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Home My WebLink About- Permits - 485 FOSTER STREET 10/9/2018 1 Commonwealth of Massachusetts Map-Block-Lot 104 B0175 BOARD OF HEALTH -------- Pennit No North Andover BHP-2018-0279 FEE DISPOSAL, WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Bateson to(Construct)an Individual Sewage Disposal System. at No 485 FOSTER STREET _. as shown on the application for Disposal Works Construction Permit No. BHP-2018-0 Sated ete 018 . _.-----, -- -_. .,... Issued On: Sep-18-2018 . BOARD OI'HEALTH i i i Application for Septic Disposal System TODAY'S DATE Construction Permit — TOWN OF ��.i.�l T $350.00-Full Repair �TR.1 � 1'�i O �-r� ri H � , _ 01845 $'175.00-Component Important: Application is hereby made fora permit to: When filling out ❑Construct a new on-site sewage disposal system* fonns on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑""pair or replace an existing system component—What? m ' cursor-do not use the return A. Facility information key. ta' ter" Address or Lot# _. citylTown —._ _. � � �3 1 2..*TYPE OF SEPT SYSTEM*: TOMI e fq rH D VE1 > ❑pump ravity(choose one) ia"l�i 9 i iwii� i iii i ***if pump system,attach copy of electrical permit to application*** p ❑Conventional System (pipe and stone system) Y ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) Y ❑Pressure Distribution S.A.S.(No D-Box) > ❑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 Make? Whatis the Model? 2. Owner information Name Address(if different from above) Zip City/Town State e �-7 W �/Code A Email address Telephone Number 3. installer information Name / Name of f9TH&ENTERPRISES,INC Address III Argilla Road City[Town State Code Telephone Number(Cell Phone#if possible please) a. Designer Information Nam@ Name of Company Address tate - Zip Code City/Town S Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 Application for Septic Disposal System e_M, Construction Permit -- TOWN OF TODAY'S DATE $350.00-Full Repair NORTH ANDOVER, MA 01845 $175.00-component PAGE 2OF2 A. Facility information continued.... 5. Type of Building: Residential 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 this Board of H Ith, the Installed system Is not approved. Name --- "- Date Ap ation pproved B ; o of Health Rep-"pntative) Name Date Application Disapproved for the following reasons: For Office Use Only: i Z Fee Attached Yes No 2. Project Manager Obligation Form Attached.? Yes No_ 3. Pump System? If so,Attach copy ofElecoical Permit Yes No 4 Applicant received copy of ''Electrical Inspection Notes for Septic Systems" Yes_ N Handout? 4. Reviewed approvalletter,all paperworkrecelved? Yes No Missrtag.• `5. Foundation As Built?(new construction only): Yes No (Same scale as approved plan) 6. Floor 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 cad scp6cs�,smi)) For plans by (IotaRelative to the application of name) And dated Dated (J o0ay 9 With revisions dated 'is(NJ d' 1C) 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 pdor to performing any work on a site. I must have thg_�iovcd_ 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 my 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 ins ection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may.-gesuldti a35O.00 fine being levied against me and/or iny company. a. Bottom...9 ain f"c —Generally,this is the first (1') inspection unless there is a retaii gwall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction inspection—Engineer must first do their inspection for elevations,tics, etc. As-built of verbal OK (or e-mail to: liealthdept( cr.CM11) 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 fanction. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, 1. understand that only 1. may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. 1—fatber understand that work&Qp,Q�bothcrswil�icensed_tQ,install septic systems in North Andover can constitute Kc,,asons for denial of the system and/or—revocation of 511-s: erasion of my license to operate in the Town of North Andover, significant-.fines 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 proper elevation of the excavation has been reached. b. Inspection 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 chamber, retaining wall and other components. 6. As the installer. I understand that I am solely responsible for the installation of the system as per the. Wrgyed nl_ --- - or or -plans. No instructio s by the homeowner..ggaeral contract any other. oersons shall absolve me of this li -4b�gation. Undersigned Licensed Septic Installer: (Todays DItc) 4 0 Town of North Andover HEALTH DEPARTMENT DATE: ' 0/8 CHECK4: LOCATION: H/O NAME: -zLa01C—x woo CONTRACTOR NAME: lypt9f Permit qtlikc�n--s�-(Check box) El Animal • Body Art Establishment • Body Art Practitioner • Dumpster 0 Food Set-vice- 0 Funeral Directors • Massage Establishment • massage Practice [3 offal(Septic)Hauler 0 Recreational Camp • Sun tanning • Swimming Pool U Tobacco 0 Trash/Solid Waste Hauler El Well construction SEPTIC Si�stems-- 0 Septic-Soil Testiug 0 Septic-Design Approval Septic Disposal Works Coustruction(DWO $ * Septic Disposal Works Installers(DWI) * Title 5 Inspector * Title 5 Report 0 other. (Indicate).------ Hea t1ht"Agent initials 3ykiLe-Applicant jqjttqu?.:-Health _PLnk-Treasurer