HomeMy WebLinkAbout- Permits - 31 BRIDGES LANE 5/7/2019 .......................... ........... .........
Commonwealth of Massachusetts Map-Block-Lot
0,121'
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BOARD OF HEALTH Permit No
North Al -BH 11 P-2,019-00 97
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P.I.
F EE
.1 $�1 75,00
DISPOSAL WORKS CONSTRUCTION
Per mIssion is hereby granted Todd Bateson
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to(Construct)an Individual Sewage Disposal System.
at No 3 1 BRIDGES
LANE
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as shown on the application for Disposal Works Construction Permit No., B -0097
t
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Issued On:May-02-2019
--------------- ----------- BOARD OF H'EAI,,,,TH
u,
.a. sal System �
:ic
V Afor Se 'S DATE
f,y;� ij Njai
— TOWN (0
Constructmon, emit
3F.
I
i
$350-010 Fulliir
R X U,
NORTH, ANDO"111M 0,18,45
$175.00 Component
Important: Application anew made for rat
When Ilion out 0 Construct a new on-site sewage disposal star
forms on the F] Re air or replace,an existing,on-site sewage disposal system*
computer,use 00p
only the tabcomponentwY �
W�Repalr r replace are existing system ham W
to move your t
amityinformation use the returCursor-do not, RECEIVED
key
Address or Lot
1V14 ht,c0o v
,
r^
1
f
«
,. GJJJfNI '
*TYPEI Y :
um G rlt (choose one)
** pump s item, attach copy of electfical permit to application"
nventiona System (pipe and store system)[
Infiltrator or 1361odiffuser(Gravel-Less) , copy of your ceilification to install this type Of system.)
0,Pressure Distribution S.A.S. -Box)
L]Pressure D -Box "resent),S.A.S.,
Does the system require an effluent filter? Yes N
If yes,, does plan specifymake and model of filler? YES further 1a
NO�(installer mist specify brand of filter before DWC issuance)
What i the , Me el
2. Owner Information ation µ
�m
5
Name
Address of i from above
State ,dip Code
Email address Telephone Number
3 Installer Information
Name Nam*AYMN ENMRPRISES, INC.
lull
glow
Address ANDOVER MA 01810
_.
City/Town State Zip Code
Telephone,Number(Ceff Phone#if po"iblelease
0 Designer Information
Name Name of Company
Address
ityfTown State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Kermit Page 1, of 2
4
9�
�� .i Niaum
site Disposal Appfication for
r 'S DATE
Construction
$350.00 Full Repair
NORTH ANDuVE, MA 01845 $175.00-Component,
PAGE 2 OF 2
A, Facility Information
00
1
Type of Bufld'lng: lentil l[welling or ElCornmerdial
B, Agreement
The undersigned agrees to ensurethe,construction and maintenance of the afore-described
on-site sewage,disposal system In ice with the provisions of Title 5 of the
Environmental Code,as well as the Local Subsurface os Regulations for the Town of
North Andover. I understand that until a final Certificate of Compliance has been issued
by
this Boa , the Installed system s not approved
Name Cate
(BoardHealth sea
Date
Application Disapproved for the following reasons*
g°�„�,�,r.9x r,�m �PeN�J r �n�✓�x':u�^NG IF/W°I/fidvl'nW mm��umu�Xu la'i'r�fVili4AN/JN�R�'�m�ru�ruml�oW�MNGIIG kTAP��d��am�P.!Wmmii�pwNlVfW� '.T� 9s�W'.o�F�9.�NlMFI&IFAARMM2ru�ryM'RM1wYO����Q�M�"!Poi�IIWlimwm�wmr wM9egMSw�LOUIIrWNNWN�Y M^Y�'iNre�mm R'rr��wwuri�l,.BJBI�. r v
For Office Use Oni
Fee Attached?
2, Project Manager� " fi adore Form Attached? ,� N
eml Attach
" � �� pelt Ye S
Afca ece d copy of
Wta Inspector Notes for Septa,Systems Yes N
Handout?
Reviewedapprowdlettezo aB k received? Ye
`9. F un adon As- ufl eve Construction only): V N
(Same,scale as appan
6. Floor Plans?(new construction � , .
c
Application for Disposal System construction t Page
t
SEPTIC SYSTEM INSTALLED PROJECT,MANAGEMENT OBLIGATIONS
,,As the NorthAndover licensed installer for the construction for the septic system, for the property t:
aR�
-�3
n
A!ILI" &\
For
lans by
w W. 1
girii et,
r
Relative to the application14
And dated17
�y
. ,
Dated
With revisions dated
S )t
ro
l
I understand "
the � w, g obligations for gm of thi
s pje
1. As the installer,I � obligated t� t� all + f=t and Board f 1 approved la to
���
' � lames and tl�
performing any wore . site. I must have ����� � t�� � � �
done.
2. As th l: t Uer must cal for any and ill inspections. If hmeow er contractor,project manager, or any
other person not associated,with,my,companyschedules an inspect-ion and the system is not ready, then
item,three shy e applicable.
: . As the installer I am,required to have the necessary wore completed prior to the ppl c l -inspections as
� � � n ins� � .trout com l tion of the items accordance
indh Title 5 and the Beard of Health RegnIations inav result in a$50,00 fine beina levied a inst me and
my n .�
a. , off"Bed G ll this, � �� inspection
shouldone first. Ili installer east request i s s not have to be present.
1 . FM* al Construction nsiDec i — ii
As-built of wal OK e-mail(or � � .) w� ,ii do ve from theengineer�inust
be submitted to the Board of --1 alth,aft :which installer alls for an inspection titne. installer must
be present for this inspection. With a pumpsystem,all electrical work must be ready and able
causepump' to workand alarm to function.
. Peal Grade—Installer must requestinspection when grading is complete. Installer deer not
have to be on-site.
the installerlI understand that only may p r r the work r 10ali simple ;cavat t)and r required
to completethe ` t ton of the t identified in the tt h ,application r in
" stallation. T ftirther
'understand that work donebv others tuflicensed to install sq)fic systems in North Andover can constitute
d
reasons � denial of tl j st or r vocau: Q s sl y,o 1� s t rat tie:" " po f
t ha i i t t i ns h of e a� also possible.
v
. As the installer I understandthat l mast on-site during,the performance the llowuiconstruction
steps:
. in that h p elevation h x t � .
. Inspection of the ,sand and stone to be, used.,
tank,c. Final inspection by Board of'Healtb staff or consultant., retaining wall and otber
d. Installation of x p stone., ventjPump ebamber
components.
6
the st r •st ,� that l �. nsi l fors tie nst ,,tign �: the: system a �the. As instructions
ersons� absolve
me of this t1on.
' 1 ed Ticen,sed Septic Installer
..Nnu w,..,..
a
_ Art Establishnient