HomeMy WebLinkAboutDisposal Works Construcion Permit - Permits - 1520 FOREST STREET EXT 6/4/2019 f
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OARD OHEALTH,/ 5
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Permit No
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BHA'' -0140
Nortn
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ISPOSAL WORKS (0.".*�ONSTRUCTION
PERMIT
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Perini sio s filer filereby granted Peter Breen ________ __.________ _ _ ---___-------- ___
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to(Repair)an Indlividual Sewage Disposal By tes.
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t No 152 S" " STREET
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as shown
n the application for Disposal Works nsh-u ti n Permit No, l 9-� 0
9
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Issued n: Jun-04-2 ,I' ' BOARD 0p' H_E,AI,,T I
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ijeation for Se cDlslno�sial Svstem
DAYS DATE
Constructione
$35 , -Full Repair
0'1845
ANDOVE-jR
NORTH' AM $1,75-00
Component
When filling out C ns r u new on-sifte on-sift sewage di,sposal system*
forms on the � w disposal computer,n I
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only the tab keyonent—What? k
o move Repair "
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cursor,-do not
use the retnrr 1*1ty information
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C.)000019
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Address or Lot
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Dom.. f
A r s
City/Torn
*TYPEF SEPTIC SYSTEM"
dump HGravity(choose one),
ump se ,afta ch r.opy of electrical p envitapplication,
'lGfi on l System (pipe and stone system)
1nfi.1,tratorr o,r R i o diff`irser G Less) (Attach a copy of yo ur,cerfifica tionto Instafl this type of system
PrOSSUre Distrib'ution S.A.S. N -Box)
r'jai' &',RD
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Does the system require an effluent1f r s� — o
If yes, Foes plan specify make and m en lte YES � further� needed)
NO (installer must specify brand of filter before DWC issuancig,
Wais the Model?
M
N
m
Name,
-,4c7)
Address different above)
100-0 -CIL
kl State Zip Cade
City/Town
Email address Telephone Number
,
3. Installer Information
Al .Ya 1 s
Name Name of Company
Ad re,
m
i own State Zip Code
Telephone um ber "Gaff Phon e#rf possible
Designer4. Information
NameName of ompany
Address
State Zip Code 1
J
".Telephone Number( s f to Ruch)
Application for Disposal System Construction Permit Fags 1 of 2
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APPI'm for SepticDisposal
OF
Construction
TOWN-
$3,5 .00-Full Repair
1 AVIA 018�45 -0 Component
NORTH ANDOVEIR-,1-
PAGE 2 OF2
i
., FacilityInformation cont"� a-e .,.., }
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5. Type of Build' esidential Dwelling orE]Commercial
B. Agreement
The undersigned re , s the construction and maintenance afore-described
-site sewage sposa �yste W sionsoTitle 5 e
EnvironmentalCode, as well as the Local slibsurface Disposal R gis for the Town of
North Andover. I un rstandthat until a,final Cerfificate of Compliance has b e issued b
this r a Health, the s Sys s not approved.
' µo 4.
Date
,spill ,App r (Board of Health Representative)
rye
Tate"
,Ai
Application Disapproved fog.the foillowing reasons:
For Office Use Only.,
1. Fee Aff c d
1
2.1
t
1
Fob tabd Yet
3. No
�Steto;l 76 Att h
_,..
Applicaat-received copy of Yes ATo
"Wiect: an cd -0 Notes foJ&Sq SY
i
zuI ,
missing.---
5. F u at o s-P R (new construction only): Yes �..
S me sc,,de,asappfoved 0 plav)l
6 FlooxP a l ew c s u nly)& Yes
Application for DIsposa,I system ConstructIon Permit Page,2 of 2
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0
16- 5, gyp, ' 4-,
SEPTIC SYSTEM INSTALLERPROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed,installer for the.construction for the septic system'. for the property
Zo -6y,"6": For plans by
(Address C)f
w
septic s
Relative to the app.fication.of (Installcr7s tlanic) And dated
Dated Withrevisions dated 7
,73Tmay's, (I SCd date)
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t
" �. obligations for n ent thisproject: I
rs � �
1, As the in t u r, I am obligated to obtain -all permits and Boal*d, Health approved,plans prior t
performing a y'W i � �t � I� t hr�.. � � ���° � �� . the it �l wany work i
i doze.
2
the installer, must 11 it tion . I homeowner,contractor,project manager, x any o As
other person not associated vAth my company schedules an inspection and. the system is not rawly, then
item three shall he p li abl ,
3. As the instaher I au required t have th. nec*nQessary work o �l t l prior to theli l inspectionsa
��l ti o the tee in -
td �.ti below. uur understand that - �u �. �� � t-.tct witl t .
dance
with .itl 5 and B ar o , lth ul tion m res It i _�50. fie h ip levied.
in t Me .n
BottomBed—GeneraRy,this is the first V inspection nl thane is a retainin wall' which
should be done fist. The installer mustrequest the hnv ti n I-,ut does not have to be resent.
1 . :final. Cogstru ti a, -�Engineer must first ffieir iu tion forelevations, ti � etc.
� .1t . 1 :it .. t t_ �w1 ,1 ry .�, � t � *meat
As-built tb,d i .(4,)t( .. ...,
be :i tt to the 13oard, of Health, after which,installer a.Fl. for an inspection, time. Installer Must
be present for this inspection. With a pump system,all electric work must be ready
causeto workand a1afm.to function.
w Final Grade—Installer must request inspection„when all gradingis complete. Installer d not
have to he -site.
perform the xl (otbe.r a excavation) � I am ewe u i.red
the tau ��� .l understand that :ul _ may�
to completc the instal-lafion of the
system identitfie.d. in the attached, apphcation for Installation.
understand that work eons by others license to in t .0 ..,, Noah.Andover can constitute
reasons, for denial of the system and x:ge-yo cationor susp9mi license,t'o operate in.the ow
North. 1� � �iia� t ��� ,� Involved are
5. As the instatter,I understand that I must be -site during the performa thell[owing construction
Steps:
a. Determination elevation of the excavation has been reached.
b. Infra, f the sand and stone to be used.
c. Final ns
I pection y Board of Health staffor consoltant.
'. Installation f tank, D-Box, pibes, stone, vent,Pam
_P chamber, retaining waii and other
omnn *
the i nsta1let .1understand that l: am, solely responsible for the in tal1 ti n off'the t m as oer the
aot)ro-vK"1ans,. No instructions by the homeoyyner,, aeneral contractor. of, any other, r h ,. absolve
e,of this o bligation.
1
Undersigned 1,icensed Septic In tau . ("Yoday's Dat
er,
�N_;,�iiie Print) -Nmanie—SigncT)
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Town of North
Andover
HEALTII DEPARTMENT
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LOCATION'.
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CONTRACTOR
Tv vie f Permit ar License: (Check box)
Aninial
Body Art Establishment
13 Body Art Practitioner
Food Service Types
Funeral Directors ._......
L-1 Massage abhin
i
Massage ?
0 Offal(Septic)Hauler
RecrealtionalCamp
Su in
swimming '
El 'Tobacco
TrashlSolid Waste Hauler $
Well'Construction
SEPTIC Systems.
f ;
' fir ` i t Approve
Septic Disposal Works Co i ' ion "
SepticEl
EJ Title 5 Inspector 'j
Title 5 Report
Agent Initials
White-Applicant Yellow-Health Treasurer
North Andover
Quick Info(Summary Data-may not be Complete Representation of Propertyti
Parcel: 105,13-0005-0000,0 Location: 1520 FOREST STREET EXT. I Owne PH L UC.,
r- FRANCIS,JOSIE ,W. 1101
A:ccount: 7923 UserAcct: M 2383 3 ne r Address:1520 FOR ESTSTREET EST BOXFOR D, MA 011
Parcel Values
Total**714900 Land:2646010 Land Area: 1.32 Building:4503010 Other:0
Sale Dati+ :'7/21/2011 Sale Price: ILegal Fief: ,12543,-0320 Seller:MORGAN
Sales,Information
'Book and Page Instrument Type Date Price Grantor
125430320 LAN'D-&-BLDGS 7/21/2011 $585,000 MORGAN
Permit,Date:3/8/20161 Number,:2016950 Description: Amount:3640
Building Type:COLONIAL Year Built: 1986, Grade:AVERAGE+ Condition:Very Good
Finished Area:4099 Heat Fuel: OIL Heat Type: FORCED H/W %A i r C on ditio ne d 1: 100
Gross Area:6766 Fireplaces:3 Exterior Wall:CLAPBOARD, Bsmnt Garage-.
Sub Areas
Area %Usable Alt Type %Alt Type
#of Units: 1 #of Rooms: 9, #of Bedrooms:4 Full Baths:2 314 Baths:0 1/2 Baths: 1
Yardltem(s)
Description Quantity Size Year Condition Quality
Building Values
Total:714900 Land:,2646010 Land Area: 1.32 Building.*450300 Other:0
Building Areas
Area and Total Sketch d Area Total Finished Area
BASEMENT BMT 1652
FIRST FL IT FFL 1872 1872
GARAGE GAR 650
OPEN FIRM PRC OFF' 24
SECOND FLOOR SFL 18512 1852
3/4 STORY TQS 5001 37'5
WOOD DECK WDK 216
Sketch Iua
10 wx
Fft
12 24 10
25
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1520 FOREST STREET EX ,
Disclaimer:This information is believed to be correct but it is subject to be changed and is not warranteed.,