HomeMy WebLinkAboutDWC - Tank & D-Box Repair - Permits - 247 FOREST STREET 6/20/2019 Map-Block-Lot.
Commonwealth of Massachusetts 1016.AO,0391
BOARD OF HEALTH Permit No
BHP-20,19-0,15,1
North Andover
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DISPOSAL WORKS ("�ONSTRUCTI N PERMIT
........
cif
John
'{Ili .
1Y 9 M' I�o hn Di V
hereby rant
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t Cr an Individual Sewage Disposal System
at No, 247 FOREST STREET ----
.f
11111iff'lop 13
as,shown 011 the application M Disposal Works ConstructionPe
rmit�:t No.
2 _
Issued On-, Jun-13-2019 BO OF HEALTH'
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fiGationDis ��astm
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WillTODAYS DATE
Construction Permit ,
M, A, 01845 NORTH ANDOVER, $17 . -Component
Important: on is
When filling the!out o�r t yu .n -site sewagedisposal s
+forms
onRepair r replace ri existing n-site sewage disposal systern*
on1y the tab keY
�r , '
cursor-d riot
r r
use tyre returnaGH l flog '01D
000
d"',
�'U �' jf=o;
-1 dress
es
t w
Ilid
ft Town
2 *TYPE F SEPTIC SYSTEM,Po5
rai choose ore)
***If'puinp system, Aach copy electrical peunit to applicaflon
G n r-i ional System (pipe andistone system)
ElInfiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your ceriffication to ihstaffs type of system.)
Pressure strw r.r n `. .S. (rho 1343ox
,Does the system require effluent filter? Yes� No,
ff yes does plan specify make and model ofre ? YES further Info.,needed)
nstaffer n7ust specify brand of fifter before DWC issuance)
MI?tis t-b 0 MAk � Wbatls the Mode
2. Own or Ip4ormaflion
rn
4�r
dd different ftall
u
�A10 -
own State Zip Gods
Email address Telephone Number.
3. Installer Information
OF
u
Name me'of Com
i
,ddress
ul ,Mate zip Code
4. PesignerInformation
Name Name of Company
Address
Gityffown State Zip Code
TelephoneNumber(Best o Reach)
Application!for Disposal System Construction Permit-Page I of 2
P11"cationfor, Septic,, em
ODAYS DATE
-Cons uction Permit ,- TOWN,
NORTH ANDOVE" 14 -MA
PAGE2 OF 2
A, Faci,fity Informatiq continued....
lw� i ._
5,. Ty f Buflfflnq. : Residential Dwelling or 0,,Commercial
I ir-I
. Agreement,
The undersIgned agrees to ensure the construction and maintenance of the afore-described
on-site sewage d1sposal systen7 in accordance wiffi the PrOVISIGns of Title 5 of the
Environniental Cos w as Me Local'Subsurface,
Nod A that until a final Gllia of'Compliance has been issued by
IN 0 f H m, Installed system isnot approved.
Y
me
,
Date
Apple J, n ved � of Health Representative
Name
Cute
Application Isapproved for the following reasons
For e Use On])L.
1. Fe e A tta ch Yes o
2,. pxofectmapagetobfig-dtioyiFojynAu;ached?
elve
"EjectricalInspecdon Noitnq f t Sepac SY,� fns
Handout?
4. eNO
nd� � �, ff e °d S
11A�
. Fozwda As B V (new construction only),:
(Slqn2escar R P C " " "
01
tp,ns (now construction only)
p licatio for Disposal s "n C n tr on,Permit-Page 2 of 2.
f
SEPTIC SYSTEM INSTALLER PROJE?CT MANAGEME'NT OBLIGXfIONS
As the Notts An v r licensed installer for the construction for the septic systew for the property at:
...........a
2
(Address of septic systern) For plans by, (Engineer)
Relative to the pp at i
n of
NWW f
And dated
' 1
Dated4 Foi3ay"s ate With revisions dated
(Last
J
Ir
1
undustand the following obligations for management of this P f
.
L A e . ated t �� ; e.� s and.,Boats.o ,l th approved .n,s p
iior to
5
y w :r ,on a site. I must have thea rived-ol. and the eawt on site when a,nv work is
a ,
4-
bein dons:.
2. As the M' staller I must call f any and ..,e r ns. I e. n .,project ger, �:any I
T other p, n, nog:.as s ociatedmy company h n n,sp ection,and the system is not ready then
item three shall be ap,.P1 .
3. As the installer,I amtequited to,have to necessary work completed prior to the ap in
indicated below. I understand th . r y � ithout cornviletion,of the items in accoidance
With Tide 5 and the B oatel of Hea e U d s maTtesudt in a J50-Q0e being le-vied"Againste n
MV e
a. Bottom Bed --� Generally, '� the s (1")inspection a e theta .
should be done Est. 'DiLie installerustto ue e inspectill.on but,does not have to be,
Coils truction.Igs � ei*
As-bit of vetbal OK - e , e - act. .d e a ..g o from t,he en must be
subn1itted to the Board of Health, aftet which installer calls :dot an ni.spection ttme. Installet raust be
ptesent,for fl3is inspection., With a pump systems., all electrical-work raust be j--eady and ab'le to cause
pump to work and alarm to function.
does not
C. iG e Installer e Lie ee . ` i
s complete. instaRet
have to be � - , e..
. As the installer,1, undetstand that only I rnayetform the word. (o6er thanm x a and I am tequired
to complete the insta-Ilation of the systems identified the attached applicationfor installation. I further
understand that wotic done et s Andover can constitute
wasons, for denial-of the s stems.arid joy e e .on or sus I Of my license to eta e�the,Town o
sQp ss
5. As the in,staller,l un e t nd th .t I must be on-site during the performance of the following constructo:.
steps:
. � . itio �� ' h exc � n bAs been reached.
. kispeetian ofe sapdand stone be used.,
c. Final n bjrBoard of Health staff t n ul a-O .
d. Installatian of ta-nk, D-Box, es,PIPstop , � � �, cbarn °, eta �. af'an o he
cornpo-nen,ts. et-the
in ons by the honieown��,- �eije�val
Me o
0110
e�: ,e ey e S n -� l e :
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Reference No: BUJ-2049-10000,18,
247 FOREST STREET NMI,,wamm
B" P-2019-0IX
15-1,
Permit No,,
loom mimmm
Department. 41
Narth Andover BOARD 0"F"' Hrl"�-'ALT`1111 AccoUnt Now 1001-001,L5.05,10,00
Fee Type'-.,
Receipt No: REJ11C-2019-000351
DWIC-0-Yinponetrit Repah-PERIMIT I. M.0 0.No I M M,11 1,Mmim M ff.. IN M MI.
M M,I a M M IN I w 11 IN m I
m -ti Junn 13,201.9
Paid By: Paid in Full Onw 'Th M,*.... o"MMIN1*1imm'Iml I"limmm No lo"ll
John DiVinceltzo
Check No: 1.83,90
M..0 IN No No IN IN IN 1. it
Received By: XI
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I I M,M I M M N I o M M IN I M M I I m w,M,M M 1#1 m m.I oh M m.N, IN 11 m 1 ..'m.N, m m.I I IN M IN M NO I M,M M I m M I M M IN 1..11 M
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Amount: $475 0Xi
DEPARTMENT'S COPY
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