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Home My WebLink AboutMiscellaneous - 250 CLARK STREET 10/23/2015 (4) � �T'fLEDl6ya'-, • • ■ PUBLIC HEALTH DEPARTMENT Town of Forth Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 11/5/2013 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System By: Timothy Willey At: Clark tree Map t North Andover, MA 018 Tlie Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Michele Grant Public,Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web wwwAownofnorthandover.com i ® "v E p rovvv'j 0 �i t4 II A"EAL j h[) UtiA I EI H PUBLIC HEALTH DEPARTMENT Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System -constructed; O repaired; (Print Name) Located at: (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated j and last revised on � �� , ,with a design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative(Signature) And—Print Name Final Construction Ins echon Date: - Engineer Representative(Siinaturil.-) And—Print Name Installer., (Signature) Date:A,� 9(),y U,,. I L An Print Name ^ Engi eer: `" ignature) Date: ( L _ AACAS And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com I r North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 250 Clark Street MAP: 75 LOT: F INSTALLER: Timothy Willey DESIGNER: Williams & Sparages PLAN DATE: 4/16/13 BOH APPROVAL DATE ON PLAN: 4/18/13 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 6/26/13 DATE OF FINAL CONSTRUCTION INSPECTION: 7/31/13 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Contractor reports any changes to design plan ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ® Building sewer in continuous grade, on compacted firm base N/A Cleanouts per plan X Bottom of tank hole has 6" stone base ® Weep hole plugged ® 3000 gallon tank has been installed H-20 loading ® 2-piece tank construction ® Water tightness of tank has been achieved by vacuum testing ® Inlet tee installed, centered under access port ® Outlet tee installed, centered under access port (effluent filter) ® 24" inch cover to within 6" of finish grade installed over all (3) access ports ® Hydraulic cement around inlet & outlet Comments: Tank is 12 feet from corner of the building. PUMP CHAMBER X Bottom of tank hole has 6" stone base X Weep hole plugged X 1500 gallon Pump Chamber installed ® H-20 loading X Monolithic tank construction ® Inlet tee installed, centered under access port ® Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ® Steel hatch cover at final grade installed over pump access port ® Water tightness of tank has been achieved by Visual testing ® Hydraulic cement around inlet & outlet Comments: CONTROL PANEL Alarm & Pump are on separate circuits Alarm sounds when float is tripped ® Location of control panel: outside near manhole ❑ Alarm signal located inside: ??? Comments: 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) Comments: SOIL ABSORPTION SYSTEM (General) X Bottom of SAS excavated down to C soil layer, as provided on plan X Size of SAS excavated as per plan 33' from bldg. X Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan ® Retaining wall (block) ❑ Final cover as per plan Comments: Bank sand not so great. Has sieve analysis lots of rocks. 34Wx55L SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber: Cultec 100 ® Number of chambers per row: 6 ® Number of rows (trenches): 8 Comments: Total Chambers = 48 FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer As-Built Plan BM = 135.71 HR = 5.01 HI = 140.72 SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Sewer Manhole Inv 7.29 133.43 133.48 Septic Tank IN 6.98 133.39 133.27 Septic Tank OUT 7.23 133.14 133.02 Pump Chamber IN 7.40 132.97 132.98 2" Pump Chamber OUT 7.86 132.69 132.73 4" Distribution Box IN 2.97 137.40 137.35 Distribution Box OUT 3.15 137.22 137.18 Lateral 1 TOP 3.36 Lateral 1 INVERT 137.01 137.00 Lateral 2 TOP 3.36 Lateral 2 INVERT 137.01 137.00 Lateral 3 TOP 3.36 Lateral 3 INVERT 137.01 137.00 Lateral 4 TOP 3.36 Lateral 4 INVERT 137.01 137.00 Lateral 5 TOP 3.36 Lateral 5 INVERT 137.01 137.00 Lateral 6 TOP 3.36 Lateral 6 INVERT 137.01 137.00 Lateral 6 TOP 3.36 Lateral 7 INVERT 137.01 137.00 Lateral 6 TOP 3.36 Lateral 7 INVERT 137.01 137.00 Lateral 8 TOP 3.36 Lateral 8 INVERT 137.01 137.00 Top of Chamber Bottom of Bed/Chamber 4.20 136.52 136.5 CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). s As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30,respectively,pursuant to 15.211(3), also by NA wetland bylaws i i Blackburn, Lisa From: Blackburn, Lisa Sent: Wednesday, October 30, 2013 3:23 PM To: Jill Mann (fill @mannpc.com) Cc: 'Sawyer, Susan' Subject: 250 Clark St. Attachments: Installation Certification.doc Hi Jill, I received the copies of the as built for 250 Clark St. We also need the attached form signed by Williarns Spara es and the installer (Tirnothy Willey). We need you to return that to us with both signatures before we can issue the COC to the owner. Thank you. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street,Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Ibaackburn towrnofnorthandover.com Web www.TownofNorthAndover.com 1 i Williams & Sparages Transmittal Letter w 3 191 South Main Street, Suite 103 Middleton, MA Phone: 978-539-8088 — WILLIAMS cL7— SPARAGES Fax: 978-767-8579 1'00 OF",- � . n.s To: North Andover Board of Health Attention: Susan Sawyer, Health Director 1600 Osgood Street, Bldg 20, Unit 2035 North Andover, MA 01845 Re: #250 Clark Street Job Number: NAND-0020 r ! //'� ",,..',"�r y"�j� //!h �—""TI "r�.,.-",r""'"""^' / ,5;3N91/,,171-....r/ « t./J/ r !ifr /, ,„; 1✓ !/!/ �, / r rr ri./ ,r i rr r. / :K,✓ r �..rr�i, r: /✓,.. /"/Ir lD i//r(l% J/%r.,//ii�i i -rf.r..J , ;/�yy,/ �,r,(,,„„r ,c ,,,r r/�/ i7 //r !+ ,, ,� ',,. ,,;, r ✓ / �c„' /rr�Y ,,, .�.,i ,r/,1C/i� r,,,,,,.�_�,,,,r o-. /1_e� ,rt�—r.,...!�....w��i�. t,r/.%C;�,�Jr L/ ,,,r i rYf✓s, �r,„.r,;%.,..�..Lc.,�,:.�,,.ru.._�..,.�..:.�.�,,..�.�..�.,.„..„..al«..w.�.:.r��( �l« Q Attached ❑ Under Separate Cover via: [Type text here] the following: ❑ Shop Drawings ❑ Prints Q Plans ❑ Other: ❑ Copy of Letter ❑ Change Order ❑ Samples ❑ Total Quantity ❑ Reproducible ❑ Specification d ✓ /J r ,r't1 ✓7,%d//' r,;.L /(i r/1! ! ,�, / J/ l p ilr . k, � / rcItlo /% 3 10/23/13 1 Sheets Septic As-built Plan - #250 Clark Street (includes one original stamp &signature) i r/rr> r r, ✓/r/(�,/�/ r. -7.7' ,'; r /”,,. !// r r 11/. .,J « / / r r '' "'y r,. r//,.L,« r..,lf1. � Jr,O 1�. ;:, r i r%. 1 /..lJ„ ,. G/. e , �(r rr'!// �, �r .1":, fa r rr,a // r r ( //G rl��/JIl?'..T//�i,� // r / al lir F//ur // =✓i // r „Gfr)/,,, /r rr �✓ I i,r. ? Glruli, Jl ii .1 �i�r�?��i,,,r."7i,a,r�i,rrric,,,'fi,,, ir,r rr./��r a // r �/i r�. r///�f i�, r ✓r r., a/,� ,� ,. ril�rW'i/d/ �,ryir„r✓., �r..�„ r,.r //�, �O,.f�//i i�,.r�l� (r�.,/, „/o, /.,v /��r✓ ,,.„ ✓„ .,�..... Er��c,lr Q For Approval ❑ Approved as Submitted ❑ Resubmit copies for approval ❑ For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN 5,,r ra%„!✓',r,,,,�;.,.,f. �'�/l y"i y r,,S,r,7,�.,,c.l,,;;”"��,Y+f rir„r a 1/ri�/�,.,r„C,„�",,,,I/!r!rI 1�f n.?.,l��/1. r v///ld,,i/r JN//r!!% ,va.r/r J r r r,.�..,.,,i r,/.�,�/v r y�J r/?r/r/��/r,i,f��(r r,ra ua «A0 r,,,�r ,,,,,✓:,, rC !r:r J r��/«/://;///d r,r r.�...i,,,f✓,,.. r r/,,,,,�,,/./r.r,:./,I,////r��/� r 12 7..^7.,T r „D_ ,-,,// 7// � G/ %P � '7 "7/ r r T / r 410 G "g,'' .. ,,. e. Dear Susan, Looks good out there...we ran through the Town's check list ...everything should be on the plan. Thank you. �. �d/, y l r....l. .r,r. 1. .,r,,.,✓ .rr . rl�/ �/ !,a�? 1��,� ,��./ir r,n a„TG,!� ,,,,,/ /�/�✓� �� r / � r�f/n, t Jill Mann Scott Stetson, KEYW Si nature, Chris 5 arage E. Sawyer, Susan From: tim340 <tim340 @aol.com> Sent: Wednesday, August 07, 2013 9:03 PM To: Sawyer, Susan Subject: Flight Data Septic D-box m ,ate Oi ma i / ➢1y t„' � t i' ' Vii/ 1� i r r � '� �� ins �i 4�/ r�/r✓ i��i � 1/ �� l/ �� J �G 0, ;r” �� I / �' lr�r � l�1 i 'ii"✓/' i ",�� l i '%w % ,c r l Oi/i IM, 0111"1 ! �'%e tee, r i r ��r�w, �,,, ,,,.1� ., �G��.a✓/, ,a�i',/ 'r�i�r�rr�„„ �.��r °,�� ,,, �,� "�' fi . ............... .,,........... ,,,-- , Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For rnore information please refer to:httDJ/www,sec.state.ma,ars/pre/ (idx.htm. Please consider the environment before printing this email. 1 I I Blackburn, Lisa I From: Isaac Rowe <irowe @millriverconsulting.com> j Sent: Thursday, August 01, 2013 4:27 PM To: Blackburn, Lisa; 'Dan Ottenheimer'; 'Pam Lally' i Cc: Sawyer, Susan; irowe @millriverconsulting.com Subject: RE: 250 Clark St. Attachments: 250 Clark Street - Final inspection.doc Susan/Lisa, Attached is the final inspection report for the above referenced property. I spoke with Tim Willey and he will call your office when the pumps have power and everything is ready for inspection. Please let me know if you have any questions. Thanks, Isaac M.Rowe,R.S. Project Manager MM River Consuffing 6 Sargent Street 1 I i Gloucester, MA 01930-2719 Phone:(978)282-0014 Fax: (978)282-1318 irowe re~7a millrivercon ul inq.com www.millriverconsultin .tom From: Blackburn, Lisa [maiIto:LBlackburri townofnorthandover.com] Sent: Tuesday, July 30, 2013 3:41 PM To: Dan Ottenheimer; Isaac Rowe; Pam Lally Cc: Sawyer, Susan Subject: 250 Clark St. Good Afternoon, Please call Timothy Wiley 503.328.7197 (installer) for inspectlon at 250 Clark St. Thank youo- Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street,Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Ilackburn @townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most ernails to and from municipal offices and officials are public records.For more information please refer to: htm. Please consider the environment before printing this email. 2 L\ Con7monwealth of Massachusetts Official use On _ - - Department f ire Services permit No. � BOARD OF FIRE PREVENTION REGULATIONS lOccupancy and Pee Checked [Rev.9/051 (leave blank) APPLICATION FOR PERMIT TO-PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(AEC),527 CMIL I2.00 (PLEASE PRINT.W INK OR TYPE ALL INFORMATION) Date: City or Town of: i- To the Inspector of Tirss: By this application the undersigned gives notice ofhis or her intention to perform the electrical woik described below. Location(Street&Number) �Grp e1 A 2)t 5 Owner or Tenant �I�L,Hi LANbAi A =s 7 TelephoneNo.. q76 em-95W � Owner's Address Sa m r Is this permit in conjunction with a building permit? yes Nn (Check Appropriate Box) . Lion No. ') ( . Date M a ®®m TOWN OF NORTH ANDOVER ® PERMIT FOR WIRING leo beivaived the L's ctoro/fYrres. :y I. Total nsformers RVA S3gC USE nerators A . Of niergeney g Otte Units This certifies that :.:.., ..( "a � �_r 's " rtT.Aitlbi(C \° Id .ofZones has ermission to erform ...... ... .' .OfDetection d P P Ini tia ' DeJ'ces 3 t _ wiring in the building of i' 4 / ofAlertin evices ... of Self- n t ......................................................... North Andover,M3S . tecti:on!- ertina Devices ; Ical❑ unecfi n ❑ Other Fee.j.`... .. :.....Lic.No ::.'6(6, .i ¢ ...... ... ....... �GC� ,> .4-, urity stems:* f ELECTRICAL INSPECTOR NO. fJuevice,SOrE uivalenf .) Wig: Check# N of Devices or E uWaleat ecommunications Wiringg ° No:of Devices orE urvatent f -_ - __-- - ---- - - —flttacl'additional de[aiL r desire Estimated Value of Electrical Work: pao,ee hen d,arasreguiredbythelnspectoraffTrires Work to Start: required by municipal policy_} �I s l I Inspections to be requested in accordance with AMC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless Wr the licensee provides proof ofliability insurance including"completed Operation"coverage or its substantial equivalent. The undersigned certifies that such cov Qe is in force,and has exhibited proof of same to the permit issuing office_ CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Spec- �y:) E;z�►e� . .I certify,trader the pair's and penalties ofperjury,thattlre i'fornurtior�on ris application is tare mid con'plet� FIRM NAME: -`,,,,,,5 ��- LIC.NO.:at. r E � Licensee: S Signat _ (Ijapplicahle,enter 'exempt"in the License number line.) �� I"IC-NO`-1,3 3 Address: /4 Ltaej-,r S— ."„ o�etrer,l r�'a Bus.Tel.No.; g7g7�'759's 2: "Security System Contractor License required for this work;if applicable,enter the license number hare.No.: O'WNER'S I NSURANCI,,ti'VAIVER- I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I amthe(check one)❑owner .❑owner's agent Owner/Aent Signature` Telephone No. PERT FED: 9i i u LL LL. Z CL -21 1 1 0 1 41 CYO ' O.L 4t 41 ^ 2,50 CLARK STREE]f Permit No.- BHP-201,3-0742 North Andover BOARD OF HEALTH Fee Type.- Account No., Septic Account Rev DWC-Fiffl Repair PERMIT Receipt No: REC-2013-001602 Paid By: Paid in Full On: Mon Jun 03,2013 Received By: Check No- 16637 Lisa Blackburn DEPARTMENT'S COPY ArnOUnt: S250.00 Commonwealth of Massachusetts Map-Block-Lot North Andover CERTIFICATE OF COMPLIANCE THIS IS TO CERTIFYThat the In ual Sewage Disposal System air) /G I eZ -- ----- - - --- \ Inst a]ler 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. _13HP-2-0-1-37-074-- Dated---June 03,2013-------- ED I Map-Block-Lot Commonwealth of Massachusetts BOARD OF HEALTH Permit-No------------ FEE DISPOSAL WORKS CONSTRUCTION PERMIT 9 +1 Pod r to(Repair)an Individual Sewa e Disposal System. at No 250 CLARK STREET as shown on the application for Disposal Works Construction PermitNo. BHP-2013-074 Dated June 03,2013 I s sued On:Jun-03-2013 BOARD OF HEALTH i Application for Septic Disposal System Construction Permit — TOWN OF TODAY'S DATE T 01845 $250.00—Full Repair ANDOVER. ACHO ` $925.00-Component Important: Application is hereby made for a permit to: When filling out forms on the El Construct a new on-site sewage disposal system* 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—What? cursor-do not use the return key. A. Facilit y Information r� Address or Lot# City/Town 2 -*TYPE OF SEPTIC SYSTEM*: qPump [:] 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 Maintenan et�t IVED El Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Name dtAtw��kPAPT�61 Address(if different from above) Citylrown State Zip Code Telephone Number 3. Installer Information Name Name of Qqtfipany Address Z2,1,,,,/"."v a' 6,_-L,w ,d 1 "^"G s .�"" ✓P'. fd Wr ^e.� d9/7!� !�% c.; City/Town State Zip Code 1) Y l Telephone Number(Cell Phone#if possible please) 4. Designer Information °K 4 �dot Phl 1 l i t l Na/me Name of Company Address Cityrrown State Zip Code - -,c Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 i i 04 ° Application for Septic Disposal System aM � "„_� `' • '� TODAY'S DATE Construction Permit - TOWN OF ORTH ANDOVER MA 01845 $250.00_Full Repair , CPeU $125.00 -Component '�� t PAGE A. Facility Information continued.... 5. Type of Building: ❑Residential 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 is by this Board of Health. f�a[pe_........._........ .r...a. Date r Application A `roved By: (Board of.Health Representative) Name / Date Application Disappro d for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached. Yes= No 3. Pump Svstem? If so,Attach copy ofElectrical Permit Yes=” No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved p)an) S. Floor Plans?(new construction only): Yes No 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 5r41 V,66 (Engineer) Relative to the application of -7/�1ti(t!r W i d,, (Installers name) And dated ,) 7 -/-4(J ngui ate Dated 3 /3 o a s ate With revisions dated ( l w (L,asf re 'sed 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(1s)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:healthdept @townofnortliandover.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 my license to operate in the Town of North Andover, significant 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. e. 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 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. Undersigned Licensed Septic Installer:_ (Today's Date) (Name—Print) ame— lgne