y .r/1 r4' n[•/ • .s!�` i 4 ti • ,A'•li' 1.:. 1.!,1 ,. f 4 Town of North Andover HEALTH DEPAIITMENT CHECK 4: DATE: LOCATION: H/O NAME: CONTRACTOR NAME: 1y,pe of Permit_cLr�jj�(—nsg: (Check box) 0 Animal • Body Art Establishment • Body Art Practitioner 0 Dumpster 0 Food Service-Type:--- 0 Funeral Directors • Massage Establishment • Massage Practice • Offal(Septic)Hauler • Recreational Camtp • Sun tanning • Swimming Pool 0 Tobacco 0 Trash/Solid Waste Hauler 0 Well Construction SEPTIC-Sy�tenL,;. • Septic-Soil Testing • Septic-Design Approval 0, Septic Disposal Works Constraction(DW0 $ " �A 13 Septic Disposal Works Installers(DWI) 0 Title 5 Inspector [j 'Title 5 Report 11 Other: Healt 'Agent Initials] White Applicant Yellow-Health Pink-Treasurer