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Home My WebLink AboutMiscellaneous - 1 GRAY STREET 4/30/2018m m TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Mainn Street NORTH ANDOVER, MASSACHUSETTS 01845 APPLICATION FOR SOIL TESTS DATE: December 5, 2017 OF NAQRTj 4y m O D S�+cHuse 978.688.9540 — Phone 978.688.9542 — FAX healthdept@northandoverma.gov www.northandoverma.gov MAP & PARCEL: Map 107B Lot 50 LOCATION OF SOIL TESTS: Off of back left corner of existing house OWNER: Mike Rullo Contact #: 603-401-2888 APPLICANT: (Same as Owner) Contact #: ADDRESS: 1 Gray Street North Andover, MA 01845 ENGINEER: Jack Sullivan Contact #: 781-854-8644 CERTIFIED SOIL EVALUATOR: (Same as Engineer).... email: jacksull53@comcast.net Intended Use of Land: Residential Subdivision =Singleamily Home Commercial Is This: Repair Testing: X Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes THE FOLLOWING MUST BE INCLUDED WITH THIS FORM No X ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11 "Plot plan & Location of Testing (please indicate test pit sites on tile plan) ➢ Fee of $585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $440.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Signature of Conservation Date back to Health Department: (stamp in): 1 I Town of North Andover, MA December 8, 2017 107.6-0078 1107.8-0048 I C f C h O m 107,8-0049 1 107.8-0050 oc �o 107.8-0051 107.B•0154 r c" m 1107.8-0052 107 Google 1 Re96 ftmep a rar Property Information • a t ;, a: Property ID 107.8-0050-0000.0 Location 1 GRAY STREET Owner RULLO, MICHAEL F MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover, MA makes no claims and no warranties, expressed or implied, concerning the validity or accuracy of the GIS data presented on this map. December, 5, 2017 Town of North Andover North Andover, MA 01845 To whom it may concern: I, Mike Rullo, owner of 1 Gray Street, North Andover grant permission for soil testing on my property for a future septic system. Thank you, Michael Rullo 1 Gray Street North Andover, MA 01845 Type 6 0 Town of North Andover CHU HEALTH DEPARTMENT CHECK #: DATE: LOCATION: / 6r& c/ 57L 0 H/O NAME: '40 Dalcit CONTRACTOR NAME: -5-ulliVal? Type of Permit or License: (Check box) 0 Animal $ 0 Body Art Establishment $ 0 Body Art Practitioner $ 0 Dumpster $ 0 Food Service - Type: 0 0 Funeral Directors • Massage Establishment • Massage Practice $ • Offal (Septic) Hauler • Recreational Camp • Sun tanning • Swimming Pool $ 0 Tobacco $ 0 TrashlSolid Waste Hauler 0 Well Construction SEPTIC Systems: h/vo Septic - Soil Testing 0 Septic - Design Approval $_ 0 Septic Disposal Works Construction (DW0 $ 0 Septic Disposal Works Installers (DWI) $ 0 Title 5 Inspector $_ 0 Title 5 Report $ 0 Other (Indicate) $ H6Uh-Agent Initials White -Applicant Yellow -Health Pink --Treasurer APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPART P. ENT --NORTH ANDOVER, MASS* Frank r. Rullo Gray Street I hereby make application for a permit for a sewage disposal installation at Gray Street . I will install this system in accordance with all the lavas of the Commonwealth of Massachusetts and regulations of the Board of Health of the Towyn of North Andover. Further# I will construct the house sewer of bell and spigot pipet the minimum diameter being 4 inchesp and will maintain a minimum grade of V until 10 feet preceding the septic tank# where the grade shall not exceed 2%. I will install a concrete septic tank of 750,f,,.1._- in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with open jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches# the bottom of which will provide a minimum of 208 lineal (iglu feet of effective absorption area. The pipes will be laid on a 6 inch layer of gashed gravel or crushed stone ranging in size from 3/4 to -1M1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench# 2 inches of gravel or stone 1/81r to 1/4n (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/:1.00 feet. No single tile line will exceed 100 feet in length and in any case# two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the in- stallation will be less than 100 feet from any private water supply.. 25 feet from any stream# 20 feet from any dwelling or 10 feet from any property line. I further officer, as provided below# and may be attached to the permit. DATE to incorporate any additional requirements tha Plot Plans must be submitted with application. Signature A^Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover# Massachusetts, DATE Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as describe . DATE./ 2 s Signature Inspecting Officer Percolation Test � min. Subsoil- sandy -clay Garbage Grinder . _ No September 5, 1957 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Gray Street building site of Frank J. Rullo. The subsoil in the area was of a sandy clay content and a 5 -minute percolation test was conducted. The land in general is high. It is recommended that a 750 gallon concrete septic tank be installed together with 208 lineal feet of drain pipe in order to take care of an automatic washer. Very truly yours, William J. 'scoll 4 BOARD OF HEALTH TOWN OF' NORTH ANDOVERS r4ASS. f L t 4 -- ys'--------� W Dic 1. NA JZ . FR . �'. U L. l.. 4 . . . . . . . DATE 2. ADDRESS f r�1 f' EAS 7 S T,.� ry %��. LOT N0. . . . TEL.'r.� 3. NO, OF BEDROOIS DEN YES NO.. . GARBAGE GRINDER YES N0, v. . 5. SHOW DII-1ENSIONS OF HOUSE � 6. SHO!►? DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMNSIONS OF LOT'S 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL ✓ 9. NOTE LOCATION AND DISTANCE OF WELL FROT4 SE UGE SYSTEM NO 10. SHOW LOCATION OF BROOKS] STREAr•:So DITCHES, LEDGE OUTCROP, ETC. US SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE ✓ NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. ✓ r, � �l; e � , \� �'�� ;. �� . � �.. /9/'i��-fir FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** �7 p *7 APPLICANT � ANk J : J ��8�9iQ' �) U'LC PHONE 6 F63 ? LOCATION: Assessor's Map Number /U PARCEL_ SUBDIVISION LOT (S)_ STREET Y ST. NUMBER *****"*"***********OFFICIAL USE ONLY******TT****�**�**�***�** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED la DATE REJECTED COMMENTS PJ S TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH ,S TIC PECTOR-HEALTH DATE APPROVED /%/g' �X DATE /R'EJECTED COMMENTS. = P -L DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT BUILDING DEFAR T MEENT' RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm UP iii I ZZ.:zz w CL O