HomeMy WebLinkAbout- Permits - 2 BANNAN DRIVE 12/5/2018 ...................... ----------- — — --—---- ----------- ............... .. ............. ..............
Commonwealth of Massachusetts Map-Block-Lot
038.00104
BOARD OF HEALTH Permit No
North Andover 11 BH-P-.20-18.-08-24
FEE"
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted James Kellett
to(Construct)an Individual Sewage Disposal System.
at No -2-BANNAN.P-RIVE-1-1. - --- -- ----- 2018
' -
as shown on the application for Disposal Works Construction Permit No. BHP-201!!o ated ee��
Issued.On: Dec-05-2018 BOARD OF HEALTH
Application for Septic Disposal System De <-, /z
I ODAY'S DATE
Construction Permit — TOWN OF
1-1$360.00-Full Repair
NORTH ANDOVER, MA 01845 $176.00-Component
IF:C E
Important: Application is hereby made for a permit to:
When filling out F1 Construct a new on-site sewage disposal system*
forms on the
computer,use 1V Repair or replace an existing on-site sewage disposal system* TOW
only the tab key E]Repair or replace an existing system component—What? N OF NDR,-I H ANDOVER
cursor-d
to move yo not our HeAtrn DEf"ARTMEN]"
use the return A. Facility Information
key. W A'4 V e-
BA
Address or............. ......_'
/Z—
City/Town
2.-*TYPE OF SEPTIC SYSTEM*:
> E]Pump AGravity(choose one)
***If pump s stem, attach copy of electrical permit to application"*
Conventional System (pipe and stone system)
❑Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.)
> E] Pressure Distribution S.A.S.(No D-Box)
> E]Pressure Dosed(D.Box Present)S.A.S.
[I 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)
What is the IMatis the Modc1P __
2. Owner Information
Name
Address(if different from above)
,A1_- A-4—a-151
City/Town State Zip Code
Email address Telephone Number
3. Installer Information
A
Name Name of Company
Address
City own State Zip Code
Telephone Number(Call Phone#if possible 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 I of 2
AIMApplication for Septic Disposal System pCz:, e-f , �o I
TODAYS DAT5
Construction Permit — TOWN OF
$350.00-Full Repair
NORTH ANDOVER. MA 01845 $175.00-Component
PAGE 2 OF 2
A. Facility Information continued....
S. Type of Building:XResidential Dwelling or FjComrnercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of
North Andover. I understand that until a final Certificate of Compliance has been issued by
this Board of Health, the inslll,d system is not approved
c 2�o t
Date
Ap li ationproved By oardal resena 01
N,Pme 'A Date
Application Disapproved for the f6l] wing reasons:
For Office Use Only:
1. Fee Attached? yes NaX
2. Project Manager OhKgation Form Attached? Yes-V-1, Na_
3. Pump S Yes P Ifso,Attach copy ofElectrical Permit Nq�(
Applicant received copy of
"Electrical Inspection Notes for Septic Systems" yes No X
Handout?
4. Reviewed approval letter, all paperwork received? es No
1�,C W16 r
5, Foundation As-Built?(new construction only): yes No
(Same scale as approved plan)
G. Floor Plans?(new construction only): Yes No
Application for Disposal System Construction Permit-Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
,2 13.A"tV 4 N Pa�k V6- For plans by ?A1 a4ft$
(Addross of'septic systent)
Relative to the applica6on of _J_A ;�i 6S
And dated J V
Dated D
(I May's date) With revisions dated
I understand the following obligations for management of this project:
I. As the installer,I am obligated to obtain all permits and Board of Health approved plans p6oar to
perforn-iing any work on a site. I must have the approved phies and the 12ermit on site when an;,,work is
being done.
1 As the installer,1 must call for any and all inspections. If homeowner,contractor,project manager,or any
other person not associated Nvith 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 rc�an nspection."Vithout corrip_L -letion of the items in accordance
with Title 5 and thC_Iioard of I-lealtli Re ilations ma result in a$50.00 fine being levied aanst me and/or
rn,V company.
a. Bottom of Bed-Generally,this is the first (V) inspection unless there is a retaining wall,which
should be done first. 'I'lie installer must request the inspection but does not have to be present.
b. Final Construction Inspection-En homer must first do their inspection for elevations,ties, etc.
As-built of verbal OK (or e-mail to: 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 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 (olberlhansbzple excavalion)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 septic systems in North Andover can constitute:
reasons for denial of the system and/or revocation or suspension of m license to operate in the Town o
North Andover, significant fines to all persons involved are also possible.
5. As the installer, . 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 solel,, responsible for the installation of the syst.em as per the
approved 1ans. No instructions by the homeowner, general contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licens(-.4d Septic Installer: C_ -44 2-0 1 A> (Todag"s Dila!)
6 _r
K-
_('R_arnc 11rint) (Nae.r-Signed)