The URL can be used to link to this page

Home My WebLink About- Permits - 74 FULLER ROAD 11/19/2018 i i r Commonwealth of Massachusetts Map-Block-rot 065.00085 BOARD OF HEALTH - Permit Na North Andover BHP 2018-0482 FEE $175.00 IP''OSAL, WORKS CONSTRUCTION PERMIT Permission is hereby granted Daniel A. Giard --------------- to(Construct)an Individual Sewage Disposal System. at No 74 FULLER ROAD as shown on the application for Disposal Works Construction Permit No. BI-IP-2018-04 ated e er 2018 Issued On:Nov-13-2018 O OF HEALTH I J i 1 Application for Septic Disposal System TODAY'S DATE Construction Permit - TOWN OF $350.00-Full Repair NORTH ANDOVER, MA 01845 $175.00-Component Important: Aiiiicationis hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer,use E] Repair or replace an existing on-site sewage disposal system* only the tab key YR 'D 4 _ I to move your epair or replace an existing system component—What? cursor-do not 1P IVED use the return A. Facility Information key, j('e/')L/. ............. A-3— rti Address or Lot# o�- Cityp1wW 2.-*TYPE OF SEPTIC SYSTEM*: > El Pump El Gravity(choose one) **"Ilfpump sy tem, attach copy of electrical permit to application*** > 0conventional System (pipe and stone system) > El Infiltrator or Blodiff user(Gravel-Less) (Attach a copy of your certification to install this type of system.) > F.1 Pressure Distribution S.A.S.(No D-Box) > D 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) mat is the MAke?__,_What is the Model?__ 2. Owner Information Name.. v Address rent from a ove) M__It.., City/Town State Zip Code _-_._--------___-.- Email address Telephone Number 3. Installer Information h7T(_ ,—I AAV L01 — --------6 ' Name Name of Company Address L,C/t) --k"1P City/Town State Zip Code e Telephone Number(Cell Phone#ji'possible please) 4. Designer Information -Na-me 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 TODAY'S DATE Construction Permit-- To" OF $350.00-Full Repair NORTH H ANDO Y ER, MA 01845 $75.00 -Component PAGE 2 4F 2 A. Facility Information continued.... i 5. Type of Building: desidential Dwelling or[]Comrnercial 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 Health, the ins Iled system is not approved. Name Date I A I` at n pproved By: oa d o Ith Re res tativej ame Date - Application Disapproved for the following reasons: For Office Use cJnly: 1 Fee Attached. Yes-_ No 2. Project Maxzaget Q,higatrop Fottn Attached? .Yes G No 3. J'ump System? Ifso,Attaelt cap�afRec tticalP�tmit .Yes_. .._ Na App t`cantzecelved copy of "Electt calInspectloix Notes fox Septic Systems" Yes ..__ No -1 pdout? 4. Reviewed apptovallettei, all pope wotk recezved? Yes Nv__..-- Missrx�g 5. Eoundatio-a As-Built?(new construction only): Ye4 _ NNE?_.___ (Same scale as apptovedplop) G. Floot•Plops?(new construction only): Yes Na_......__ Application for Disposal System Constniction 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: /1U d " (Address of septic system) liar plans by (F?nginec,r) Relative to the application of i t? Jnstaller's name) And dated rigina ate Dated f, ,-- / 3 o ay s ate With revisions dated _. (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. I must have the approved plans and the permit on site when any work is being c Qne.. 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 tieruesjii,art inspection without completion of the items in accordance with'Title 5 and the Board of health Repullations ma result in a $50.00 brie being levied against:me and/or lny company. a. Bottom of Bed— Generally, this is the first (1')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— :Engineer must first do their inspection for elevations, ties, etc. As--built of verbal OK (or e-mail to: healthdept@iiortl.iandoverma.gov) from the engineer must be subrrritted 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 r:e:quest 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 Man satraple excavation) and I am 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 septicsysterns in North,Andover can constitute reasons for denial of the system._and ar revocation or suspension of in license to o erate in the Town of North Andover,s _Ljgqjficaat fames to alI x7ersans itivalvcd pie also passible. 5. As the installer,I understand that I must be on-site dieing the performance of the following construction steps: a. Deteiinirlation that the ptope-t elevation of the excavation has been.wached. b. Inspection of the sand and stone to be used, c. Finalinspectron by Board ofl3ealtb staff at-consultant. dl Installation of tank, D-Box,pipes, stone, vent,pump chamber, retainr'ng walland other components, 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowizer, general c;canttactor, or any c>ilaer _)ersons shall absolve ine of this ablilYation. Undersigned Licensed Septic Installer: 11--1 3 — / 8 (Today's Irate) (arise—Pi nit� �Kame— ignedj 1 of � y ' � 1 Town of North Andover HEALTH DEPARTMENT �x'sacw+uswti � CHECK#: :, LATE: ( 1 LOCATION: H/O NAME: CONTRACTOR.NAME: Type of Perrr►it or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type:__. ._..__....__._._ . $ ❑ Funeral Directors $— ❑ Massage Establishment $ ❑ Massage Practice $—— ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ -- ❑ Sun tanning $— ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid"Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-n Soil Testing $ ❑ Septic--Design Approval $ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers{DWI) $ 81 ❑ Title 5 Inspector $ ❑ Title 5 Report $ i ❑ Other:(Indicate) $ -- Hea,,UkAgent Initials White Applicant Yellow®Health Pink_- Treasurer I :w