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HomeMy WebLinkAboutHealth Permit # 12/18/2015 Commonwealth of Massachusetts Map-Block-Lot 104.80170 ----------------------- BOARD OF HEALTH Permit No BHP-2015-0924 North Andover ----------------------- PA. FEE $125.00 F.I. ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd-Bate-son----------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. atNo -7-8-VEST WAY(R-1)------------------------------------------------------- -------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. .1311P-20157-092. DOA—P" Ibcr-1-8,2-0-15- ------------------- Issued On:Dec-18-2015 BOARD OF HEALTH ---------------------------------------------------------------------------------- rI C ti r p tt 1 t TODAY S DATE N Construction;P'ermit ` OWN OF c�► $250,00'—Full Repair NORTH ANDOVER MA 01845 $125.00-component Important: Amiication is hereby made for a oermit to: When filling out E]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 Dykepair or replace an existing system component°What? to move your cursor-do not use the return A. Facility Information key. 9 � Address or Lot# 6 � Cityfrown 2.-�pdp Sra�ty(chooseolne) � TOWN jf�� ���f' C� * elf pump sy , attach copy of electrical permit to applicahori 9 Conventional 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. ➢ ❑ Does the system require an effluent filter? Yes Noe 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 theModaV 2. Owner Information Name Address(if different from above) a Cityrr awn State Zip Code f " �7 /", Telephone Number 3. Installer Information Name Name ofCompanyl11 AF1, ehl'dDOVLC 6, tWr ,4t U Address Cityfrown State Zip Code Telephone Number(Cefl Phone#if possible please) 4. Designer'lnformta on Name Name of Company Address City/rown State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit Page 1 of 2 I 1 lip tion Or cpti .is p l , y t m jJ_4 J_5 e j e ,b°•.°�po TODAY'S DATE or`°, •; ,�n tru tin armit -TOWN O a * $,250.00-Full Repair . . MA 01845 s125.00:.comp®Went �s�AC14U . PAGE2OF2 A. Facility,Information continued.,.. 5. Type-of gyjjd ng: B<esidential Dwelling or[]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of T1tle 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system In operation until a Certificate of Compliance has been Issuay by this Board of Health. Na We lira n A prciv B • (Boar of Health-Reptesentative) - ame Date Application Disapproved.for the following reasons: For Off ea Use Only: 1. FeeAttacbed?- Yes No® 2,• Projectlllar}ager Obligation Form Attached? Yes No 3.: LMa$j stcm? Ifsoj Attach cOME aLE-1=tical Permit`,; Xes ` No 4. Fbund'adoaAs Built?(hew construction ronly), Yes No (Same scale as appr©Yed plan) 5. FloorPlans?(hew cornstructlon•only): Yes_ No._ Mplfdatldnfior•plsppsal$y.stb6i s oristractlori PermR Rage 2 oil Aaflo•Nsxxth Andover.licacteetl3 t t ,f 446 slzulcttgrifox. -septicayate fot.the�propedyat: Oe (Ad4mg ot'eqttc opt=) ( •-Farr pits by (bil1t wl Aid dMad Datod - /r --/„5 . o $ x Wft icvidaes daocd . . . rcvtstd date} I undetotand the fbNowinc obligadow fbt.mmagement ofibia prgect: ,. 1. As the ia6t a:4.I am vblivt c d io 6btaia xffPeMi and BOVA ofRe alth xpprove4 plms p t to edonftany'WO&da a edter. . ,!!s 4iertmtft' +Ip� tO1. my and aA'#p+t I£haupem. aatn c=ftctq4 prajectmasmgat,or any o*etpataatt tint ts#ochftd radth my campaetyr �an I> Qe aa�aaet tdsex aystesa is not=84 that iteszi thtaee•ahall•2:�,s�.pliatble. ''. . s • . .` Ae t6 I sip' d fv.hxvejb� wa s d•piioftlo the.applWbIt itt id sts • - aht�st b�dtin� '° •�; t�e iiiagtm�t l�!ut�i�•not ha.Pr;tio-bti pt�,s'ctix+•. 6, Out iiat diiiap>:d5taa fear -t�es,etc, M t a v cb it iDI '(ar e- 1 tirx m from the edginair must ba itibbinitfrd•toll ooBo'ttad'ofHeak alit: `� fOr,e i6vectfpn Ome, he.pte l at&r tl kaperticim va a i�;atba pao ad able to' '- 'a►nse .to�or3c�id�tatar"�a ti�w•. '• .• -.. - c• �i [atsille�mt:at requeaaP�ctsoa a►hitlt r:atppltte: Iustaliar dory aot fin ' hava#o be: tine,• - ,'' •• '' ."' 4. 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