HomeMy WebLinkAbout- Permits - 2198 TURNPIKE STREET 9/6/2018 Commonwealth of Massachusetts Map-Block-Lot
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108 00006
BOARD OF HEALTH ermitNo
North Andover BHP-2018-0222
FEE
$350.00
DISPOSAL4 WORKS CONSTRUCTION PERMIT
Permission is hereby granted JoesPh Watson
to(Construct)an individual Sewage Disposal System.
at No 2198 TURNPIKE STRE,EI' - ---------- -- -------
as shown on the application for Disposal Works Construction Permit No. BHP-2018-0222 ated July 2
Issued On: Jul-09-2018 OA OF �ir,AI.,TH
_.
Application for Septic Disposal System
'S
Construction Permit -- TOWN OF TODAYDATE
$350.00-Full Repair
NORTH ANDOVER, MA 01845 $175.00-Component
Important: Application is hereby made for a permit t
When filling out Construct a now on-site sewage disposal system*
forms on the
computer,use j:kI;:CepaIr or replace an existing on-site sewage disposal system*
only the tab key U Repair or replace an existing system component-What?
to move your
cursor-do not10
use the return A. Facility Informafion
key.
00
Address or Lot#
'M
2.-*TYPE OF SEPTIC_SYSTEM`;—-----
"P
> El Pump M15ravity choose one)
***If pump system, attach copy of electrical permit to application"*
� El Conventional System (pipe and stone system)
> HKhfiltrartor or Blodiffuser(Gravel-Loss)(Attach a copy of your,certification to install this type of system.)
> 0 Pressure Distribution S.A.S.(No D-Box)
---------->---E]-Pressure-Dose&(D;;Bo)c-PreswrAY&.*;S-.
> n Does the system require an effluent filter? Yes—.-- IN o_,e-
If yes,does plan specify make and model of filter? YES =(no further info. needed)
NO=(Installer must specify brand of filter before DWG issuance)
Miatis the M. zke? Wbat is the M0dejP__._____.
2. Owner Information
jz,lt�
Tia-me-
Address(if different from above)
AY—It—-----------
—citv'(0,W�(I State Zip Code
Email address 7,Pepbw',Number
3. Installer Information
Name Name Of Company
'V
— 3
Address
_6AtY/TO"f State Zip Code
ne Number(Cell Phone#hFpossible_please)
_
4. Designer Information
Name Name of Company
-5 h&'_'6
Address
City/TownState Zip Code
.__.mm.--.._._.._
—
Telephone Number(Best#to Reach)
9 3 Z.—JoZ Application for Disposal System Construction Permit-Page I of 2
Application for Septic Disposal System _
Toa .�rT rE
Construction Permit — TOWN OF
$350M-Full Repair
NORTH ANDOVER MA 01845 $175.00-Component
PAGE2OF2 _
A. Facility Information continued....
5. Type of Building; [A esidential Dwelling or❑Commercial
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
thisBoard of Health the installed system is not approved.
_ �t
Nae _ — Gate
Appli c%nApp
d By: (Board of Health Representativ
Name — mate
Appli ation Disapproved for the following reasons:
For Office Use Only:
1. Fee Attached? Yes No
2. PtojectManager•obligation l-%ottn Attached? Yes V✓ .No
3. _&g2p_S��? If so,Attaclz_cc� y afElectt zcal.Pertnrt Yes.— Na
AppAcatztxeceived copy of
"L'lectrrcal kispeetran Nates fat Septic Systems" Yes /\/Pr No
.Clandoxxt?
4. Reviewed apptovallettet; allpapet-watkseceived? Yes No
5. Fotxodatloo As-Built?(new construction only): Yes .No_
(Saxaae scale as apptovedpLw)
G. Floot-Flaas?(new construction only): Yes__.._.. No
Application for Disposal system(construction Permit-Paye 2 of 2
f
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGXI'IONS,
As the North Andover licensed installer for the construction for the septic system for the property at:
(Address of septic systeFor plans byA
(Engineer)
� Cd
Relative to the application of J, _41
(installer's name) Zla t c d 2
�41rignnal aate)
Dated 1fhfl
(I oday's date With revisions dated
(f.as renis
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 prior to
performing any work.on a site. I must have the approved plans and the permit on site when any work i
being done.
2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any
other person not associated with my company schedules aninspection and the system is not ready, then
item three shall be applicable.
3. As the Installer, I arriteclui-ted to have the necessary work cornpleted prior to the applicable inspections as
indicated below. I understand that requesting an inspection,,without col-yipletion of the items in accordance
with'title 5 and the Board of Health Regi1lations may result in a $50.00 fine being levied agaigsLt-n n /)r
a. Bottom of Bed—Generally, this is the first (Vinspection unless there is a retaining wall,which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inmectioti---Engineer must first do their inspection for elevations, des, etc.
As-built of verbal OK (or e-mail to: bealdidept@nc)ithandovertna.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
pump to work and alatri-i to function.
c. Final Grade—Installer must T cquest inspection-ion when all grading is complete. Installer does not
have to be on-site.
4. As the installer., I understand that only linay perform the work (otber than sil*. le excai)(Wim)and I am recluircd
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by_otl ets unlicensed toitistall septic system,., inNorthAndover can constitute
reasons for denial of the systeinand or revocation or suspension of my license to operate in the Town of
North Andover, sinifiicant fines to all persons involved ar.ealso-p
s?sai b I e.
5. As the installer, 1.understand that I must be on-site during the performance of the following construction
steps:
a.
Detatinination that the proper elevation of the excavation has been reached
b. Itisp ection of the sand and stone to be used,
c. Final inspection by Board of Health staff or consultant.
d Installation of tank, D-Box,pipes, stone, vent,pump chainber,retaining wall and other
components.
6. As the instLaller. T.undetstand that I am solgly respons Lble for the installation of the systepqjis p
11 )rovcd plans. No instructions ley the homeowner, general contractors or any odici persons shall absolve
.me of this obligation..
Undersigned Licensed Septic Installer: joy, ze�, � (Today's Date)
(Nat-ne—Plhiit) e—Sitmed)