HomeMy WebLinkAbout- Permits - 2 BANNAN DRIVE 10/4/2018 .... -----.... ........ ................ ............_........ ................
• , Commonwealth of Massachusetts Map-Block-Lot
038.00104
BOARD OF HEALTH _.
Permit No
North Andover BHP-2018-0458
FEE:
$350M
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted James Kellett
to(Repair)an Individual Sewage Disposal System.
at No 2 BANNAN TD IVE
as shown on the application for Disposal Works Construction Pen-nit No. BIIP-20 ate ct 018
Issued On: Oct-04-2018 BOARD OF HEALTH
Application for Septic Disposal System
Construction Permit - TOWN OF TODAY'S 4DA E
$350.00-Full Reair
NORTH ANDOVER, MA 01845 $175.00-Componpent
Important: Application is her
made for a permit to:
When filling out ❑E] Construct a new on-site sewage disposal system*
forms on the
computer,use --<Repair or replace an existing on-site sewage disposal system*
only the tab key to move your E] Repair or replace an existing system component—What?
cursor-do not
use the return A. Facility Information
key.
-n A, JVA t 4 J
Address or Lot#
-AL—A
City/Town
2.-*TYPE OF SEPTIC SYSTEM*:
> El Pump ' '
Gravity(choose one)
***1fpunVsCstem,'6'5h copy electrical permit to application
Conventional System (pipe and stone system)
> El Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of systerrij
> El Pressure Distribution S.A.S.(No D-Box)
................. -EI-Pressure-Dosed,(D-Box-Present)-S7.A Sr.----r-
> E] Does the system require an effluent filter? Y, No
If yes, does plan specify make and model of filter? YES no further info. neede�""
NO=(installer must specify brand of filter before DWC issuance) el 51,
, ly
Wlbatis the Whatis the Model
2. Owner Information
Name
Address(if different from above)
City/Town State Zip Code
Email address Telephone Number
3. Installer Information
Name Name of Company
Address
City,T wn State Zip Code
el
/76 cl
Telephone Number(Cell Phone#ifpossible please)
4. Designer Informatio "",'
4-'
Name '-Name of Company _7
X)CI_. ILA/Al Z' t
Address
City/Town State Zip Code
-Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
Application for Septic Di 0sposal System TODArS DATE
Construction Permit - TOWN OF
$350.00-comma
NORTH ANDOVER,, MA 01845 $175.00-Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building: esidential Dwelling or E]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 a the Local Subsurface Disposal Regulations for the Town of
,Arn
10 North Andover. lunderstan th until a final Certificate of Compliance has been issued by
tj t
oard of Health he in ta ystem is not approved.
to Date
----------
Ap ion Ap o By: (Board of Health Representativ
Hain Date
Application Disapprove 'for the following reasons:
For Office Use Only:
1. Fee AttachedP Yes No
27. Ptoject Manager Obligation Foam Attached? Yes No
3. P"m System? If so,Attgc&eo _ Jectrical Peimit Yes No K.ofE
Ap_pA cant-received copy of
"Mectdcallnspecdo_v Notes for Septic Systems" Yes No
II-andout?
4. Rei4ewedapp-rovallettex, aflpaperwotkfeceived? Yes No
Missing-,
-5. Fozwdadon As-Built?(now construction only): Yes No
(Sa.me scale as approved plan)
6: Floo-t 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) For plans by
Relative to the application of�J A J�e 1 (Engineer)
jnstaller's name) And dated
(ungmal date)
Dated
t
Voday's date) With revisions dated 'Al
(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 Health approved plans p 17or to
performing any work on a site. I-must have the approved plans and the permit on site when any work is
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 ray company schedules an inspection and the system is not ready, then
item three shall be applicable.
3. As the installer, I am-required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspection,without completion of the items in accordance
with Title 5 and the Board of Health icaat6is may result in a $50.00 fine being levied against me and/or
my compare-
a. Bottom of Bed— Generally, this is the first(1'� inspection unless there is a retaining wall,which
should be done first. 'Ihe installer must request the inspection but does not have to be present.
b, Final Construction Inspection—Engineer must first do their inspection for elevations, des, etc.
As-built of verbal OK (or e-mail to: healthdept@no-tthandove-tma.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 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 I inay perform the work (other than simple excavation)and I arnrequired
to complete the installation of the system identified 'in the attached application for installation. I further
understand that work done by others unlicensed to install septic systems in North Andover can,constitute
reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of
North Andover, significant fines
s to all persons 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 the properelevation of the excavation has been reached,
b. Inspection of the sand and stone to be used.
c. Final inspection by Board ofHealth staff or consultant.
d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other
components.
6. As the installer, I understand that I am sol*-responsible for the installation of the system as per the
approved plans. No instructions by the homeowner
me of this obligation.
Undersigned Licensed Septic Installer: (Today's Dat
7 'W1
(Name—Pnnt)
Town of North Andover
HEALTH DEPARTMENT
CHECK#:, 1/
DATE: 4 ArIl
LOCATION:
H/O NAME:
—71
CONTRACTOR NAME: /c,
Tvve of Permit or License:(Check box)
• Animal $
• Body Art Establishnnuit
• Body Art Practitioner
0 Dumpster
0 Food Service
0 Funeral Directors
0 Massage Establishment $
0 Massage Practice $
• Offal(Septic)Hauler $
• Recreational Camp
• Sun tanning
• Swimming Pool
• 'Tobacco $—
• TrasIVSolid Waste Hauler $
• Well Construction $
SEPTIC Systems.,
0 Septic-Soil Testing $
El Septic-Design Approval $
$
Septic Disposal 1works Construch C)
0 Septic Disposal Works Installers(DWI) $
0 Title 5 Inspector
0 Title 5 Report $-
0 Other(Indicate),—
H t"PAgen eal t Initials{
White-Applicant Yellow-Health Pink- Treasurer