The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 44 CARLTON LANE 1/20/2016 North Andover Health Department Community Development Division QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: . , MAP: LOT: INSTALLER: DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS ❑ TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: ❑ �� .r- �" - DATE OF FINAL GRADE INSPECTION: , SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by testing ❑ Inlet tee installed, centered under access port i ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade j installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed ❑ loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: OR Appilcation for Septic Disposal System 0 TODArS DATE 0 f" — Xonstruction Permit ' TOWN OF V . - 4A V $;5 j.0Q_=_fp1_Rppair ORTH ANDOVER, MA 5 S C US r 0184 ,$1'25.00-Compo"e Important: Application is hereby made for a permit to: When filfing 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 to move your p4irepair or replace an existing system component–What? R) j*6jz_ 2e^_,+6 jv, cursor-do not use the return key. A. Facility Information 6(A/ ITV Address or Lot# REC-EIVErl Cityrrown 2.-'TYPE OF SEPTIC SYSTEM*: JUN 15 Z011 ❑Pump ravity(choose one) TOWN OF NORTH ANDOVER DEPARTMENT ***If pump system,attach copy of electrical permit to ap ' Zr ❑ Conventional System(pipe and stone system) ❑Infiltrator or Blodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑Pressure Distribution S.A.S.(No D-Box)(Attach Draft Maintenance Agreement) ❑Pressure Dosed(D-Box Present)S.A.S. 2. Owner Information Name r Address(if different from above) Cityfrown State Zip Code 33" lo Y Telephone Number .3. Installer Information BATESON ENTERPRISES,INC. Name III AgGli I A R,An Name Of C?mPanANDOVER,MA 09 Z -dress Cityfrown 4-2— State Zip Code . 9 OLl'i Telephone Number(Cell Phone#ff poss6lei/ease) 4. Designer Information Name Name of Company Address CitylTown 'late . lip Code Telephone Number(Best#to Reach)� Application for Disposal Systen,Construction Permit-Page 1 of 2 1 N°RTH Application for Septic Disposal System iTt.o °gti0 ` �"� •;,•' ' ` �» TODAY'S DATE on tructl®n Permit - TOWN OF $250.00-Full Repair goAltin.•N.� ANDOVER, MA 0184 $125.00 -Component 9sSgcNUS�� PAGE 2OF2 A. Facility.Information continued.... 5. Type of Building: e-idential 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, and not to place the system in operation until a Certificate of Compliance has been issue 'his Board of Health. Name Date Application A1,S'roved By: (Board of Health Representative) °g Name Date ,.��`� ,/ � Applicatio Disappr ed for the following reasons: For Office Use Only: I Fee Attached? Yes_ No 2. Project Manager Ohljgation Form Attached, Yes No .3 Pump Svstem? Ifso.,Attach copy ofElectrjcal Permjt Yes_ No 4. Foundation As-Built?(new construction ronly), Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only); Yes_ No W Application for Disposal System Construction Permit•Page 2 of 2 I i SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: plans pl by (Address of septic system) For (En Relative to the application of /,*X�) (Installer's name) And dated Dated I 41q-1( I/(UrigmM date) (FoUay's Z[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 permit on site when any work is 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 an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my co=aM. a. Bottom of Bed—Generally, this is the first(V) 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 Inspection—Engineer must first do their inspection for elevations, des, etc. As-bat of verbal OK (or e-mail to: healthde2t Qtownofnorthando V er.co from th e en gin ee r 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 ample 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 others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant 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 reached A Inspection of the sand and stone to be used c. Final inspection by Board ofHealtb staff or consultant d Installation of tank,D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,9 eneral contractor, or any other persons shall absolve me of this obligation.. Undersigned Licensed Septic Installer: (Today's Date) /4-1 (Name—Print)— igne