HomeMy WebLinkAboutHealth Permit # 3/10/2008 *4 ,1 --
Commonwealth of ---
Massachusetts --
Board of Health 107,D-0004-
P.I. North Andover Permit No I
SAC F.i. - BHP-2008-0013
FEE
Disposal Works Construc X250.00
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P
e
rmission is hereby granted Todd Bateson n ernl1t
to(Upgrade)an Individual Sewage Disposal System.
at No 394 BOSTON STREET
as shown on the application for Disposal Works Construction Permit No
BHP-2008-001 /Drfated////////March 10 2008
Issued On Mar-10-2008 , f
, �_,.,
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--------------- _ - u Board of Health
h
Commonwealth of Massachusetts
Map-Block-Lot
Board of f H 107.D-0004- I
North
Andover i
Certificate Of Com e
pn _.
lis c
THIS IS TO CERTIFY That the Individual Sewage Disposa m"
l Syste "`"U
by Todd Bateson
.p--radel
Septic V System°4 ° TM W G� '1r111 Apolicatlon or
TODAY'S D TE
- Construction Permit - TOWN OF
* 250.00 Full ReaW
RT ANDOVER MA 01845 w
cHU $1 :Onoponent
i
Important: Application is hereby made for a permit to:
When filling out
forms on the El Construct a new on-site sewage disposal system*
fr❑ „
computer, use N4epair 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
use the return
key. A. Facility Information
rQ Address or Lot#
CityfTown
2.-*TYPE OF, EPTIC SYSTEM':
❑ Pump ® Gravity (choose one)
*** pump system, attach copy of electrical permit to application***
onventional System (pipe and stone system)
❑ Infiltrator or Biodiff user(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
S� Y& P �-0c,JLL,
N°RrN.T Application for Septic Disposal System - '
TODAY'S DATE
. ° -Construction Permit - TOWN OF
, MA 01845 $ 250.00- Full Repair
ORTH ANDOVER
�9S^• .�� $125.00 -Component
SACNUSE
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: 24esidential 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 issyd by this Board of Health.
Nam Y Date
Applicati Approved B Z�Board of Health Representative)
Nafiie `��`"� Date
Application Disapproved for the following reasons:
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
j (Engineer)
Relative to the application of
(Installer's name) And dated
_ ngma ate
Dated
o ay s ate With revisions dated
(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 approved 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 requesting 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.