HomeMy WebLinkAboutHealth Permit # 11/16/2015 —"�'r^ w e^m¢m.�m Ibum.. iuuuuur�ulomuu mrrw",ium ,a�nww ��
a
il,ll� f IN "R• Commonwealth of Massachusetts
BOARD OF H A : H
M
I' Iii
North And ver
Y 6i r li i�ili II�i :.
,II
CERT ICATE OF OM I
THIS IS T+ ERTIFYJ t the Individual Sew ge D,isposal s-
b Todd eson
_a__------ ----- ----------- ---
Installer
at No 193 FOS STREET
ha been installed in acco ance ith the provisions of TI E 5 ofth State Enviroru
ap lication for Disposal Wo s nstruction Permit No. 13 -2015- 90 Dated
Printed On: Nov-10-2015 __---__---
• , Commonwealth of Massachusetts
BOARD OF HEALTH
North Andover
Y � w
DISPOSAL WORKS CONSTRUCTU
Permission is hereby granted Todd-Batesan
to (Repair) an Individual Sewage Disposal System.
at No 193 FOSTER STREET "b -1
as shown on the application for Disposal Works Construction Permit No. BHP-2015
----
- --------
Issued On: Nov-10-2015 f,o-`
Application D1
Construction 'Pe ft-� TOWN OF
rml
NORTH ANDOVER, MA ,
Important; Application is hereby made for a permit to.
When filling out ❑ Construct a new on-site'sewage disposal system*
forrns on the
computer, use ❑ repair or replace an existing on-siter sewage disposal's
only the tab key epair or replace an existing system component Wha
to move your
cursor-do not
use the return A. Facility Information
key. 1 ,
. ` 'taa Address or Lot#
Cityfrown
ia° *TY PE OF SEM SYSTEM
➢ ® Pump gGravity(choose one)
**•T pump system, attach copy of electrical permit to application'"'i
EjtZo-nv�entional System (pipe and stone systemm),
❑ Infiltrator or Biodiffuser (Gravel-Less) (Affach a copy of y
> Q Pressure Distribution S.A.S. (No D-Box)
➢ [ Pressure Dosed (D-Box Present)S.A.S.
❑ Does the system require an effluent filter? Yes
If yes, does plan specify make and model of filter? YES
'NC? = (installer must specify bend of titter before DWC issue
What is the Make? What is the Mod,�€�
. Owner Information
Name
Address(if different from above)
A-4
Cityrrown State
Telephor
3. Installer Information
15d All Name of
Address Aj- (i
s
City/Town State
Tpipnnnr
i
, 11 ca 1" R r Septic DismsaVS
Construdion -Permit '-TOWN -OF
14 ANDOVIER,,'MA 01845
a ,
PAGE 2 OF
A. _Fadiiify infoL ation continued.... '
6. Type'_of Building: esld'ential Dwalling or ,EJCommerci
B. Agreement
The undersJgned agrees to ensure the construction and ir;
on-site sewage disposal system In accordance with the t
Environmental Code, as well as the Local Strhsuiface DI#
North Andover, and hot to place the system lri operation u
been issu y this Board of Health.
Cam _ Date
A 1 Ml Apprdv y oar o elth Representative)
N me . Date
M
Application Cltsapproved or the following reasons:"
For e use ante: ' • •
1. ..FeeA chedp' Yes
2.• Ptolect "aget 0h.&gw oa Form Attache'ur
arf
say A-ttacl5r cane vfE'l��tr�"cal�''crt` �es "
4. fora don -BWW{new constiuctlon,ronl,��: des
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