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HomeMy WebLinkAboutDWC - dbox repair 04/02/2014 - Permits - 45 TUCKER FARM ROAD 8/2/2019 • ,�rT1Epfev Map-Block-Lot Commonwealth of Massachusetts k c �• 107.00102 ' . �� --- ------------------ BOARD OF HEALTH Permit No North Andover BHP-2014-0490 ----------------------- FEE $125.00 ----------------------- DISPOSAL WORKS CONiSTRUCTIONi PERMIT Permission is hereby granted Todd B-ateson - - - - ----------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No _45-TUCKER-FARM-ROAD--------_ ----------------------- --------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2014-049 Dated April 021 2014I { ' a Issued On:A r-02-2014 - p LL BOARD OF HEALTH I s< a. . Application_for Septic Disposal System TODAY'S DATE Construction Permit - TOWN OF ' NORTH ANDOVER, AIA 01845 $125 oo-comp e�e�t Important: Application is hereby made for a permit to: When fining out ❑Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key to move yourD-Wepair or replace an existing system component—What? — 3C cursor-do not use the return A. Facility Information _ key. yS !.(d L /t fir, Address or Lot# � I City/Town 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump ravity(choose one) ***If pump system, attach copy of electrical permit to application*** ➢ 2 conventional System (pipe and stone system) ➢ ❑Infiltrator or Biddiffuser(Gravel-Less)(Attach a copy of your certification to install_this type o system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No f If yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of filter before DWC issuance) What is the Make? What is the ModelP 2. Owner Information Name 1-4 Address(if different from above) City/Town State Zip Code Telephone Number 3. Anstaller Information Name Name of ComparBATES©N ENTERPRISES,INC. 111 ARGILLA Rn,gp I Address `V VER,MA 01810 City/Town State Zip Code '70 Telephone Number(Cell Phone#if possible please) 4. Designer Information Name . Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 Applicati-oh..for Septic Disposal :System ` �r`''+ .,,•cpConstruction Perrrrit TOWN 1�J. �F TODAY'S DATE -ORTH AND OVER, MA 01.845 $.250.00-Ful;Repair CHUS - $125.00.-Component PAGE 2 OF 2 A. Facility.Information continued.... 5. Type*of Building: Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been Issued by this Board of Health. Name Date I Application Approved By: (Board of Health Representative) Name Date Application Disapproved.for the following reasons: • II For Offiee Use Only: 1 •'Fee Attacbedp Yes No Z ProjectMadager Obligation Form Attached? Yes No Pum�3vstem? Ifsoj Attach cony ofElectrrcal Permit Yes ' No 4. FoundadonAs Built.?(new construction•ronly). Y'CS No (Same scale as approved plan) S. FloorPlaas?(lnew construction only): Yes_ No Applfcatidn for•p(spGsat Systerli: onstrUctiaii Permit Page 2 of 2 � r I SEP'�IC SYSTEM.INS'hALhEK'PROlj3c.r MA�T�GEMENTDBLIGATIONS As tl�e.North Andover•licensed;uistaller for the const me tori'for': the septic systetu'fat,the•propetty a l w (Address of septic system) For Plana by RelatroC to the.application of •� '"/� � Ahd dated (installer's name) Dated ' �1h rvins dated kIo s a e d ' (Last revised date) I understand the following obligations for management of-this project: 1. A.s the installer,I am.obligated to obtain.apermits and Board of-Health approved plans.PLO to T must have*�''a roved,•Tans and the n imit•on site when a work is perfomsvng any.'work on a site: p .$ nv hr k done, . 2. As the installer;.I must:.'•call-for any and all:inspt'ctibns: If homeowner,contractor,,project manager, or any other,person not associated with my company schedules an inspection and the system is not ready,then item ihree•shai bri applicable. 3.`' As•thy:irtsta�ler,I am-req#ed tot.have.t'he necessary work cgmpJeted'piiar;to the '.applicable in$pectipris as ' indicated hels�wx 1-Ai deittat,4 41,at 1Pq�jiinZ-dn iticf,erfinn without comliletioa•of the'items in accordance e 1 e s me.•a'd 'or ai. Bottom�if] e+dti tnerally, this'is tha'fitSx.(1"j'im'spebtiom nnl�ss.there is a�retaining Wal,which. shotdi •be dzSneArst:' T-he*;ihst4rx-- iWs rppest die inspect ds�but cloesriot have to be prtsetit %b. Final7('on do fi-ppgctiQti—Engineer mtis't first do theit;imspectton for elevations;tte¢;'etc. As-1 iiilt of verbk OK,(or e-nuil•to: a' • ' r. .from the ea neer must be submitted to,t e,Bo'ard•ofHealth,afterwhieti installer,calls for •an!1ispecdpn tine. `Installer must be present for thikinspection, With•a pump.Syst .1. a, electrical•** 7±kxnust.be ready and•able to muse putxtp.tri-work Arid alarm:to fiuition.. C. :Finn Grade in5ta.kx must request'inspection wheli' 11•grading'is:cornpltte:•.Installerll'does not " have jo be•on4ite. 4. As-the installer,'I=4 stand that only I•Inay pttform the•wofk(other than:eimple ixravation)and'Y1 atri required to cotoplete the installation of the system identffied in xli attache licatfon for installation: understand:that work•done bX.otliets uil)?ceiise�i.. ins ueptt;a ssykeims•in Wort_ Andover call coi'at ite' reasons for deival of tht systexzx and/6 inf• y liensprithe Too Wsm wn of North Andover.s p�ficant fines.xo a orsons,uivQ�vet'ire also Bible.' 5.. As the.ins&Uerj understand that.I rnu§tbe on-site dutiag'tho.perfoimance•of the following construcfiibn steps:.. a: Detatiost+that,the privpet�elevation Of the earczttion has been reached b. InsP ectron ofihe sand and stade-to be used. c. F&dinspecdorr byBom-4of.Iealth st#fforconsultant. d. Installatron:ofLank,Dfox pipes,stone, vent,.pump chambei,reta rtirr, miff and other . components. .. 6. As tbg installer::I,WW rstand that I:am sbl*reapo sible for the inEt?llation of fhe s ysitem as per the ' W d•;li mp No instructions by ihAtiM� a='Qtneral contrast r any 6thk persons shall absolve me o f-this dlj tion. Undersggned Uceased Scptic.Inataller. -•!� �}.-�..�-.gyp`c/ F ,.,:.1>..:i' ' j�•,.:,• •�r,:•;>'. . . i Of NORTp, 6 % T :' a° os a ,a Town of North Andover HEALTH DEPARTMENT SACMus .� CHECK#: DATE: LOCATION: ) �a (S H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ a ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ < 13) Septic Disposal Works Construction(DWC) $ .1f❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ , ❑ Other. (Indicate) $ Health \\\Agent Initials ''° White-Applicant Yellow-Health Pink-.Treasurer