HomeMy WebLinkAbout- Permits - 339 ABBOTT STREET 5/14/2019 W9101WI9.. iWWWWWWW@IW�i9... WW19WI�1WWWOIMl9 WI6tlWWWIWIV.IWWtl. �uwmak. -.aruluu«wmwru�n+ crp�krklurori IW1IXWIpWWeYW WWWI1IIdW17WWWk WWWW1AGWqu01kIWIN... ek�nlwnuawWl�WW �WIWWWW7WWWWWW 9WWWf4kWpWUpWI�W WIWRO� WWWWp � NWWWWWW6'SWWY.. IWWWWIWAIWIWIu ewkwnarumakCuaarm urwurwunn�r..�,.
M Blocky-Lot
0, Commonwealth of Massachusetts
000�89
BU
ARC * HEALTH . _Pennit o__ _ _mm__mm.
FEE
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-----------------------
EONSPOSAL WORKS (,",*�*ONSTRUCTION .
PERMIT
Permission is hereby granted Todd ates n
to(Construct) n Individual Sewage Disposal System.
at No 3 ABTT STREET
as shown on the application for Disposal Works Construction Permit No B - 11 atMa. 1 , 1
ssued n �� - -� 1� BOARD Off"HE TH
sal S em
Agplication Tor Septic Dispo
TODAY'S DATE
construction Perot - TowN, OF
pNORTH ANDOVER, MA 01845 $175.00 Component
$3,501. Full Rear
Impotent: Aa i*shereby ade ror a Rermlt
When filling out l
forms,on the
computer,use 0,Repak or replace «s ing on-sifte sewage dilsposalsystem*
only the tab key
� � r a a or r replace lstl systemone at
cursoir-do not
use the return A. Facillity Information3 "3
fe lrro
AiV
w /
, b
p
Address or Lot
OA,o o 0 f-
Cityrrown A,
*TYPEf,
.=a 2 F SEPTIC SYSTEM . �J
O Pump 01di0wfity(chose ore)
U SYS e ,attach copy e ec ca i a id io *
�v il s (pipe and stone system)
Infiltrator r �a sir(Gravel-Less) ach a copy of your c rtifica on to install this type of system.)
Pressure 1strr uion
Pressure Dose sent)S.A.S.
Does the system require an effluent filter? Yes No
If yes., does plan specify make,and model of filter? YES (n�o further info.needed)
NO installer must specify brand of filter before DWC lfssu ce)
mat t*s the Make? What Is the Model?
2. Owner Information
partake^
Address if different from above)
City/Town State Zip Code
�.
Email)address Telephone Number
3. Installer Information
PS4,� El
w d
Name Name of*"09P%Jq'V=N I WWRIbE51 INCo
!!4 ', 1 (00, ARGILIA,H-OAD
,addresMDOVER; MA 01810
s
'.
City[Town State Zip Code
µ
Telephone Number(Ceft Phone#if possible ple"e
'. Desimer Information
t,\
Name Name of Company
Address
Cityfrown State Zip Cod
Telephone l one Number(Best#toReach)
Application for Disposal System Construction n it Page I of 2
ispos
..........
ys
lication for Se c D al S M te
�owiimwwaw ,.
TODAY S DATE
Constructolon
NORTH ANDOVE NU 01845 $175.00 Component
PAGE 2 OF 2
ELAF
IV
A. Faci*li*lly,,,,,,,,I,'nformat"ion co inued.,...
Type of B�u dImMU114esidential Dwelll' g or UC mmercial':����
B,. Agreement
The,undersigned ages to ensure the co� s act n and maintenance of the afore-described
on-.site sewage disposal system f accordance with the provisions of Title 5 of the
En VI A Code aswell as the Local Subsurface Disposal Regulations for the Town of
North Andover. I understand that until a final Certificate �f Compliance has been issued by
this oa � understandhY the installed system is not approved.,
Name Date
iw
AppliVI' n A riby d, By.- (Board of Health Representative)
d
Name I Date
Application 131sa � ve for the following reasons.*
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For Office Use On.
1. Fee Attached? Ye Sol I No
2. Project Manager ObYgadon Form Attached? Yes No�
3. EM tem " If so,Attach gppv ofEleettical Peet Yes N 01°
Applicant receive o
"Electiical InspectionHandout? 00100000"OYes No
4. Reviewed approval leter, a9paperwork received? �
5. Foundation As (new construction, only).- es 0
p �..
(Same,kale as ap ovedp an)�
Floor6.
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:
32 c�- b 6
( L,IVS, IMIC gc I C111,10 For plans by
i,kci i S jl�,S 11 1.31
ee;�w
................Relative to the ap lication of
P
And dated
Dated
(Tic)da4i,", dat e,,)' With revisions,dated
(']""'Ast eviselilf".111, i,"e)
1 understand the foffowm* g obligations for management of this projecto
1 As, the installer, I am obligated to obtain all permits and Board of Health rove ap to
pd plans pii r o
performing any work,on a site. I must have the an d.plans and ffiepe=t on site whep 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 ass oc.ate ct 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
i wi i-I ndicated below. I understand that reaue sting an insoection th out comnletion or the items in accordance
-with Title 5 and the Board,of Health RegWgtLions mav result in a$50.00 fine be levied aeainst me and
mv CO=
.1 A.
a. Bottom of Bed—Generally,this is the first(V) inspection unless there is a retau*n*ng waft,which
should be done first. The installer must request the *inspection but does not have to be present.
b. Final Construction Inspection—r-,Angineer must first do their inspection for elevations,,,ties, etc.
As-built of verbal O�K
(Or e-mail to: I'd,, w,',yr(- fnortl,,,[�,i nduv-
Ak 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 fiinction.
c. Final Grade—Installer must request inspection when all grading is, complete. Installer does not
have to be on-site.
4. As the installer,,1 understand that only I mayperform. the work(of than simple 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 bv others unice d to install,septic systems in North Andover can constitute
reasons, for denial of the.systern and/o�r revocation or sus erasion of My license to o crate in the"fown of
P
North Andover sianificant fines to all persons,involved are also'Dossible.
0 *�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 bas been reached.
b. Inspection oftbe sand and stone to be msed.
c. Final i s n pection by Board of Health staff or consmitant.
d. Installation of tank, D-Boxpipes, stone, vent,pmmp ebamber, retaining wall and other
components.,
6,. As the installer...1 understand that I am sole y.-Te,sp ores ible for the installation of the_astem as_per the
at)moved plans.--- No instructions by th,e homeowner. general co,ntractoL,,or anv other,versons shall absolve
X_1111A11 I'll,'A.
me of this obiMro
,ation.
'Undersigned licensed Septic Installer-. (',rod,zl ,s I at,e)Y
00
(Mme will.. t--'
00
,4,4 ft 0 fey
Town of North Andover
**Too HEALTH DEPARTME'NT
SACHU
DAT "y
ell,............. tW
7'
LOCATION.,
/ Ja
00V_Z2
H/O N�AME.
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CONTRACTOR NAME
J,
Ty J
pe of'Perm"'t or License,,,(Check box)
0 Animal $
• Body Art,Establishment
• Body Art Practitioner
0 Dumpster
0 Food Senike-Type.-
0 Funeral Directors $
0 Massage Establishment $
0 Massage Practice $
0 Offal(Septic)Hauler
0 Recreational Camp $
0 Sun tanning
0 Swimming Pool
11 Tobacco $
01
11 TrashlSolid Waste Hauley
13 Well Constniction $
SEP77C Systems',.,
0 SepticTesting
0 Septic-Des* Approlv�ail $
Ign
Septic Disposal Works Constmction WWC)
Septic Disposa Works Installers(DM) $
J
0 Title 5 Inspector $
13 Title 51 Report
0 Other.-(Indicate) $
J,
Ifea"if gen t Ini'tia Is"
White-Applicant Yellow-Health Pink-Treasurer
/////,."",., ,-,.; l/,M"�".�,,,,�................sir ..................