HomeMy WebLinkAboutDWC Permit - full repair - Receipt - 487 WINTER STREET 8/30/2019 h
• Sts 1.ED'�s' . Commonwealth of Massachusetts Map-Block-Lot
104.A0071
BOARD OF HEALTH --------------------
Permit No
North Andover BHP-2019-0173
FEE
$350.00
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Todd Bateson
to(Construct)an Individual Sewage Disposal System.
at No 487 WINTER STREET
as shown on the application for Disposal Works Construction Permit No. BHP 173 D e y ,2 00
ssue On:Jul-22-2019
-- ------------------------------------------------------
BOARD OF HEALTH
,=,.F*-w •. Application for Septic Disposal System 17_ a
Construction Permit - TOWN OF TODAY'S DATE
-Full Repair
NORTH ANDOVER, MA 01845 $75 00-Component
Important: Application is hereby made for a permit to:
When filling out ❑Construct a new on-site sewage disposal system*
forms on the �/ RECEIVE
computer,use LJ Kepair or replace an existing on-site sewage disposal system*
only the tab key
to move your ❑Repair or replace an existing system component—What?
cursor-do not ANppVEFZ
use the return A. Facility Information •�DWN pF NpR�H TMENT
key. L/`� '7 ' t 5 f uF ALZH DEPAR
Address or Lot#
IY4-
City/Town
2.-*TYPE 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)
➢ ❑Pressure Dosed(D-Box Present)S.A.S.
➢ ❑Does the system require an effluent filter? Yes V No
If yes, does plan specify make and model of filter?,,- E (no further info. needed)
NO=(installer must specify brand of filter before DWClssuance)
W1 hat is the Make? '4 ghat is the Models1-
2. Owner Information
Name �/s�rs/►�Q-- / /��Q'i�-dC
Address(if different from above) 7�
Cityrrown State Zip Code
Q✓.. g 7219 �9-a-`7— '`j a 3 9
Email address Telephone Number
3. Installer Information
ON ENTERPRISES, INC.
Name Name o 111 ARGILLA ROAD
Address ANDOVER, MA 01810
City/Town State Zip Code
Telephone Number(Cell Phone#if possible please)
a. Designer Information
Name Name of Company
Address
City/Town State Zip Code
3 IV_ R--731
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
Application for Septic Disposal System -,I a q
Construction Permit — TOWN OF TODAY'S DATE
NORTH ANDOVER. MA 01845 $175 00-Compo�e�t
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: esidential 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. I understand that until a final Certificate of Compliance has been issued by
this Board ofH Ith, the installed system is not approved.
r
Name Date
Applic5�z
p ed I
rd 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? Ifso,Attach cQRv ofElectrical Permit Yes No
Applicant received copy of
"Electrical Inspection Notes for Septic Systems" Yes Nol
Handout?
4. Reviewed approvalletter,all paperwork received.-P Yes No
Missing.•
5. Foundation As Built?(new construction only):
(Same scale as approved plan)
6. Floor Plans?(new construction only): YET— o
Application for Disposal System Construction Permit-Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
(Address of septic system) For plans by r-+� r VIA ��
(Engineer)
Relative to the application of
(Installer's name) And dated 4--5—/p
ngin ate
Dated aa— 19
�s�ate With revisions dated !�'3�-1
(Last revised date)
I understand the following obligations for management of this project:
1. As the installer,I am obligated to obtain all permits and Board of Health approved plans prior to
performing any work on a site. I must have the aWror ved plans and the permit on site when any work is
being done.
2. As the installer,I must call for any and all inspections. 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 three shall be applicable.
3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that recluesting_an inspection,without completion of the items in accordance
with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or
MY company
a. Bottom of Bed—Generally,this is the first(1'� inspection unless there is a retaining wall,which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties,etc.
As-built of verbal OK(or e-mail to:healthdeptna townofnorthandover.com) from the engineer must
be submitted to the Board of Health,after which installer calls for an inspection time. Installer must
be present for this inspection. With a pump system,all electrical work must be ready and able to
cause pump to work and alarm to function.
c. Final Grade—Installer must request inspection when all grading is complete. Installer does not
have to be on-site.
4. As the installer,I understand that only I may perform the work(other than simple excavation)and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others unlicensed to install septic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of mg license to operate in the Town of
North Andoversi�mificant fines to all persons involved are also possible.
5. As the installer,I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached.
b. Inspection of the sand and stone to be used.
c. Final inspection by Board of Health staff or consultant.
d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other
components.
6. As the installer,I understand that I am solely rem risible for the installation of the system as per the
approved plans No instructions by the homeowner,general contractor,or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: ��Sony (Today's Date)
(Name— rint ame— e
{
f 8 6
" � • do !
G 9
Town of North Andover
HEALTH DEPARTMENT
,SSACMUSt�
1
3
CHECK DATE: 019
LOCATION: �i-7
H/O NAME: �����l� �lcLU
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 $
❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
Septic Disposal Works Construction(DWC) $ -50—
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
i
❑ Title 5 Report $
❑ Other:(Indicate) $
*&Ag2ent Initials
White-Applicant Yellow-Health Pink- Treasurer
7/22/2019
*Electrical Permit Applicant Location
49516 . Richard McNamara 487 WINTER STREET
c� 617-799-5140 NORTH ANDOVER, MA 01845
@ richard.h.mcnamara@gmail.com
Primary Contractor
Firm(Business) Name Licensee
-- RICHARD MCNAMARA
License# License Expiration Date
35025 07/31/2019
License Type License Active
Journeyman Electrician Class E 0
License Status Type of Business
Current --
Mailing Address Preferred Telephone#:
, Wilmington MA 018871215 617-799-5140
Alternate Phone# Email
-- kristyp@hallpump.com
I certify, under the pains and penalties of perjury,that the
information on this application is true and complete.
true
Project Information
TYPE OF PROJECT Is this permit in conjunction with a building permit(select yes or
In Conjunction with a Building Permit(Commercial or no)
Residential) No
Estimated Value of Electrical Work(when required by municipal
policy):
2500.00
Occupancy Type(NOTE: For any residential structure larger Total Number of Units
than a two family please select Commercial) 1
Residential Singe Family
Location and Description of Work to be Performed
install a new septic pump, floats, control panel,wire and fittings
to make a complete system
Are you installing a generator? Date Work is to Start(inspections to be requested in
No accordance with MEC Rule 10,and upon completion)
07/17/2019
Panels
1/4
7/22/2019
Is This a Service Change Is This a New Service?
No No
Existing Amps(Existing Service) Proposed Amps (New Service)
-- 0
Existing Volts(Existing Service) Proposed Volts(New Service)
0 0
Utility Authorization# Number of Feeders
0 0
Location of Work Number of Ampacity
Underground 0
Panel Change? Proposed Amps(Panel)
Number of Sub Panels Temporary Service
0 No
Proposed Lighting/Outlet/Circuit Work
#of Recessed Luminaires #of Luminaire Outlets
#of Luminaires/Exit Signs #of Receptacle Outlets
#of Switches #of New Circuits
undefined
Total Number of Outlets/Luminaires/Switches/Circuits
Proposed Appliance Work
#of Ranges #of Waste Disposers
#of Dishwashers #of Heater/Boiler/Furnace Wiring(Oil or Gas)
#of Water Heaters #of Dryers
#of Air Conditioners(room size or roof top) #of Tons
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#of Ceiling Suspended(Paddle Fans) #of Hydromassage Bathtubs
#of Heat Pumps Electric Baseboard Heat
#of Heating Appliances #of Transformers
#of Washing Machines #of Microwave Ovens
Repairs to wiring,outlets,and/or fixtures #of Other Appliances Not Listed
Description of Appliance Not Listed
undefined
Total Number of Appliances
Miscellaneous Fixtures
#of Hot Tubs Swimming Pool
Type of Pool #of Solar Panels
Septic Pump Re-Wire #of Motors
false --
Motor Total HP Smoke Detectors
Other type of work to be performed
Fire Alarms/Security System/Data Wiring/Telecommunications Wiring
Residential Fire Alarm(multi-family) Security System#of Devices or Equivalent
No --
Commercial Fire Alarm Data Wiring:#of Devices or Equivalent
No --
Telecommunication Wiring (phone cables):#of Devices or
Equivalent
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7/22/2019
Insurance
I have a current liability insurance policy or its substantial If yes, indicate the type of coverage
equivalent. If NO is selected a copy of the signed Owner's Liability
Insurance Waiver form must be attached to this application.
Yes If other,specify
Worker's Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Are you an employer?Select the appropriate type. Any Type of project
applicant that selects#1 must also fill out the section below 11. Electrical repairs or additions
showing their workers'compensation policy information.
2. 1 am a sole proprietor or partnership and have no employees
working for me in any capacity. (No workers' comp. insurance
required).
Workers' Compensation Affidavit Signature
I do hereby certify under the pains and penalties of perjury that
the information provided above is true and correct.
true
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