Loading...
HomeMy WebLinkAboutSeptic File - Miscellaneous - 1701 OSGOOD STREET 3/30/2023 10/02/2006 NON 9:20 FAX Q 001/001 ' roper INC. Environmental & Engineering Consulting 323 New Albany Road • Moorestown, New Jersey08057 • 856-813-3000 Fax 856-813-1068 October 2,2006 Freedom of Information Officer North Andover Community Development Department of Health 1600 Osgood Street North Andover,MA 01845 VIA FACSIMILE: 978-688-8476 RE: Stor-U-Self 1701 Osgood Street North Andover,Essex County,MA 01845 Parcel ID: 210/061.0-0066-0000.0 Property Solutions Project#: 20064431 Dear Freedom of Information Officer: Property Solutions Inc. is conducting a Phase I Environmental Assessment of the aforementioned property. As part of a property assessment, we wish to determine whether government agencies possess records on the subject property that may include potential environmental concerns. We request information on the following: • Underground/Aboveground Storage Tank(UST/AST)removal or installation • Lead-Based Paint(LBP)or Asbestos-Containing Material(ACM)abatement • Hazardous releases or responses • Environmental health code violations • Water supply concerns If you have any questions, please call me at 856-813-3000 x 233, or email me at eregan@propertysolutionsinc.com. If you have no information on the property,please fill in the box below and fax back to me at 856-813-1068. Thank you for your assistance. Sincerely, F[Phone: s for subject property or address - .� Erm Regan Environmental Scientist Date SERVING YOUR NEEDS NATIONWIDE FROM OUR OFFICES IN: PHILA NY CHICAGO LA DALLAS PORTLAND • ATLANTA BALTIMORE I - Town of North Andover No. .rth Andover, Mass., ' BOARD OF HEALTH Food/KitchenPERMIT TO BUILD 7 Septic System' / � BUILDING INSPECTOR THIS CERTIFIES THAT.......................... •�l .. „L,Y..... P/l-NY............................................................ Foundation p has permission to erect.....�,el ..a4 buildings on ......./. .75.....05¢� .... r ................ Rough to be occupied as.. `,350..5, '.......3....1 '7PRY...Sc'LF'.-.5. ....1Ci C�.G�... . ..................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR cL, VIOLATION of the Zoning or Building Regulations Voids this Permit. CAlil`< `{— Jr—G L LSE M .IT VI.RES IN 6 MONTHS (�r at UNLESS COI�iST�UCTT�"vT Q'rAP7-� ELEC ICAL IW R Service BUILDING INSPECTOR Final Occupancy. Permit Required to Occupy Building GAS INSPECTOR ou h C-It 00, Display in a Conspicuous Place on the Premises — Do Not Remove ' p P No Lathing or Dry Wall To Be Done FIREDEPARTMENT Until Inspected and Approved by the Building Inspector. Burner • ���G��4� Street No. � SEE REVERSE SIDE Smoke Det. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*******************"" I APPLICANT ` kt'�1 ( � PHONE79 ✓LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) / STREET !:.-t 'mil �� `� ����M�i�� ST. NUMBER 6 G *****************************************OFFICIAL USE ONLY*********************************** OMM ND TIONS OF TOWN AGENTS: C SERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED t� COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED �� DATE REJECTED EPTIC INSPECT/OR-HEALTH DATE APPROVED D DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS a� eFeidz," DRIVEWAY PERMIT Z FIRE DEPARTMENT, RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm �aORTH ob�q�.o ,d"moo Town Of North Andover �a Community Development & Services WilliamJ. Scott 27 Charles Street Director x (978) 688-953 ` 9 North Andover, Massachusetts Ol 845 9SSACHUS'64 Fax 978-688-9542 Board of August 8, 2000 Appeals (978) 688-9541 Steve Erickson Building Norse Environmental Services, Inc. Department 3 Pondview Place (978) 688-9545 Tyngsborough, MA 01879 Conservation Department Re: Lot 1 Osgood Street, North Andover (978) 688-9530 Health Dear Steve: Department (978)688-9540 This letter comes to notify you that the proposed septic system plans for Lot 1 Osgood Street have been approved. Please call if you have any questions. Public Health Nurse (978) 688-9543 Planning Sincerely, Department �f (978) 688-9535 Sandra Starr, R.S., C.H.O. Health Director Cc: R. Kaminsky File t BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL 'PESTS DATE: SEPT. 21, 1999 MAP & PARCEL: MAP 61 PARCEL 66 LOCATION OF SOIL TESTS: 1679 OSGOOD STREET ( r )60 OWNER: R.J. KELLY CO. TEL.NO.: (781) 272 - 2899 ADDRESS: 55 CAMBRIDGE STREET, BURLINGTON, MA 01803 ENGINEER: RICHARD F. KAMINSKI & ASSOC-INC- TEL. NO.: (978) 68701483 CERTIFIED SOIL EVALUATOR: STEVEN ERIKSON Intended Use of Land: Residential Subdivision Single Family Home Cor&ercial Repair Testing: Undeveloped lot testing: N.A. Conservation Commission Approval: - THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan 3. Fee of$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or up. ram. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarian and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line Date Received: Check Amount: Check Date: SEF 21 '99 09:2-41PH F'• T•k:ELLY F.1 ISO R.J. KELLY COMPANY DEVE_OMAINT � CONSTRUCTION - MANACAWNT September 21, 1999 Kaminski Associates 360 Merrimack Street Lawrence, MA 01843 To Whom It May Concern: Permission is hereby given by Richard J. Kelly to allow Kaminski Associates to enter upon my property located on Route 125 in North Andover to perform surveying, soil testing and other related services. Sincerely, Richard J. Kelly 55 CAMBRIDGE STREET.BURLINGTON,MA 01803(617)272.2899 FAX(617)273-2075 -� U-s6fOr AM • M � 1 111 NI IIIuI N Iu0© - 1��` nnl n1i 1111�n111 111� � - Iuinni111 III 1nNNiInNMEN ,. - IIIIIIIIC.. ��i1�111111N11n1 1 IIIIIIIIIIIIIIIIINIIIIIIIIIIIIn 1 1111�11',•�IIE�V1111/213�,C I 11111�N IIIn11n1111Nola Milli I III1UN 111111111111 ��.' • 11 .R'?1V�t/�llNISI -13"T�111/ p?�11 Milli�� IIIIIIIIIIIIIIIII�IIi111111F� ��1 Hill IIIIIIIIIIInn1/II III i1ly4,d IIIIIIIIIIIIIIIIn111fI11111C : � � 1111111111111111111111111n��'�'�x ��. � IIIi111111111i11111111����"�'1��'i�I1 I IIIIHIM 111111111111:C MEN it NHIM 11111IIIIIININil �� 11i IlNilllll Inlll 111 1�� 1111i11NNIN1 IIn IIIIIINIIIIN IN NIII _ WIN lilIIIN li11 I1i1N11N1 .■ INI Illnillull� 1111l1111111 inIIIIIIIIIIIIN NIIII IN IN 111111 11 11 1 ,.7 , ,.::.. �'` ., . , �, _, �. - #,. . �. ,.. �. .�� ,t_. f�: '� :;E, M Q U IBM _ - y . ate K' C.. i Ufaa F; Y N ... . FM _mw� s W, 'VaLer. left " m _ems � i► �__ _ _s _s sss_ s�_ r� ,:. :,. .�F - ,, .: �. 4 �, r.2 �,,; _ ., .. .. -: �:., ., •- �:, '"r a°�'' Oct-21 -99 01 : 28P Paul D. Turbide , PE PLS 508-465-0313 P .05 If Ami, f Are T IT_ l � I � I ` II j , j �N mm . el '„�r ,q� F ',C7-- c� "�,:A f 1 .:• :�JR.v "P;:.S ,`h�. .t� rkP.,[', r.a• ''n 'V+4R 'V!, r� `' d•T" iT' �i .+�" '!� 43"''..P:'fi,fi.: 9fT r ' �i _ h ' i a : ,> s = r v a r 'h r t t. t( r • V y Y" Al U z • f a L , �� .. _.., .-• .. .. .. .. y is �«k�: rn :F� � ` y yy♦♦�� • k , r. R ..,,::.. "';i' �`N' xf.�n3". 7 •4 n +A' 5�G1A. x,� f +kY '§'::<a ''Lr#' %'.""�ts 'Y,`�,°e• 7 �]o' K. t�. Town of North Andover, Massachusetts Form No. 2 o* "OoT#1 BOARD OF HEALTH ., o i 5�,:; %��* DESIGN APPROVAL FOR s,q`"�sf SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM J (2Aw / Applicant Test No. Site Location " Reference Plans and Specs. �y NGINEER DESI N DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH : Fee Site System Permit No. //� Page 1 Date P— Z6- `f • Commonwealth Of (Massachusetts AtjDodeF , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal r • Performed By N6Fz-5E EWJtr-OrJm6NTA-C- S vtce 5 tNc . Witnessed •By Ca 7- t-I ga-oV-1 N — N0, A Noov E� 8 0.H. Itxa con address or G\.,ne/s Vaeie / / - Lot♦ I O- Add—and TO �� " >R-F 17�.LF 7Th F,%E 1 L- Tele?h—0 (97 6,z COD (RT. OS�oo:j S-r�-� ��T• 1"ZS) - �)0, �Do�trR r Nl� NO, ANDo\15R, , MA, New Construction n Repair❑ Ofr'ice Review Published Soil Survey Available: No ❑ Yes ❑ Year Published 1981 Publication Scale 1'.15 840 Soil',vfap Unit ^ Drainage Class a Soil limitations kAODe: t-re ' St.aP6 Surficial Geologic Report Available: + NoX Yes ❑ Year Published Publication Scale - Soil Map Unit Geologic Material(Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Cl Within 500 year flood boundary No 11 Yes ❑ Above 100 year flood boundary No ❑ Yes El Wetland Area: National Wetland inventory i`rfao (map unit) Wet!a:ds Coaser;aycy ProQ-a.= Map (map u it) Current Water Resource Coadidors(USGS): Month: OGToL�e� P—j,,ae: Above NormaT ❑ Normal Below Normal ❑ - Other Ref reaces Reviewed: WD -- "- _ -r""�.. _._. .. __ - .. -.i:..-.� - _� .a ..�_. .....- .�_�'.0 :na::��` ..- _�CJ�er,''�G3;.��w`Ce`•"rri'-t• • = F0F Nf I I -SOH,EVALUATOR FOR.Ni Page 2 Date.(0-�5-CIq On-site Review • Deep Hole Nu=ber•r�- ( Date:l0-ZZ-IgTime: P-0-1" l-m Weather. 6�6A-9, SrwN- -WL Location(identify on site pla-i), SEA PI,P N Land Use: Y400DED. 'Slope(")—Surface Stones Vegetation: Re'D M"uc- 51zz0 Landform: D914m(,,n4 Position on landscape (Sketch on back) Distances from: . Open Water Body • 104) Feet Drainage way f=e Possible Wet Area71V Feet Property Line 7 10 f DrLnk-n-Water Wen>.I�D Feet Orzer DEEP OBSERVATION HOLE LOG = Depth G-oa Soil Forizon Soil Tzctt*e Soil Color Soil Mardiag Other Sur.-ace (USDA) (v[trsetl) (SZca=gStoaes,'boulde;s, (inches) Consistea .%Crave[) za $� L 5 �bYR5�8 Nang FewMo mz1 , P(KM - NtA-!ss t'a'G �, V. �"7e.11" 2�r _0 Ct �S 2.� Few a 2S•, ox�DE ��n a Z5" 2011_(�f3` GZ F5� 25Y��Q" fi'fKrn - rya-gl.� 8"T MOT Mrr55I vE FvW �,ourJoe•D �, sKd kN�, STv n/ES• _ Pa:e^tt:+(atir_t(a�[ogc) �e.A'fIUN Tl,rl.. Dep�oc3e�-rc< — - Del l to GroundhvaL-r C' r r Q e 2,i o •Fit � Y/I�}Z( C?....C�..T'tQ W2�.L*t�Q.[_: �i �4' �{2_7_.Q�� apt—C_. 25'1 it - - FORM 11 - SOIL EVALUATOR FORM Page 3 Determination Lor Seasonal High Water Table P Depth observed standing in observation hole 14-Z inches P Depth weeping from side of observation hole 14z inches P Depth to soil mottles ZS inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring material exist in all areas observed throughout the area proposed for the soil absorption material? YES If not, what is the depth of naturally occurring pervious material? Certification I certify that on Nov. '`14 (date) I have passed the examination approved by the department of Environmental Protection and that the above analysis was performed by me consistent with the require aining, expertise and experience described in 310 CMR 15.017. Signature V h Date - '- FORM I I -SOIL EVALUATOR FORM Page 2 Date. On-site Review , Deep Dole Number. T�-7- Date: 0-Z L-ii Time: I5',(5 Af Weat_Zer. Cam"¢- 7011S Location(identify-on slte plan). s PLnnl . Land Use:. N60Db-D Slooe(a) Su—,,ace Stones Vegetation: F)6b MA-PLC Land. Posluon on landscape (Sketch on back) S per" Disc*ices from: Oce_-t Water BoCy? 100 Feet Drainage way7s0 feet Possible Wet A.zea'?1°y Feet Property Line 710 feet Dr-t':i*t�Water Wert (00 Feet Oti.er o — DEEP OBSERVAi1ONHOLE LOG Depth E-am Soil For;zon Soil Text=e Soil Color Soil Ntoadir:g Oche: Surt"ce (liSDA} (tits rsell) (S�sc t—e,S�ones,'bou�de.;, (inches) Corsiseacr.%Gravel} �S(, tole-2(2 No toIR4((b NUNS � � (-ODSF �INGI.� Lay�S��- �t✓►k Ntv,i LES �tzO�vtin�ErVT, �iS i ruc,T q0t' CZ �Slr 2,57&/Z FrtM MA97(V6 - F-p-mtecLE Z 15 y51 Pa =^ttita*=r=j (Qeoiaa c) LR'rtoNDep IaC, e,: FORM 11 - SOIL EVALUATOR FORM Page 3 Determination,for Seasonal High Water Table ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches P Depth to soil mottles z inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring material exist in all areas observed throughout the area proposed for the soil absorption material? `IES If not, what is the depth of naturally occurring pervious material? Certification I certify that on NOV. �4 (date) I have passed the examination approved by the department of Environmental Protection and that the above analysis was performed by me consistent with the re ed airing, expertise and experience described in 310 CMR 15.017. Signature Date FORM I 1 -SOIL EVALUATOR FORM Page 2 Date. 10:ZS-q�l On-site Review , Deep Hole Numbe_.-54-S Date: LIZ- (q Time: Io' 3o 44 Weaf-ier. � �-SuNNY 70 s Location(idennts f on site plan). S0� Pt,Ar� Uund Use: �40ODa Slope(%) Satiate Stones Vegetation: PIED Mfmc� ` Y��RC,}t Land or-=: DR-UNnL_i"l Position on la_zdscape (Sketch on back) Se7� fN 0is-nces fraa,: Open Water Body Feet Dra_nage way 7 50 feet Possible Wet Area 7L0c:I Feet Property LLne 7 tD feet Dr-i'_c-tg Water Wel 7100 Feet Otter DEEP OBSERV zTIOiV HOLE LOG Depch from Soil F-lorzan Soil Textte Soil Colar Soil Madicg Other Sur."ac= (USDA) (46 ei1) (5. __L—e,Scones,'boulde.�, (iac a) Coasire.^. %Czve[) i 10�— ZQ-" bv� L S 6 �' onlrr 4" "-1 N[1i'i1lnP-n�b� t��PaS1 T S . . .. 68`_lLo� G r 5 L Z,5 �!5I3 Mk-5S cv� F�tA-Bl� Z �rrsS tvG F-?Z4^-zsLC- Q-3l•A-rLoN 'ri DeveLa:SeL=r < y K4N6 711 `� FORM 11 - SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table M Depth observed standing in observation hole 05 inches ❑ Depth weeping from side of observation hole inches ® Depth to soil mottles z4' inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturallv occurring Pervious Material Does at least four feet of naturally occurring material exist in all areas observed throughout the area proposed for the soil absorption material? 166 If not, what is the depth of naturally occurring pervious material? Certification I certify that on KOU. ,�¢ (date) I have passed the examination approved by the department of Environmental Protection and that the above analysis was performed by me consistent with the re ed aining, expertise and experience described in 310 CMR 15.017. Signature Date (D Z5 _qC1 FOP—M, 11 - SO M EVA UATOR FOPUMI Page 2 Dae.�� _Z5 '119 On-site Review , Deep Hole Number. Date:1"Z'ctq Time: I a i 4-S A-M W F�ie� GL��rz' Su�Y 75 ea Location(identify on site plan). SEA Pc �t� . Land Use: V60119j Slope(Y) 5L,-ace Stones Vegetation:_ " gn MA-'!.,_O A $lug► Landfo cm: bR-ti Nl u N Position on landscape (Sketch on back) se�w_ �711klj Distances frow.: Open Water Body 7100 Feet Drainage way 7 5 o fee Possible Wet Area 7lvo Feet Property Line to Drz: ekLto Water WeL 7t°a F Oet Other DEEP OBSERV=SON HOLE LOG Depth&oct Soil t orzoa Soil,=:= Soli Color Soil MoMirg Offer Surace s (USDA) (tit�seli) (SZ:c:`•-e,Stoaes,'boulde.., (inches) Consivea .%0 vel) (: (vyR2�Z NO► gnu 18u �w L S ?.6Yr�4(b NoN� Ft;,7W M(ITrLCS DtSTw(,T MP-N07A-Ne re bt? O Z*u Ntt_S(vc R u ¢ za Gz sL Z,SY5�3 FlXm) NtAsStvg - ✓. Fa4A-sL,5 Pa ttMa-ri=t(a>7ioa c) hLA-T lc�N '('il.L 1 DevczoE3e�-cc< . Dent s b Gro d-.vat_- S�_-nd_ng Wa_-i:-t ale: 1l$a weeP_-tg;1-o=_-itFac_: Nyn1,r- 121 ZIF FORM 11 - SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table 3 Depth observed standing in observation hole, 118 inches ❑ Depth weeping from side of observation hole inches �I Depth to soil mottles Zg" inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturallv occurring Pervious Material Does at least four feet of naturally occurring material exist in all areas observed throughout the area proposed for the soil absorption material? YES If not, what is the depth of naturally occurring pervious material? Certification 1 I certify that on Oj• (date) I have passed the examination approved by the department of Environmental Protection and that the above analysis was performed by me consistent with the req tr ' g, expertise and experience described in 310 CHAR 15.017. Signature vi Date (0� Z I FORM I I -SOIL EVALUATOR FORM Page Z Date��_ZS�q On-site Review Deep Hole Number. � ' Date:(O-ZZ-`l`I Timte: 11 ;� /ten Weather: G��' Sw.1rJY 70 Location(identf-y on site plan). . Land Use: Slooe Su„ace Stones Ve-etrtion: 5D M��l� ' P��rzc H Land fo rrt: Dr- Posilon on landscape (Sketch on back) Dis-^.ces from: Open Water Boay QUO Feet Dramaoe way 5 D feet Possible Wet Axea 7100 Feet t ? to Proper.�r Line feet DrinkL -Water We1T-7 tno Feet Or ter DEEP OBSERV , ON HOLE LOG Duch Fxam Soil Forizon Soil Tdmte Soil Color Soil M0C-,7 Oche: Sur"zce (USDA.) (yt�setl) (Surf..,Sioacs,lboulden, (ind es) CorSiszca .% Gravel) i 0 — q'' AP5� Iv7R z�2 tiarJ� Z4 u- 7Z`� G BLS Z, 6(3rrt+✓S FI�N� , Mlk�r - v, Pri 7Z`�- Ito" Z Few F-4 ,0JDk5'D E Su6 A�jc, Fa=^.ttifzti.�T Q�IO�r f� gc aTlonl �c-!� _ De7ct�[:CJLL^.GT:vZ�- .��^.L•=na T/V?=:L�=Ql�: N01�1t r!'�2?7�=Lo�D����r2C=: N�(v�'. FORM 11 — SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches Depth to soil mottles inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturallv occurring Pervious Material Does at least four feet of naturally occurring material exist in all areas observed throughout the area proposed for the soil absorption material? Yes If not, what is the depth of naturally occurring pervious material? Certification I certify that on Na'V• "I (date) I have passed the examination approved by the department of Environmental Protection and that the above analysis was performed by me consistent with the re ire auung, expertise and experience described in 310 CMR 15.017_ Signature / �� Date �� Z5 Cie, FORM L - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS Massachusetts CiTOfZ — U — SEt� OSG.00 ` S-r, r � T IZS� Percolation Test Tine: . 4.C3"OQM ............................_ Observation Hcle Depth of Perc Start Pre-soak IZ : 19 I 11 •. 3� End Pre-soak Time at 12" - Tine- at 9" IZ ' 3�, Nine at 6" 43 Imo. 53 Time (9"-6") I - MuJ 'Rate Min./Inch I 7 Z r, I�GAF �3 MuJ INGI+ - Site Passe' Sit_ Failed ❑ Performed By: Qv1�_o cti-T/I- Witnss'sed By: C ALTON PAR-0WNJ 1�0, 7� a. o, N. Car;.ments: ...... Town of North Andover, Massachusetts Form No.3 NORTH BOARD OF HEALTH 3a ;sue o< ��Jr�( t y �,S•••.oE{h DISPOSAL WORKS CONSTRUCTION PERMIT SACHUS Applicant_ �4T-/ j / 1) / NAME �J ADDRESS 1 TEL PHONE Site Location llc 77 (1-61 , .r oIa Permission is hereby granted to Construct (Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee > D.W.C. No._-[ INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the prop2rty at L O OS &Mlb ,S�' relative to the application S• Iced y of A dated ICU q g for plans by ✓) ��S"� IM and dated c5*6 with revisions dated 9 /y o0 I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With 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. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. 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. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible 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. Undersig3kd Licensed Septic Installer C444 ✓: V ;;i/,. Date: Disposal Works Construction Permit#A 1 BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: Y - ,Io?>Z 0 CURRENT INSTALLER'S LICENSE# —,-- LOCATION: /C// J / o S G_ ova S LICENSED INSTAL ER: S SIGNATURE: Cf ��� d"� '�i TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use 160.00 Fee Attached? Yes ► ' S' G Z' E No Project Manager Ob. Yes No Foundation As-Built? Yes No Floor Plans? Yes No A _ Date: Approval ��� I