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HomeMy WebLinkAboutDWC - Construct New Septic - Permits - 345 BOSTON STREET 7/20/2006 Commonwealth of Massachusetts Map-Block-Lot o�°�;�•'° �oo' 107.D-0006- Board of Health - --------- Permit No------ a^''* ° BHP-2006-0218 North Andover --____-_-_------- ��.,'o...,>•r< ' P.I. FEE as,Knust F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Charles-Todd ---------- --------- to(Construct)an Individual Sewage Disposal System. at No 345 BOSTON STREET as shown on the application for Disposal Works Construction Permit No. BHP-2006-021 Dated July 20,2006 ----------------o f-IL - - - ------ Issued On:Jul-20-2006 Board of Health °wTM Application .for Septic Disposal System —_ 7/_MO� - -- ! N DA "Construction Permit - TOWN OF TO Y'S DATE NORTH ANDOVER, MA 01845 250.00— Full Repair 1 ss�G HU`�4 Important: Applicatio is hereby made fora permit to: � When filling 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 your ❑ Repair or replace an existing system component cursor-do not use the return A. Facility Inform tion �^ key. T Address or Lot# p� City/Town 2.- *T PE OF SEPTIC SYSTEM*: ump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information Name -- — — —_ Addres (if differqnt from a oye) City/Town State Zip Code Telephone Number 3. Installer Information Name Name of Company 41 S E41Q VIS L,�4rl Address st FRITA ©��0 Cityrrown State Zip Code v_9--9(4)=--03// ---. . Telephone Number(Cell Phone#if possible please) 4. Designer Information c,9.5'T Av1 �✓1 G� S v►2 V �� �}SSC- Namo Name of Company ly c.aw E �r✓ s- . --- Add Aess Cityfrown State Zip Code^ Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 04 °:I Fe1tio Application for Septic Disposal System -Construction Permit - TOE OF : TODAY'SDATE k MA 01845 $ 250.00- Full Repair NORTH ANDOVER . $125.00 -Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: LyResidential 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 i ued by this Board of Health. Name Date Application Appfove y: (Board of Health Representative) Name ,� Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes �� No 2. Project Manager Obligation Form Attached? Yes %� No 3. Pump System? If so. Attach copy of Electrical Permit Yes_ No 4. Foundation As-Built?(new construction ronly): Yes i� No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes i/ No Y Application for Disposal System Construction Permit•Page 2 of 2 ffC Town of North Andover Health Department Date: �lp Location: /* F (Indicate Addr if Residential,or N e of rosiness) Check#: / T Te of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ V ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ (,--Septic Disposal Works Construction(DWC)$4m,_ r' 0 Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) 6b9 Health Agent Initials i White-Applicant Yellow-Health Pink-Treasurer