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Home My WebLink AboutHealth Permit # 12/10/2015 Commonwealth of Massachusetts Map-Block-Lot • " �'"'` BOARD OF HEALTH 081.00037 North Andover TI T HISIS TO CERTI Y,Tha the l divid Sewa Dis al Syste (Repair) 1 by Todd Bateson ------ -- Install at No j BRAD ST ET pp Disposal -- - - – - - h installed in accorda e wit the T LE 5 of the State onm,e al Code as es ribed in the application for Dis osal Works ruction Permit No. —HP-2-0-1-57-090- Dated---November 10 20 5 ------------ Printed On:Nov-10-2015 ------ - ----- BOARD OF HEALTH Commonwealth of Massachusetts Map-Block-Lot BOARD OF HEALTH ------061,00037 --- -00037 - --------------- Pennit No North Andover BHP-2015-0904 FEE $250.00 DISPOSAL, WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Bateson - -------------- to(Repair)an Individual Sewage Disposal System. nt Nn Q 1 DD A YlUciTf T-% ci rI --- Application for Septig-Disposal stem TODAYS DATE Construction e > it — TOWN 2501: —Full Repair NORTH ANDOVER3 MA 01845 .oa-Component l Important: Application Is hereby made for a pennitto: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer,use epalr or replace an existing on-site sewage disposal'system* only the tab key n Repair or replace an existing system component—What? to move your c 1)cursor-do not � use the return A. Facility Information ll key. YL r� �✓r ` Address or Lot# ^u TOWN OF N( �N uI, Gityn'own �6i.r��'i.i i C)�.�"'f°4i-�T �-6vi 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump cavity(choose one) ***If pump sy m, attach copy of electrical permit to application" ➢ onventional System (pipe and stone system) ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) A ❑ Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed (D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes Na If yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of filter before DWG issuance) whatis theMakeP What is theMo&V t p- lIc . tip for Septic .i po: l : tone �p ConstYUctlon—Permit �TOW �� TO DAYS DATE x v' j t . RT14 AND V � A 01845 x.250.00-Full Repair '� "''°°•• ' om$125.00-C anent ,ssgewus p PAGE 2 OF 2 A. facility.Information continued.... 5. Typo-of Building: esidentlal Dwelling or®Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-descrlbed 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 1n operation until a Certificate of Compliance has been Issued by this Board of Health. Name Date p I ca(ti© A proyod y: oar of e�a h Representative)) Ta � I As f wN armc=sedaistvd Dateds - ------ (1-0clars l tts dated (Dart taised dste) I undmftd the following obligations far eat of Shia proycc ,, I. As the is I'am.obliptmi iv abtra&&Up and Bo offIe�titb+�pprov 4 glace' to � any.'mosY visa.ac tsita• Mai ftra 2. As tliaisstmtteWlI.�tItf< taaci tiff It aontrac pmjectmagrs,or unp o�ucpateon:rott wA jrbedUj"*ninSVOC oCMtnd'the Sptcin ian®txrady tkc 'item t1>ta�tdsall.hs�,t�,plit�ibla '. ` .`' As4ob ;mar, q fAh&vat'oa piica to thesppl4b kw 't�ttk'�Ide5l�tct�tt�l�bt3 dEl tttlt iiAiev �n,4 ,:.a eriinr w__s`,�.... �.�_�_ I — . . ...