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Home My WebLink AboutSoil Testing Results - 105 WINTERGREEN DRIVE 6/8/1999 1 , BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: &I Ojfc4 LOCATION OF SOIL TESTS: t,c 9 k VIA96 0 e n1 Assessor's map & parcel number: ti o4 \99 (7� 6,813— ��®OWNER:�Y � 41 e4 �1� ADDRESS: Ion ENGINEER: /l�e�,� ,,., � TEL. NO.: 68 CERTIFIED SOIL EVALUATOR: Vie,, ,, Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing N. A. Conservation Commission Approval: 1 THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of 2$ 75.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. 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). 7. Within 60 days of testing soil evaluation forms shall be submitted. All POP. MOUSE IZ3 00 Do r j 14 r •� ...�- I � r �� .��r�F 7P. 3� lSB � I I I ► i I - ;, -- , . �o&4z n £ gar! u v Li � r 4a a ~ U VE:tiJE,�✓ r 1 y'rl�lr� � C7 VE f 4 n k rc, t crt 5 a u' d r� f J f I o. r', W - l G y .z : I+OIZM I I - SOII, EVALUATOR I,'ORNI Page I of 3 No. / 2 Commonwealth of Massachusetts ^l.' ,�. , Massachusetts Soil Sui bility Assessinelzt or On-site Sewa. eosal -Z:>/_-k4,OX j e- _ Date: -11Z-1-f117 Performed By. Witnessed By: ' � ' l.aca�ion hddrest �✓ gym ,pp�"' ®. /d,� ,4 C9�� Address.and �a'7� Grc✓/N/Z'i7G GlYC,.G--7�`"e °"'"- Lat I Telephone / New Construction ❑ Repair FRI office Review Published Soil Survey Available: No ❑ Yes ' �// Soil Ma Unit Year Published Publication Scale i.... p Drainage Class Soil Limitations Surficial Geologic Report Available: No �] Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No El Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) - Current Water Resource Conditions (USGS): Month W61w-19-- Range :Above Normal El Normal ❑Belcw Normal Other References Reviewed: DEP APPROVED FORM- 12/07/45 FORM 11 - SOIL EVALUATOR FORT I Page 2of3 Location Address or Lot No., A/0 On-site Review r7 j 'e Deep Hole Number .: Date:� Z/�/ Time;�� Weathe is Location (identify on site plan) � f� ..::.`3!' -G . ..:.....:.:...:..:.::........,.. Land Use .:. '` '�L Slope M Surface Stones Vegetation . . .. Landform Position on landscape (sketch on the back) Sim Distances from: Open Water Body/�� feet Drainage way/ feet Possible Wet Area 2 . feet Property Line . .f0.:.. feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG" Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) NUNIMUM OF 2 ff5UES7EUURED AT EVERY PROPOSE -�� Parent Material (geologic) 49'!� DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: /N7 DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR I+OIZNJ Page 2of3 Location Address or Lot On-site Review Z, a Deep Hole Number °2 Date:.... Time�.. ...:. . Weather��/Z Location (identify on site plan) .:. :.:. . Land Use ...: sf ?`<�G Slope (%) Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body/5�D feet Drainage way Irv. feet Possible Wet Area 113 -. feet Property Line . feet Drinking Water Well . . feet Other .....:.:::.. DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) a� G co�i�aL NIMUM OF 2 HOLES REQUIFIELTAT EVtRY PROPOSED DISPOSAL AREA Parent Material(geologic) �C�C�G �� ` DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: `— Weeping from Pit Face: Estimated Seasonal High Ground Waters DEP APPROVED FORM-12/07/95 i DORM I I - SOIL LVALUATOIt FORA4 Page 3 of 3 Location Address or Lot No. /A/,I �� G Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole : inches ❑ Depth weeping from side of observation hole inches Depth to soil mottles 77 inches ❑ Ground water adjustment ... _ __.. feet Index Well Number ..._ ._. .. Reading Date ...... . Index well level Adjustment factor ...._......... Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on ?�; ? 4?5� (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date Z g9 DEP APPROVED FORM- 12/07/95