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Home My WebLink About- Permits - 312 BOXFORD STREET 9/5/2018 Commonwealth of Massachusetts Map-Block-Lot 10430059 BOARD OF HEALTH - - - • Penmit No North Andover BHP-2018-0265 FEE $350.00 DISPOSAL, WORKS CONSTRUCTION PERMIT Permission is hereby granted Dean Dynan to(Construct)an Individual Sewage Disposal System. at No 312 BOXFORD STREET as shown on the application for Disposal Works Construction Permit No. BHP-20I ate d Pt 2018 .---- ----- .. -. --------------- Issued On: Sep-05-2018 BOARD OF HEALTH I I I 1 Application for Septic Disposal System ZTOArS D Construction Permit - TO" OF $350.00-Full Repair NORTH ANDOVER, MA 01845 $176.00-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* only the tab key El Repair or replace an existing system component—What? to move your cursor-do not use the return A. Facility Information key. w.. 1 1Z )1 jes or�Lot 0 City)-, 2.-*TYPE OF SEPTIC SYSTEM*: ➢ El Pump 3ravity(choose one) ***If pump system, alch copy of electrical permit to application'* Conventional System (pipe and stone system) Infiltrator or Blodiffuser(Gravel-Less) (Attach a COPY Of Your certification to install this typo of system.) ➢ Pressure Distribution S.A.S.(No D-Box) =oes 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? W75 a t is di e Mo del? 2. OwpQr Information arne N . ...... -;kd(3rs;(if di erent fr above) ity)"ro n St� Z' Cpde Telephone Db h Bm a I I address ,p one umber 3. Installer Information me Name of Company Vdress eT City awn S#a#a Code Telephone Number(Cell Phone#if possible please) 4. Desiciner Information NPe Name of Company er Address City/Town State zip Cc ie C one lNu gt, Best 4 to Zip )f Teler) ,,1, Application for Disposal System Construction Permit-Page 1 of 2 Application for Septic Disposal System raDAY'S DKrE Construction Permit — TOWN OF $350.00-Full Repair NORTH ANDOVER, MA 01845 $75.00- Component PAGE 2OF2 A. Facility Information continued.... 5. TV pe of Buildingesidential 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 over, I under:st d that until a final Certificate of Compliance has been issued by thi oar of Health i stalled system is not approved. ame Date Appli 'on App y: (Board of Health Representative { i f Na Gate Application Disapproved for the following reasons:. For Office Use Only: .1. Fce Attached? Yes`�/. No 2, I'tojectMaxxaget•pblrgation PorznAttached? Yes Na 3. Pzzrnp_S sue? If so,Attach copy ofFlectt lc l Pertnrt Yes_ Nv.� Apph°cantreceived copy of "ElecoicalInspection Notes for Septic Systems" Yeses_ No I3atxdozzt? 1! 4. Reviewed approvalletter, all paper work recez`ved? YesNo -- 5. Foundation As-Built?(new construction only): Yes No (Satrie scale as approvedplan) 6. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit-Page 2 of 2 8 4 Town of North Andover HEALTH DEPARTMENT CHECK#: 3 DATE: LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) • Animal $ • Body Art Establishment $ • Body Art Practitioner El Dunipster $ • Food Semice- • Funeral Directors • Massage Establishment $ • Massage Practice $---- • Offal(Septic)Hauler $ • Recreational Camp $ • Sun tanning $-- • Swimming Pool $ 0 Tobacco $ 0 Trash/Solid Waste Hauler $ El Well Construction $ SEPTIC Systems. • Septic-Soil Testing $ • Septic-Design Approval $ Septic Disposal Works Construction(DWO $ ❑ Septic Disposal Works Installers(DWI) $ 0 Title 5 Inspector $ 0 Title 5 Report $ 0 Other. (Indicate),----,,--- $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurers E 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) Fox plans by (Engineer) :[2el2tive to the application of eil_ (Jnstalles name) And dated 1 /lamDated - . o ay s ate `kith revisions dated (Last r date) I understand the following obligations fot management of this project: 1. As the installer,I am obligated to obtain all permits and Board of Health approved plaths.prior to performing any work on a site. I must have the a .proved plans and th.e-_pertriit on site when any world is beang.._datre. 2. As the installer,I.trust 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. 7 understand That requesting an inspection without completion o£the items in accordance witli Title 5 and,the Board of Health Re egLilatians may result irz a 150.00 fine bezn�;levied against the arL/c� rriy COM-p ny, a. Bottom of Bed—Generally, this is the first (V$ inspection 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 Inspection--Engineet must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdept@notthandoverma.gov) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present fox this inspection. With a pump systern, 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 may perform the work (other"tban simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work clone by others unlicensed to install septic systems in North.Andovet can constitute reasons for denial-of the s sty ens.aged/or f-evocation or suspension of my_license,to operate in the Town of North And.ovc r,_significant fines to_all. etsons involved.ate_also possible... 5. As the installer, I.understand that I must be on-site during the pe:tformance of the following construction steps: a. Dete v�latzo-tz that the ptope..r•elevation of Me excavati tx l'as been te�ccbecl b. Inspection of the sand and stone to be used c. Finalitispection by Boatel ofllealtlz staff`oz•consultant. d Itxsta,16ition of tank, -;D-Box,pipes, stone, vent,pump chamber, tetaitVog wall and ethet components. 6. As the installer I understand that I arhi solely responsible for the installation of the system as pc,r the approved plans. Na instructions by the homeowzaer�general e,onttactor or any otlagr_Wersotis shall absol_v me of this obil ag ti.on. Undersigned Licensed Septic,Installer:: Z (Today's Date) .stile— rint ne