Loading...
HomeMy WebLinkAbout- Permits - 7 CARLTON LANE 10/17/2018 Commonwealth of Massachusetts Map-Block-Lot 107.A0019 BOARD OF HEALTH -.-- . ....... Permit No North Andover BHP-2018-0464 FEE $175.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John D1Vincenlo to(Construct)an Individual Sewage Disposal System. at No 7 CARI.,TON LANE _,. as shown on the application for Disposal Works Construction Permit No. BfIP-2018-04 ated 0, r 5, 8 Issued On. Oct-15-2018 13C) OF HEALTH s i i i Application for Septic Disposal System TODA'Y'S DATE Construction Permit — TOWN OF $350.00-Full Repair NORTH .ANDOVER., NU 01.845 $1 s 00-Component Important: Application is hereby 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* onf the tab ke to mane your key or replace an existing system component--Whafi?_ _,__ f _. cursor-do not use the return A. Facility Info m key. 74LKI—L-K-1-YY Address or LA City/Town 6 2.-*TYPE OF SEPTIC SYSTEM*: > El Pump ravity(choose one) �r ni r; ***If pump system,attach copy of electrical permit to application"* ➢ anventional System (pipe and stone system) > ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system,) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) Y . �_-:Pressuee-Dosed(D=13ox'r reserifl_�,.. .. ,__�___ Y ❑Does the system require an effluent filter? Yes--_— No-- If yes, does plan specify make and model of filter? YES W(no further info. needed) NO=(installer must specify brand of filter before©WC issuance) Wlbatis the Make? ......_._..-- Mat is the Mader_ 2. Owner Information Name Address(if different frorn above CitylTown State Zip Code Email address Telephone Number 3. Installer Information Name Narne of Company jej 2Addr ss City/Town State Zip Code Telephone Nurnber(Cell Phone 4 if passible please) _._. 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 Application for Septic Disposal System w Construction Permit — TOWN OF -roDAY's DA-re NORTHANDOVER, Mai. 01845 $75 Oo-Component PALE 2 0F_2 A. Facility Information continued.... 5. Type of Building: 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 En -o ne tal Code,a well as the Local Subsurface disposal Regulations for the Town of No nd v r. 1 and rstand that until a final Certificate of Compliance has been issued by th B ar o tth, he installed system is not approved. ._-___ _._ ___ Nai e Date JHAI ',A-15"-ro d By: (Board H altl e resentative) Data Application Disapproved for the followin easons: For Office Use Only: 1. FeeAttaclied? Yes No .._ a. ',-- Yes No 2. Iraject Managex Oblr�,titian Fatxn Attached ._.__ 3. Pzzxn. S stern? Ifsa,Attach cagy af=Flactxrcall'eztztzt Yes No — -- App Rant xeceived copy of "EUccoicalIn&pection Notes fax Septic Systems" Yes No t Hatzdout? i 4. Reviewed appxovallettex, allpapetwozk-received? Yes _ No missing:—_ --------- - - 5, Fozzndation As-Bzdlt?(new construction only): Yes No (Same scale as apptovedplan) F 6. FlootPlans?(new construction only): Yes No__...,. Application for Disposal System Construction Perrriit-Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the Nor ndovet licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans by _ f (Engineer) Relative to the application of 6, (installer's name) And dated �3rtinal- ate Dated �� f� ���, xev I o ay s ate With isions dateei (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 prior to performing any work on a site. Itriust have th€a_approved plans and the�gtnv.t on site when any work is being done. 2. As the the installer,I must call for any and all itzspections. 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 unez-statzd that requ€stYin inst�ection�withc>ut cotni�letiorx of the items in accordance with'Title 5 and the Board of Health I2 egulatinns may result iti a $50.00 fine being levied a€tainst m�_andto trey company,. a. Bottom of Bed— Generally, this is the first (V)inspection unless there is a retainingwall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction l nspection--Engineer must first do their inspection for elevations, ties, etc. As--built of verbal OK.(or. e-triail to: healthdept@northaridoverma.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 Gracie—Installer must request inspectionn when all grading-is complete. Installer does not have to be on--site. 4. As the installer,I understand that only 1.may perform the work (otber thdta simple excavation)and I a:txi required 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 selLtic systeins in North Andover can constitute reasons-for_denial of the system and/or tevocation or suspension of-my license to operatc_in the'Town of North Andover, significant fines to all Dersons involved are also Dossible. 5. As the installer,I understand that:I must be on--site during the performance of the following construction steps: a. De tet7nina tion that the proper elevation of the excavation 11a8 been tea ched. b. Inspection of the sand and stone to be used. c. Final.itzspectlon by Board offlealtli staffor consultant. d Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As rile installer I understand. that;I am solely-tesponsible for the installation of die system as tier the approved lalans. N<>instructions key the homeowner, general contractommr or-any other persons shall absolve me of this obl.i ag iron. Undersigned Licensed Septic Installer: od s Dat J i ill f7 C-e Y) Z '!C .t e— tgne E3 ,11ir 6 of Town of North Andover HEALTH DEPARTMENT pSSACHU$ CHECK#: DATE: LOCATION: H/O NAME: . CONT9ACTOR NAME: Type of..Permit or License: (Check box) 0 Animal $ • Body Art Establishment $ • Body Art Practitioner $- 0 Dunipster $ • Food Service- $— • Funeral Directors $ • Massage Establishment $ • Massage Practice $ • Offal(Septic)Hauler $ • Recreational Camp $-- • Sun tanning $ • Swimming Pool • Tobacco • Trash/Solid Waste Hauler 0 Well Construction $ SEPTIC Systems: • Septic-Soil Testing • Septic-Design Approval $ Septic Disposal Works Constructiou(D4V0 $0 0 Septic Disposal Works Installers(DWI) $ n Title 5 Inspector 0 Title 5 Report 0 Other. (Indicate)—,---- $ He4itkAgent Initials � i White-Applicant Yellow®Health Pink--Treasurer 1