HomeMy WebLinkAboutHealth Permit # 8/25/2015 i
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North Andover Health Department
Community and Economic Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 571 Forest St MAP: LOT: �)
INSTALLER: Todd Bateson
INSPECTIONS
DATE OF FINAL CONSTRUCTION INSPECTION: 8/24/15
® Outlet tee installed, centered under access port
(gas baffle)
® 24" inch cover to finish grade installed over one
access port
DISTRIBUTION-BOX
® Installed on stable stone base
® H-20 D-Box
® Inlet tee (if pumped or >0.08'/foot)
® Hydraulic cement around inlet & outlets
® Observed even distribution
® Speed levelers provided (not required)
® Schedule 40 PVC Pipe
Comments:
SOIL ABSORPTION SYSTEM (General)
® Portion of lateral on street side replaced
Comments: Approximately 8' section replaced.
I
BM = Top of bottom step (assumed)
BM = 100.00
HR = 4.34
HI = 104.34
SYSTEM ELEVATIONS
ROD AS-BLT INVERT DESIGN INVERT
ELEVATION ELEV ELEV
Benchmark
Septic Tank OUT 6.74 97.27
18'+/-
Slope = 0.015'
Distribution Box IN 7.00 96.99
Distribution Box OUT 7.17 96.82
Lateral 1 TOP 722/726
Lateral 1 INVERT 96.77 / 96.73
r , , Application for Septic Disposal System S;`
TODAYS�DATE
Construction Permit — TOWN OF
NORTH 2501.00'—Full Repair
ANDOVER, MA 01$4 $125.00-Component
Important: Application is hereby made for a permit to:
When filling out ❑Construct a new on-site sewage disposal system*
forms on the
computer,use ❑Repair or replace an existing on-site sewage disposal system* /
only the tab key D-Repair or replace an existing system component—What?
to move Y our
cursor-do not
use the return A. Facility Information / f
key.
Address or Lot#
Cityfrown A ji(,
2.-*TYPE OF SEPTIC SYSTEM*: ,�� d
❑ Pump ravity(choose one) v
p �
'**If pump system, attach copy of electrical permit to application***
➢ ❑Conventional System (pipe and stone system)
➢ ❑Infiltrator or Blodiffuser(Gravel-Less)(Attach a copy of your certification to instaff this type of system.)
➢ ❑ Pressure Distribution S.A.S.(No D-Box)
A ❑ Pressure Dosed(D-Box Present)S.A.S.
➢ ❑ Does the system require an effluent filter? Yes No
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 Mod lk
2. Owner Information
Name
Address(if different from above)
City/Town ° state( Zip Code
Telephone Number
3. installer Information
Name e— Name of
Compan y
VpT d N
r•l f. f H( 1 p,,.r.y
Address
�
9 e 1� JC 7VER, MA f 0
Cityrrown State Zip Code
%7y / '"" j W°
Telephone Number(Cell Phone#if possible please)
4. Designer Information
Name Name of Company
Address
Cityfrown State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
pdMTN
Appllpatl•o .. or Septiq DISPO.Sal Syste rrl
Monstruction ' .'crr It T
TODAY'S DATE N OF
•OR.T • AND OVIER, MA 01845 $.250.60-Fun Repair
a CADS $`125.00,-Component
$ACNU+
PAGE 2OF2
A. Facility.Information continued....
5. Type,of Building: MAesidential Dwelling or[]Commercial
B. Agreement
The underslgned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system In accordance with the provisions of r/tle 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 Certlflcate of Compliance has
been issued y this Board of Health.
Name
Date
A Uc A� oved B^ ai`
I y of He lth Representative).
e
Application Disapproved,for the folowing reasons:
For O fee Use only
1. "Fee Attached, : Yes No
2,• Prolectl f"Rget Ohlrg don Forth Attached? yeo
No '
31: P= L&A=? Ifsot Attach cop y ofElectrical Petmrt Yes No
4. FOundadOnAs-BuAt,?(new construction•ronl ';
}/) Yes® No
(Same scale as approyedplan)
A. F1oorPlansa(new construction'only): Yes
No
Appllc tion'{or p(sPpsal 0y.st6n't06rt9truatloh Penn-Page 2 of 2
i
P8UGATIPM
Aa f�ie.N�rtle Andovtr ' et13 5 f tr tliiC n folih6aeptic systein for thevop at:
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ana daaed
Damd
® : Wstlt"done dated'
revised date}
I undentand the Wowing 009gatlom fat srwna9=cut ofob protect:
i, As the 30stRUC4 I ism Obl*ted io abW&allpmofts and Board oMealth appmvcd PIMB.Rft to
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pxOrjeatsuauager.or any
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_ - --- -.....--
Commonwealth of Massachusetts Map-Block-Lot
105.D0080
-- - --
i%f! BOARD OF HEALTH Permit No
North Andover BHP-2015-0343
P.I. FEE
F.I. $125.00
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Todd-Bateson
to(Construct)an Individual Sewage Disposal System.
at No 571 FOREST STREET
as shown on the application for Disposal Works Construction Permit No. BHP-201 0 �1 °° ted Au ust 12 2015
�
Issued On:Aug-12-2015 BARD OF HEALTH
Commonwealth of Massa h etts Map-Block-Lot
105.D0080
BOARD OF HEAL H
North Andover
ERTI ATE OF C MPLI NCE
THIS S TO CERTIFY,That e Individual Sewa e Disposal Syste (Construct)
by Todd Bateson
---- -
-----.----------- -------- -- ------------ ------------
Listaller
at No 571 FOREST STREET
has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the
application for Disposal Works Construction Permit No. -BHP-2015-034- Dated --August_122 2015
------------------------------- ---------------------------------
Printed On:Aug-12-2015 BOARD OF HEALTH