HomeMy WebLinkAbout- Permits - 2 BANNAN DRIVE 11/30/2018 1
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__ Map-Block-Lot.
038.00104
•• Commonwealth of Massachusetts _ _
t/ Permit No
BOARD OF HEALTH Lt „o i
BHP-2018-0458
North Andover FEE
$350.00
KS GONST'RUCT"in
p PE MIT
LISP SAL< ' C?R
J�meSl�.ellett
Pertnis ion is h reYay granted"
to(Repair)an In ivid al Se age isposal System.
m,,,�
or Disposal Works Construction P"W_._._ ___.
at No 2�31�Nr, ctob _ _ 18
as spawn an the app cation fV permit Na. BHP-20I8-0 Date
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e, /0 -- -------- BOA R'D 01'° H F A I,TH
Issued On: Oct-04-2018
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— App Construction Permit — TOWN OF
$2GODO-Full Repair
$175.OD-Component
Important: � ~�
nU| � dh�puue|aynt�m^ �I�� �~����0v��^ �� ire, �
�xvn filling L� unn�oonzanowvn-�/.u�mmuu� \ � " '� /
�nmovnmu ° — w
computer,use epmiror replace an existing one)tosewage disposal system
only the tab key [] Repair or replace ou existing system component—What?
w move your
numor-dvnotuse the return A.
Facility Information
> 0 Pump Gravity(choose one)
***If pun s stem,'a5ta h copy of ctrical permit to app�l ation'
> VC 011((pipe and stone system
> El Infiltrator or Bio4iliuser(Gravel-Less) (Attach\Nopy'of your certification to install this type of system.)
'—
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> El Doe� �ztem require an effluent filter?,"" Yes/�4 No
If Yes, does plan specify make anZ' del of"Xilter? YES =(no furthe Anfo. neede
NO r,1,1�1`efbre DWC issuance)
NO =(installer must specify brand 3f
Whatis the "What is the Model?___
,�dress(if Adi r'e t from above)
State Zip Code
city*, ,own
Enmitaidr s
Instal%lr Information
Address
_67Y;��vvn' State Zip Code
Name Na " of Company
Address
CitylTown State Zip Code
Application for Disposal Syatern Construction Permit^Page 1mo
Application for Septic Disposal System _
AftTODAYS DATE
Construction Permit - TO" OF
$350.00-Full Repair
NORTH ANDOVER3 MA 01845 $175.00-component
PAGE2OF2
I
A. Facility lnforr'etion continued....
5. Type of Buildinq: sidential Dwelling or❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and ml intenance of the afore-described
on-site sewage disposal system accordance with the rovlsions of Title 5 of the
Environmental Code,as well a theLocal Subsurface sposal Regulations for the Town of
North Andover. I understan th util a final,Certifico`te of Compliance has been issued by
t oard of HealtlI he in tal ys em is of approved.
„ c
- _
--
� ate
e
App" ion Ap a By ( oa of Health Re.p
�psen tiv r
Nam
Application Disapprove for the following,reasons
For Office Use unl;
1. PeeAttached? Y s 1 No__
2. P.toyectMazsa�er Cab 'rattotz Forrrz Attac-bed? Yes Nrs _
3. I'zxzxz�,S s I�`sa,._ taela CQM afEleCttzc_aLB < 'F zt Yes._ Na--�.
Applrca,nt Ire cezve opy fo -
"EleadcalInspeet otes foc•Septk. ____Systers" Yes o
llaxzdout? I
l
4. Reviewed approvalletter, all Pape-wb_k recer`vedP Yes No
Mzss,ttz�._
S. Fouvdatlon pis-Built?(new construction only): Yes. _ No
(Same scale as approved plan) -
6. Floo...Hans?(new construction only): Yes No
Application for Disposal system Construction Permit•Page 2 of 2
SEPTIC SYSTEM INSIALLER PROJECT MANAGEMENT OBLIGATIONS
As the NoxthAndover licensed installer for the construction for the septic system for the property at:
(Address of septic system) Fox plans by
(Engineer)
Relative to the application of -Q-A-"
(InstaUer'sname) And dated
Ungina at
Dated AUe
te With revisions dated -
o ay s(ate) (Last revised date)
I understand the following obligations for managemen of this project,:,
1. As the installer, I am obligated to obtain all permits and'Board of Heal -1 approved plan,, at riot to
d thel
performing any work on a site. I h- ennit on site when any work is
niusil /Ve the roved' , an_aq-t-tiel�12
being done.
2. As the installer, I must call for any a all inspections.ections. If bow
ie�6 n,,,., contractor, project manager, or any
p trie wnek
other person not associated with ft c6many schedrdes an� p ills �, on n and the system is not ready, the
item three shall be applicable.
'ess�ary work c leted prior to e -able inspections as
3. As the installer,I am required to have the ne
indicated below. 1 understand that re Iles ecti out Como e f e texas,in accordance
an W,
or
with Title 5 and the Board of Health R m e ulattions - tina --
150.00 fine being-le-vi apLu me and/against ----------al------
MY_Compaoflly�
Bottona of Bed n'emlly, tllki�the first inspection unless d4e, is retaining wall,w1rid
ir b
should be done fi t. The installer ust-re, est the in' ection I do6sa t have to be present.
SIN Y
ru fir
, 11 et must firs bn for elevations, ties -c
b. Final __e la
A�'o n It __(itt u c t i 11 isp _�_ction-
ido�,qrtria.g from, the engineer be
As-built�f verbal 1K (or e-mail.to: b aldidept@nordiai
submitted,�t,o the Bo,4,,,K.d of Health, aft t which installer calls for'an ection time. Install st be
in �e
present for this inspection. With a p rip system, all electrical work:mustbe ready and a 111-1 0 cause
,
PUMP to want',and alarm
11astaller must requestinspe( n when
c. Final Grade aria)inis co fete. Installer es not
have to be on sit ,,
4. As theInstaltpr I understa4d that only I :may perform lr)�()o'�Jer than sivil5le excavation am required
to complete the,-installation of the system identified in the attacbe4�application r instal n. I filither.
all r n ) e can constitute
understand�di-ft-two-11AAQae bylgthers unlicensed--toin,all septicc-Ustews .11
reasons for denial.,of the U` �stqW)qa I A�®r reyocation ,tST1)C11,, n of my license to o ratin the Town of
North And nt fisle�s �11: Dus M' VO I a_ alsossible.
�!(_ , invo [lie following construction.
5. As the installer, I understand that I nest be on-site du the per ance
steps:
a, Detennination that the pi-opet elevation of the excava� .bras teacbed,
b. III sp e c tion of the sated and store to be used.
c. Final inspection by Boafd ofHealth staff or coil s altaP t
d. InstaRation of tan1k, D-Box,pipes, stone, vent,pump cbam&�tetaining wall and other
components.
6. As the installer,I understand that I a 9 responsible or. the—installation-of—the system—a-s-.petthe
--m- _L_
Ap _--eTgeneral _)ntraq� absolve
L�_qd plans. No _pc -pegs
instructions by�Ilc homeown solLs shall-absolve
ring
me of this QUIgalure,
Undersigned Licensed Septic Installer:
(Today's Date)
(Name-Print) "a e
yb R7M
ti io
Town of North Andover
HEALTH DEPARTMENT
�SSACKUS
CHECK 4: DATE:
LOCATION: 77-
H/O NAME:
CONTRACTOR NAME: R
Type of Permit or License: (Check box)
❑ Animal $
❑ Body Ail Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Set-rice-Type:-.---. � $
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
❑ Suit tanning $
❑ Swimming Pool $
❑ Tobacco $ --
❑ Trash/Solid Waste Hauler $
❑ Well Construction $ -
SEPTIC Austents:
Septic«Soil Test°ittg $
❑ Septic Design Approrral $
Septic Disposal Works Construction( C)
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
❑ Other;(Indicate),w $
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Healih"Agent Initials
White-Applicant Yellow-health Piny-Treasurer