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HomeMy WebLinkAbout- Permits - 500 REA STREET 3/20/2019 i i • �r w�, Commonwealth of Massachusetts Map-Block-Lot 038.00315 BOARD OF HEALTH Permit Na Borth Andover BHP 2019-0020 P.I. FEE F.I. $175.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted _Todd Bateson to(Construct)an Individual Sewage Disposal System. at No 500 REA STREET as shown on the application for Disposal Works Construction Permit No. to March 2 ]. d�m Issued On: Mar-20-2019 BOARD OF HEALTH I � Application for Septic Disposal System TODAY'S DATA Construction Permit - TOWN OF �~�, $350.00-Full Repair NORTH AA�NDOVER3 MA �1�4.� $175.00-Component i I Important: Application is hereby made fo_r_a permit to: When filling out ❑Construct a now on-site sewage disposal system- ;I forms the computer, r,use ❑Repair or replace an existing on-site sewage disposal system"" only the tab key ®R"epair or replace an existing system component—What? ^ { to move your cursor-do not �� `P use the return A. Facility Information r - key. J fI c 7 ?! Address or Lot# City/Town 2.-*TYPE OF SEPTIC SYSTEM*. � ➢ ❑ Pump Unravity(choose one) ***If pump system, attach copy of electrical permit to application*** 9 ❑Conventional 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) > []Pressure Dosed(D-Box Present)S.A.S. ➢ ©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) Wbatls theMakeP WbatIs the Model? 2. Owner Information Name � Address(if different from above) „ -• City/Town State Zip Code Email address Telephone Number 3. Installer Information / Name ---- Name o µ � - RENTERPRISES, INC. Address - — DOVER, MAC 01$14 A " City/Town State Zip Code Telephone Number(Ceti Phone#d possible please) 4. Designer Information Name Name of Company ----- ----- -- -- - — Address City/Town _ State Zip Cade Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 Application for Septic Disposal System 3 .._._.dam TODAY'S DATE Construction Permit -- TOWN OF $350.00-Full Repair NORTH ANDOVE& MA 01845 $175 00-Component PAGE 2 OF 2 A. Facility Information continued. 5. Type of Building: [BResidential Dwelling or C]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 Andover. 1 understand that until a final Certificate of Compliance has been issued by this Board of Heal h, the installed system is not approved. Name .',", Date Applic n Ap v tl By: (Board of Health Representative) Name -.. Date Application Disapproved for the following reasons: For office Use Oniy: 1. Fee Attached. Yes - No s 2. Project Manager Obligation Form Attached. Yes No 3. Pump System? Ifso,Attach copy ofElectdcal Permit Yes No Applicant received copy of "E'lectricalInspection Notes for Septic Systems" Yes No Handout? 4. Reviewed approwdletter, aUpaperworkreceived? Yes Na Mr`ssrng.° 5. Foundation As Built?(new construction only). Yes No (Same scale as approved plan) 6. 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: (,Odds c x.ti of��m p ic.sy< ctn) For plans by ec Relative to the application of'—""~_M/c9eVIVj :� ('f ist Her's name) And dated � at��s st 3c Dated .... l� r�day's ci deb With revisions elated a�rax n.a st revised datcb I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of I-lealth approved plans por to performing any work on a site. I must have the-,a proved plans and the Dermit on site when any work is being done. 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 requesting an inspeconr,without completion of the items in accordance with'Title 5_and the Board of Health Itegulatica is may i.esult in a$50.00 fine,.being levied against me and/or my company. a. Bottom_Qf Bcd—Generally, this is the first(1') inspection unless there is a retaining wall,which should be done first. 'I'lre installer must request the inspection but does not have to be present. b. Final Construction Ins ection—Engineer must first do their inspection for elevations,ties, etc. As-built of verbal.OK (or e-mail to: f eall.9ltcic�%t.ist�t ����_��>i;�t.�r.�iaw<tamta�ca�r�,.E >�i�) 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 purnp 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 (other than siirrple 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 septic systems in North Andover can constitute reasons for denial of the system and/or revocation aat_suspension of my license to operate in the Town of North Andover, significant fines to all persons rnvolyed ar~e. also laossible. 5. As the installer,I 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 solely responsible for the installation of the system as per the a.moved plans. No instructionsby the homeo ner,gener I contractor,or any other per_sc>rzs shall absolve me of this obligation. 1 Llndersi},med Licensed Septic Installer: ("1 oday`"s 1)alv) 1 TF