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Home My WebLink AboutHealth Permit # 10/23/2015 i •• Commonwealth of Massachusetts Map-Block-Lot " . 10630149 BOARD OF HEALTH - � Permit No North Andover BHp-2o15-oss9 p,l, _ FEE F.1. $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James-currier to(Repair)an Individual Sewage Disposal System. W.. at No 1770 SALEM STREET, - as shown on the application for Disposal Works Construction Permit No. BHP-2015-088 Dat er 22'2015 ----- rz Issued On: Oct-22-2015 BOARD OF HEALTH Com nweal of Massachusetts M Block-Lot 1�� y - s •� 1 6._q149 .. BOAR O LTH - North n o-�er CERT E, OMP N THIS IS ER T FYj t th ndividu e Dis os ste (Repair by Ja s a er alle at No 77 EM E has been sta ran ccordance wit the ions of TITLE 5 o the State Environmental Code as cs be the co application for Disposal Works Con ction Permit No. BHP-2015-088_ Dated October 22,.2015 [Pr inted On: Oct-22-2015 - BOARD OF HEALTH Commonwealth of Massachusetts Map-Block-Lot 1� �� r,,•. 106 14 ------ BOARD OF HEALTH - -- -- --------- + Permit No North Andover BHp-2o15-oss- FEE $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted James Currier to(Repair)an Individual Sewage Disposal System. at No 1770 SALEM STREET w -- - -- -------- ------- ----- - -------------------------------- as shown on the application for Disposal Works Construction Permit No. B 2015 0 °'""°�Dtl y ctober 22,2015 --------------------------- Issued On: Oct-22-2015 BOARD OF HEALTH Application for Septic Disposal System 0 z"L Construction Permit — TOWN OF TODAY'S DATE $250.00—Full Rpair NORTH ANDOVER, MA 01845 $125.00 -Componeent 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 Repair or replace an existing system component—What? to move your cursor-do not use the return A. Facility Information key. 1 ;7;7p �c&/-'t_ Address or Lot# tad City/Town RECEIVED 2,*TYPE OF SEPTIC SYSTEM*: oc"i U11315 ➢ E] Pump 9 Gravity(choose one) *,k*lf pumps 6m, attach copy of electrical permit to application*** OWN 01:NORTH ANDOVER ➢pumps System (pipe and stone system) 4 jhpEPARTMENT ➢ ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to I M6 Is 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 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 Model? 2. Owner Infor mation . Name Address(if diff6rent from above) City/Town State Zip Code Email address Telephone Number 3. Installer Information Name Vfne of Company'v Addresg City/Town State Zip Code Tep one Number(Cell Phone#if possible please) 1, � CV&2 Cd_� r 4. Designer Information � d 4 elf- Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 i i I ��, � �• Application for Septic Disposal System Construction Permit — TOWN l�+l OF TODAY'S DATE $250.00—Full Repair NORTH ANDOVER, MA 01845 $125.00 -component PAGE 2OF2 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. 1 understand that until a final Certificate of Compliance has been issued by this Board of Health,th,a installed system is not approved. N e Date Application Appr ..,,;o,,vrW o of Health Representative) N Y 00 Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Pro'ect Mana er Ohli ation Fosrn Attached., Yes No 3. Pump Sys tem? If so,Attach copy ofElectrical Permit Yes No Applicant received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Revieived approvallettei; all paperwork received? Yes No Missing' 5. Foundation As-Built?(new construction only): Yes No (Same scale as approved plan) 6. 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: t 1770 Salem Street (Address of septic system) For plans by i (Engineer) Relative to the application of lap Currier (Installer's name) And dated (unginal date Dated 10/23/15 (May's 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 nermit on site when any Sv_oKkjS 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 cation'without completion of the item-,in accordance vyrith Tide 5 and the Board of 1 Iealth Reauladons may result in a S50,00 fine being levied against me and/or my company. a. Botto>na 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)4is action—Engineer must first do their inspection for elevations,ties,etc. As-built of verbal OK(or e-mail to: healthdept@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 other-, unlicensed to install Septic systgms in North Andover can constitute reasons for denial of the system and/or revocation or suslension of my license to operate in the Town of North Andover; Sib ificant 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 react.ed b. Inspection of the sand and stone to be used c. Final inspection by Board of.Health stafl'or consultant. d Installation of tank,D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. G. As the installer.I understand that I am Solely rc_sponsible for the installation o- the-,rA 'm a s •er the a12212roved elan-,. No instructions by homeowner,general contractor or nv other 1)ersons :.hall absolve ,,,P of this obligation. Undersigned Licensed Septic Installer:James Currier (Today's Date) 10/23/15 James Currier II ame—Print) — tgnc