HomeMy WebLinkAbout- Permits - 540 SHARPNERS POND ROAD 5/28/2019 C we It o � �
I
B'OARD OF HEALTH
Permit N
Nosh Andover BHP- 1 - � 2 'c
I i it FEE,
$175, ..
DISPOSAL WORKS CONSTRUCTION PERMI'T'
J r,� i
Permission' hereby granted, DynanV
1
to(construct) �
n.Individual Sewage Disposal,system.
at No 540 SHARPNERS POND ROAD
p I 'isposa 0
as shown on,
e a plication for Di W rks Construction Permit No. BHP- 1 "
�Issr May-231-2
t
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f
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C ?�PPJM
teation for tie Ic sl $ystem
TO �r�
Construction Permit — TOWN OF
$35 w00 Ftjl Repair
i
NORTH ANDOV-ER,4-MA
O1845 5. Goy onset
Important, Application Jis hereby Made for L .
when filling,out Gonstruct a,now ors-s to sewage disposal system*
forms on the
MpU r,USe Repair or rep lacexi g on-site sewage disposal s s
te
only l n
to move your l
cursor-do not
A. FaGilityl formation
use the ret�urn
key. 0
Address or Lot
IA I
City/Town
J'TYPE OF ,
2.
SEPTIC SYST
,F
Pump Gravity G Se one)
V
tem,attach copy electrical permit l
)> nven i l System (pipe and stone system)
I nfiltr or r iodif'user G ��-Less)(Attach copy our c i s i �� t;�o system.)
-Press'Ure Dist0bution S.A.S.(W -Box)
. + � � � " Yes_ No
ff s, does plan specify make an d'rno deli r"? YES r th r lanfol. needed)
(installer must specie d offilter before C issuance)
th A&L- M c Mod&
2Owner Information
Name
Address di eren m above)
Ci Mate Zip Code
r7o
law
Ern if address Telephone Nnwnnlnb r
-
3. Installer Information
rrn e Name of Company
don
00017 /1 6/0
fit n State Zip Code
Telephone Number(Cell Phone#ifposslble please)
4. Designer Information
Name Name of rll-Imp;ir�
Address
Gtyc Mate dip,Cede
Telephone Number(Best�f to Reach)
Application for Disposal System Construcflon Pennit,Fags i of 2
N
-I,r �«
8p2ficationZ,
for r
T a `�°
Cnscin PeOF
rmi
TOWN
$350-00 Full Repair
MA NORTHANDOVE''.
01.845 $175.00 Crin
PAGE 2, OF 2
A., Fadflity InformationGOn tin u led'.x x x
5. Type of Buil OResidential Dwelling or E]Comrnerclal
B. Agreement
The Uel afire ensure the construction and Maintenance � b
ed'
sewage � � in accordance with � IS Title
Err s well a,s the Local Subsurface Disposal Regulations for the Town of
final Certificate C l has been issued b
North A, r., I derstand tha u ai' l the ins,, e to is n o,t appro Ve d.
00� 1 09
Date
"
Ap l cat
p r o,, E3 and Representative)
sei
e"
w:u
Namile
Date
Applica lon Disapprovedfor the fallowing reasons:
For OffiGO Use OnhL.
Y N -
' � �� Yes
tofect maw g g ...,
t o p e Notes for Septic s NO
Ha do U
4. Reviewed apf . w ,. tt llpP . * elve Yes NQ---
d
Nisce .
9. n Ow c ns c only): Yes N
(Slalme Scaasapp-tovedpjav)
Fjoof (new construction only). Yes No
Application for Disposal System construction rmi .Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer fp(,)- he t tl t. �*the septic system for di-e pro,perty t:
F For plans,l�:)y
,.wµ
,r; inert
Relative to the appli,cation.
And dated
77 gi
F-T—na.date)
�Dated
1 s� A t
With t at
understand the following li gat Ii ons for m ti g t.ent of this project:
1 As theiristafler I am obligatedto obtain i�. all permits � Board f mm lth approved plans,prior t
performi
ng ��.y work.o itw _ must have, �
o
rove(L .l. .tand tie te when any w�.~1:�.�
eina done.
ALlIx
2. As the i l t ller lrnulst ems. for any andall inspections. If hotneowner,, contractor, project manager,or
t t-person not associated with my company schedules ninspection and the system is riot r d l) then
Item three sha'11 be applicable.
3. As the instatter., I am requircd, to have the necessary work completed prior to the applicable inspections
indicated be.l. . I underst.andthat w tinaan insnection wtfli u t Comoletion of the items in rdance
k. f e to Regulations s mg,.y e 1t g .0 fie b 1 le' to 'i&y me t� I �,
Ott t� ar.
m. y ot .
. tom, f BedGenerally, this is the,fist V inspection .le there is a reta,ming wall,which
should done fist, The installer must request the 'inspection budoes not have to be present.,
b. Final Construction
must, first tl e.7 ins � forelevations� ties, etc.
As-built of verbal OK (or
�. +gry,�qy py+ sWp ^�1y must
^rygI�(r�
�NdltliAc
� n �W'Mm�+.L:M'+w,rJL �: � 1 the engineer d�1,1'�.�M,"6.St
e submitted.to the Board of Health, after er-w h Installer calls �for a 'Uon time. Installer must
be present for this inspection. With a pump system,all electrical work must be ready and able to
cause putnp to work and alarm to function.
. Grade -Installer ust request inspection whenall grading icomplete. Installer does,not
have to be on-site.
4
the 1 t ll ~, understandthat ��r I m performthe wok (olber l xca I m required.
. As t complete t t ll tion f the system. identified ..the tuached plication fit*�� t tll t� � tt�� t�
M
understand,that r �. others unlicensedto install fie systems in forth Andover can constitute
reasons for" denial of the system and or revocation or susPension of'mylicense to op,erate in the Town of
North Andovei ant fines to all oersons,i are also 0OSSIble.
5. As the installer, 1. understand that I meat be on-site during t .e pedorm f the l i ng constructAon
steps,
. Determination that the proper elevation of the excavation has been reached.
h. lion of the sand and stone to be used.
c. Fin fi y Board ofHaalth sta�� m/tart.
d. Instal/aHon of , x , stone,, vent, � r,
Components.
. As, theinsta, stallation, ofthe , stem as per the
a.00,roved r)laris. No instructions by the homeow
k
me of thLs,—
Undersigned Licensed Septic Installer.
1
i
(Today s Diate)
7_411111,17le t
a �igte
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'V2011.9-1000012,5,40 SHARPINERS PON'D ROAD Refererlm,e No- Bl"i Plermlit No-. BH"P-201191-01-25
Yi Department,
A] T H
North Andover BOARD OFUlt
Account No., 1001001.1.5.10540.100
Fee Type.-,I)W'C-Co,nipo,11'ent .Repit'it- PERMIT Receipt No", RE G2 0 191-00,03,27
Paid By:
Paid in Full Onw, 17hu May, 23,2019
k N,m m m m w m m w 0 IN w W m m�1,1 1 N I I a M M 11 M ml 11
Dean Dytian
Chieck No,, 2457
R ece ive d' By
iY
wu
"ron"i Wolfenden
Amount
DEPARTMEENT'S COPY $1 75*00
NO ON MEMO m m m m I.w N M WO..1 .1......W.....