HomeMy WebLinkAboutMiscellaneous - 440 BOSTON STREET 11/24/2015 Application for Septic Disposal System
Construction Permit — TOWN OF TODAY'S DATE
0.0 —Full Repair
MA 0
01845
(:;V2
NORTH ANDOVER iirk 0 -Component
Important: Application is hereby made for a permit to:
When filling out ❑Construct a new on-site sewage disposal system*
forms on the I I
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 A. Facility Information
key.
Address or Lot#
wb
City/Town
2.-*TYPE OF SEPTIC SYSTEM*:
➢ ❑ Pump ❑Gravity(choose one)
***If pump Sys m, attach copy of electrical permit to application'
➢ W01 r ventional System (pipe and stone system)
> F-1 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)
➢ &Pressure Dosed(D-Box Present)S.A.S.
> ❑1boes 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 Information
(_5'rz_VN Al
Name
Address(if different from above)
City/Town State Zip Code
Email address Telephone Number
3. Installer Information
jl Lg%A/ A Ilk,
Name Name of Company
Address
4
City/Town State Zip de
phone Number(Cell Phone J possible please)
4. Designer Information,
Name _w�fe of 6ornp any
�`
Rvafm 'V
Address
el R't_
City/Town State e
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
1
Application for Septic Disposal System
TODAY'S DATE t
Construction Permit — TOWN OF
$250.00-Full Repair 1
NORTH ANDOVER, MA 01845 $125.00-Component 1
PAGE 2OF2
A. Facility Information continued....
5. Type of Buildlng: EIResidential 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. I understand that until a final Certificate of Compliance has been issued by
this ' if"He Ith, the installed system is not approved.
-i Board.
Name Date
tName oeti n Approv g, ( oar- f Health Representative)
I
Date
Application Disapproved for the following reasons:
For Office Use Only:
1.
Fee Attached. Yes No
2. Project Mari ger Obligation Form Attached? Yes_ Na
3. Pump System? 1f, o,Attach copy ofElecttical Permit Yes No
Applicant received copy of
"Electrical lnspectil,Notes for Septic Systems" Yes No
Handout? '"`
4. Reviewed approvallettei; all paperwork received? Yes Na
Missing
5. Foundation As-Built?w(new construction only): Yes No
(Same scale as a proved 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 syo temfor the property at:
Lt -t 0 `'�� � �� ^u'� s--T�
o.
(Address of septic*yur=ui) For plans 6r -r
(Engineer)
Relative m the application^f /n »-'m��� � -I^�`
(Installer's narne) And dated
L)^tuJ k �� \ ��
YQU`re��on,6utod / /
�,a*t revised d^t6 �
I understand the following obligations for management nf this project:
1. As the installer,I xuzobligated to obtain all permits and Board of Health approved plans igr to
performing any work ouasite. I must have the a1212roved 121ans and the 12ermit on site when anj�work is
being done.
2. Ao the installer,J must coO for any and all inspections. IE homeowner,contractor,project manager,ozany
other person not associated with my company schedules an inspection and the system is not ready,then
item three shall.6capplicable.
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 Tide 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or
my company.
u. Bottom of Bed—(}ooczxUv, this is the Oiot/1"1 inspection unless there is u retaining nnJL nddcb
should bc done first. The installer cunatrcgucxtLbcioopcctionbotdoosoothmrcxubopzoacot.
b. Final Construction Inspection—Engineer nuoat first do their inspection for elevations, des, etc. �
As-built oE verbal {}K (or e-mail to: from the engineer cuoxt
be submitted to the Board of Health,after which installer calls for an inspection time. Installer must |
6c present for this inspection. With u pump uystcnu uDcicct�culnvozk/unnr�u�ou6�uodublctn /
` -' |
cause pump ku work and alarm no function. |
o. Final Grade—IoatuUornzuatregueatiooDccduunhcuoUgrudinpiucocuplotc. Installer does not
have tn6cou-sitc.
4. As the installer, I understand that only T may perform the work (olber than silzple excapation)and I am required
to complete the installation of the system identified in the attached application for installation. T`further
understand that work done by others unlicensed to install sel2tic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of m�:license to operate in the Town of
North Andover, significant fines to aU persons involved are also t)ossible.
5. As the installer,I understand that I must be on-site during the performance of the following construction
steps:
m. Dx/xvwmiwutiow that the proper elevation of the xwxaxa/iwm has been mxuxhrd.
b. Iw{pxwi*w *f/�xx�m�m���bvwx �� �xmxx*� |
' |
c. Final inspection bv Board ofHealth staff orconsultant. �
d. Installation of tank, D`Boxpipxs, stone, vent,pump chamber, retaining wall and other �
mowp,wxmtt.
6. As the installer,I understand that I am solel,
y responsible for the installation of the system as l2er the
approved plans. No instructions by the homeowner,general contractor, or agy other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: Qbday'S'D te
UUU1 1116-11—In accorciance wim tne provisions-ot-l'ITLE 5 of t1je S,kate Environmen de as described in the
app n for Disposal Works Construction Permit No. BHP-201526� Dated No, em er 05,2015
p ...................... 1X1—
VeMT,
---------------------
�4 0
-----------------------------------------------------------------
Printed On:Nov-05-2015
-------------------------------------------------------------------------------- BOARD OF HEALTH
Commonwealth of Massachusetts Map-Block-Lot
BOARD OF HEALTH -1 0-7.-D-00-03----------
Permit No
North Andover BHP-2015-0899
FEE
------------$250.00--
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Chad Jablonski
to(Repair)an Individual Sewage Disposal System.
at No 440 BOSTON STREET
--------------------------------------------------
-----------
---------------
as shown on the application for Disposal Works Construction Permit No. BHP-2-0-1-5---089--. Dated—November-052-201-5
Issued On:Nov-05-2015 -----------------------------------------------------------------
- ----------------------------------------------------------------------- BOARD OF HEALTH
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•
North Andover Health Department
Community and Economic Development Division
October 27,2015
Frank Villalobos
440 Boston Street
North Andover,MA 01845
Re: Subsurface Sewage Disposal System Plan for 440 Boston Street (Map 107D,Lot 3)
Dear Mr.Villalobos:
The proposed wastewater system design plan for the above site dated September 1, 2015 with a
final revision date of October 5,2015 and received on October 5, 2015 has been approved.
The design plan has been approved for use in the construction of a new on-site septic system for
a 3-bedroom home utilizing a gravity leaching facility. This design plan approval is valid until
October 27, 2017.
Daring this time, a licensed septic system installer must obtain a permit and complete this work,
and a Certificate of Compliance be endorsed by the installer, designer and the Town of North
Andover. In the event an imminent health problem, such as sewage backup into the dwelling is
occurring,the North Andover Board of Health may reduce the time period for which this plan is
valid.
At a regularly scheduled meeting of the Board of Health,this plan received the following
approvals by the members.
Local ngjade Approvals:
• To reduce the separation distance from the soil absorption system to the estimated
seasonal high ground water table from 4' to 3'
• To reduce the separation distance from inlet and outlet tees to the high ground water
elevation from 12"to 10"
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035, Fax: 978,688.8476
Phone: 978.688.9540
North Andover, MA 01845
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440 Boston Street October 27,2015
This approval is also subject to the following conditions:
I. If site conditions are found in the field to be different from those indicated on the design
F
plan and/or soil evaluation,the originally issued Disposal System Construction Permit is
void, installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit(3 10 CMR 15.020(1))
2. It is the responsibility of the applicant and/or the applicant's septic system designer,
septic system installer or other representative to ensure that all other state and municipal
requirements are met. These may include review by the Conservation Commission,
Zoning Board,Planning Board, Building Inspector,Plumbing Inspector and/or Electrical
Inspector. The issuance of a Disposal System Construction Permit shall not construe
and/or imply compliance with any of the aforementioned requirements.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
/'Sn rely,
Michele Grant
Health Inspector
Encl. Installers list
cc: Doug Smith,RS
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
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Grant, Michele
From: Grant, Michele
Sent: Thursday, October 15, 2015 3:05 PM
To: 'fsrv382 @gmail.com; 'SOILSMITH @aol.com'
Cc: Hadge, Lisa
Subject: Mtg Change
i
Hi Doug
Just letting you know the North Andover Board of Health meeting has been rescheduled from October 22, 2015 to
Tuesday Oct. 27th,at 7:00pm in town hall, on the second floor, in the selectman's room.
Sincerely,
Michele E.Grant
Public Health Agent
Town of North Andover
1600 Osgood St I Suite 2035
North Andover,MA 01845
Phone 978.688.9540
Fax 978.688.8476
Email errant townofnortitandover.com
Web www.TownofNorthAndover.com
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Douglas J. Smith
R. Kate S771ith
15 Foxherry Drive
Neiv Boston, NH 003070 RECEIVED
(603) 487-2298
SOiIS771ith @ol.corn
TOWN OF NORTH ANDOVER
October 6, 2015 HEALTH DEPARTMENT
To: North Andover Board of Health:
Re: Variances for septic system located at 440 Boston St., Tax Map 107-D Lot 103 for
Frank Villalobos.
I would like to be put on the agenda for the Board of Health meeting on Oct. 22, 2015 to
discuss local upgrade variances.
The variances we are seeking are State DEP local upgrade variances:
1) 310 CMR 15.405(h) requesting a local upgrade approval for the requirement of a
4' separation between the bottom of the soil absorption and high groundwater
with a reported perc rate of 3 min per inch. This results in a P reduction
resulting in the bed bottom being 3' above high groundwater.
2) 310 CMR 15.4050)Requesting a local upgrade approval for the requirement of a
12" separation between the inlet and outlet tees and high groundwater. A 10"
separation is provided for the septic tank and a 5" separation is provided for the
pump chamber. Rubber boots are provided on tank and pump penetrations.
I appreciate your consideration!
Sincerely,
Douglas Smith, RS, MS,CWS,SE
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Grant, Michele
To: SOILSMITH @aol.com
Cc: Hadge, Lisa;fsrv382 @gmail.com
Subject: RE: Revised pdf 440 Boston
Hi Doug,
Now that we have an approval plan to present to the Board of Health. I Just wanted to follow-up on our phone
corpersation this morning in regards to the 3 items that are needed to move forward.
1. Check for$75.00 made out to the Town of North Andover.
/2. A Letter requesting to come in front of the Board. Listing the LUA's and why.
e73. 3 Copies of the Approvable Plan for our Board Members and the file.
Again, please call me with any questions you may have.
Sincerely,
Michele E.Grant
Public Health Agent
Town of North Andover
1600 Osgood St I Suite 2035
North Andover,MA 01845
Phone 978.688.9540
Fax 978.688.8476
Email mgrant townofnorthandover.com
Web www.TownofNorthAndover.com
From: SOILSMITH@aoLcom [ma!Ito:SOILSMITH@aol.com]
Sent: Tuesday, October 06, 2015 7:55 AM
To: Hadge, Lisa
Cc: Grant, Michele
Subject: Revised pdf 440 Boston
Hi Lisa and Michelle enclosed is the revision per the Sept. 30 comment letter Thank You!
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