HomeMy WebLinkAbout- Permits - 115 COLONIAL AVENUE 5/15/2019 r
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BOARD OF HEALTH
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Permit
r { North Andover BHP-201191-0084
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LJISPOSAL WORKS
Permission.is hereby granteld, Todd Bateson
t + tr t Individual Sews„go Disposal system. i
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t No 115 COLONIAL AVENUE
as shown,ort the pli .tion for Disposal Works Cowtruiction,Permit No", - D t pril�
Issued
_ BOARD OF HEALTH
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S snos yst�e ........
ti on for c Di al S M
Aoplica
TODAY'S DATE
Construction Perm1mit TOWN OF
A $350-100-Full Repair
NORTH ANDOVEIM MA 01845 $175.010-Component
r a permit to:
Important: App lic ation is herSb made fb
ite ewage dspoal *
When filling out Construct a new on-st s i s system
forms on the,
puter,
Cj Re or or replace an existing,on-site sewage disposal system*
com use
only the tab Re key pair or replace an existing system component—What?
to,move your V it,
cursor-do not
use the return A. Facility iniformation
key.
Address or Lot#
RE
City[Town, �A'
2.,-*TYPE OF SEPM SYSTEM*:El Pump M;5-ravity(choose one) owg 01- "Tmgl N"T'
pu M. attach copy of electrical permit to application*** �a P0 j'��
> mUronv�,,nflonal System(pipe and stone,system) n to install this type of system.)
> [] Infiltrator or,Bilodift ser(Gravel-Less) (Attach a copy e
of your crtificatio
> '0 Pressure Distribution S.A.S.,(No D-Box),
> Ej Pressure Dosed(D-Box Present)S.A.S.
> E] Does the system require an effluent filter? Yes Nq�
If yes, does plan specify make and model of Mter? YES�(no further info. needed)
J�,NO C issance), (installer must specify brand of fil u
ter before DW
Wy &e Made]?
What is the Make?
2. Owner Information
Name
Zo j A
Address it different from above!)
CityfTown State Zip Code
Telephone Number
Email address
I Installer Information
Name,0 NM, u*E"e Name 140o--
11,ARM"ROAD,
ht�' Ro IM 01810
Address
State Z,ip Code
CityfTown q1)�( �e 4 4
Telephone Number(Ceff Phone#if possible please)
4. Desiqner Informatiqn..
Name Name of Company.
Address
Cityffown State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal,System Construction Permit 9 Page I olf 2
o"dicau Ap0 for �esposell.... w `S DATE
Uonstruct, on Permit — ,I kjV/N %j F
$350.00, Full Repak
uizs45 N 0 RT ri AiN,jj OVE R NU
• Component
f
f
PAGE 2 OF 2
A. Facil formation cont' nue
11001'
Type of
l
..
r
Bull esidential Dwelling or[:]commercial
B. Agreement
i
undersignedThe
reel to ensurethe construction and maintenance of the afore-described
-site sewage disposal system 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 finer Certificate of Compliance has been issued by
this Board f'ealth, the installed system, s not approved.
t
a WMIIIII.
nm
Date
A lira i : oar of'Health �r son a
Nam Oahe
Applies ion Di approved for thefoRowing reasons.
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For office Use
p+��rr.,vi„�wfird�;,Y .�d nardinW all M,rn Jr�r''¢.n3,,,.4 rruw.rNru,; n�r�NJr„uW^am�Yiu.MmmVdYlWri�mpul'G"GUmiirnwn„�Mo�nIIG Y�KKi'Jtl6'Xlrfi/�RYi/d' wmwvm.'"liflN Wh'M!RY'Fw tlMMPRvmm�,wFiWF9"GdIIRYVMtRN m/YIM"mi4nnY" 'k'�Y'mv�tlFSr-0JWY3vum� �.�iNlar9H1Po11iIC✓IffM19Wr;nrv9'dUn"'vmeil,rtr✓�I Y'r//M1� - � I ..
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1. Fee
N
2, Prqject.Mana Ohffgation Form Attached
3. S s m S Attach� fE c ic e t Y — . .—
pfcan ° ived copy of
,"Wiectdcal.Inspection Notes for Septic Sys s" Yet
Handout?
, . Reviewed approval lettex, al(paperworkrecelved? Yes No
iSSM
.5, . ,�(new suc only); Vey
(Same scales p p )
No
. Ft Mans il(new construction only) Yes
pliGation for Disposal System Construction Pen-ni�t-Page 2 of 2
W
SEPTIC SYSTEM INSTALLER PROJECT NAG ENT OBLIGAT IONS
As the North Andover licensed installer for ffie construction for the septic system for the property at
40 01-liee4 J_ 19'11'.e
For plan by
Relative to the application of
. And dated
Dated
Withrevisions at
understandthe followling onfigations,for management o this project:
.. the in t r,, l at t obtain all t and Board ... 1� � is
�� t
* k.g any work n a site. must st -ov ans and t o r "t on site when any wo,rk
2. As the illstaller,, east cal for any and 1 s ti(,)ns. If homeowner contractor,project manager, or any
other person not associated with my,company schedules an inspection and the system not ready, thin
item,th-ree shall be applicable.
3. A the n t� am, r� ui t - t . necessary wok et � t .thy � inspections
as
Indicated e o w. understand that r Westin n ins ti ith t m letio t �� � �
� t t� � d k t �Re �d n ma � es, fibs i� � � d � t �: .
my comoany.
. Botts Generally,t the Est (P) i .ti n, unless. there is a retaniuing wall,which
should e done first., is .staUer'must request the inspection but does not have to be present.
b* Final Construction Ids eCt+ — n e m. u t first their,inspection. r elevations,ties, etc.
engineer
As-built of verbal OK (or e-mad
�f' ortlian(""Ioverx n from the
„w , .. , w .w W„
be submitted to the Boardf Health after which installerfor ani,nspection time., I nstaller must
be present,for,this,inspection. With a pumpstem,aU el ctrical wore mush b ready mid able to
cause pump to wore �nd alarm to function.
. FM* al Grade Installer m , t equest inspection when. all,grading is complete. Installer does not
have t -site.
the that only,I may p r �u the work , . ,r tbait shvple excapatim)and I am required
to completethe installation o the system identified.in the attacheld apt 'cation forinstaflation. 11 further
understandthat vor one t t � � d � t t ��rt v � st t t
reasons for deffl'al.of t�e tre�vogati,o , e t grate .the Town of
North Andover i ' c t . es to all arsons mvolved are also Dossible.
. As the installer,I understand that I east be pan-site during the performance of the following t t. .
steps:
., DeterMination that the proper elevation of the excavation bs been r ..
b. In,spectian ofh sand and stone to be used.,
c. Final inspection y Board of Health s �`or consuira
Installationd. i
pes, stone, gent,pum 1 camber, retaining wall and o b r
Components. e as,t)er the
6. As t installer er I understand that I olel. � . . for tin. t� t d ii t t
_ .
am)roved olans. No tr homeo; a
ns shall absolve
me of this bli*
Undersigned �� d Septic:Installer:
„ "'i t
SignLe.,
V
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t% RTi
y 90 04, ",
Town of'North'An'dover
HEALTH, DEPA1,rfMENT
'ATIro _
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LOCATIONjjj
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H'/0 NAME: "," ",J(,',/W"/./
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CONTRACTOR NAME: S Ll
al
Type of Permit or s Cie b ,
Animal
;t
El
BoidyArt EstablishinentN
Body Art
umps w
11 Food Service T yew
FuneralDirectors $� �
w
Establishment0 Massage
i
Massage Practice
i
El Offal
(Septic) au
Recreational n Catnp
0 Sun tanning
swimming Poo
I
I
Tobacco "
TrasIVSolid Waste Hauler
Well Constriiction
I
SEPTIC System
h
Soil Testing
Of m
w r� for
Septic n Approval $
'Septic,Disposal'W,brks C l s uctin C
C] Septic Disposal Works Installers °
0 Title 5 Inspector
Title 5.Report
Other:Undfc
"gib I
He
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thAgent Initials
White,-Applicant Yellow-Health
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