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Home My WebLink AboutSoil Testing Results - 93 WINTERGREEN DRIVE 9/17/2002 BOARD OF HEALTH NORTH ANDOVER, MA 01845 � 978-688-9540 o, APPLICATION FOR SOIL TEST DATE: II I 0 Z MAP &PARCEL: 1v� loI,(3 o�C��t -crc7rac M LOCATION OF SOIL TESTS: !�2 i,-, 2 reeA OWNER: /Ac,r r-e nr TEL. NO.: ADDRESS: ej 3 T Me h ��► a mq Aw o c),)e z-- ENGINEER: AJ&1 j0 E/y 6-1A.)ECa1p6:--- TEL. NO.: CERTIFIED SOIL EVALUATOR: 12,Ltd 0 C Intended Use of Land: Residential Subdivision rn aInily Home' ) Commercial Is This: Repair Testing: _ Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for re airs or upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarian 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"A 00') 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. Please Do Not Write Below This Line N.A. Conservation Commission Approval: M ... T� D Date Received: Check Amount / % �i - `%` _ N !�e- we d� 6 �x 6 r pROPasr Aw- FAS�M�Nr�/� p `N 1600 Gnu IVsE pTC,7ANt� �, m `�ipc�sjERED EtvG1y�ti�` op 14p Town of North Andover, Massachusetts Form No. 1 I NORTH BOARD OF HEALTH O t.�IED b.6' O a'd L td 70 APPLICATION FOR SITE TESTING/INSPECTION t ACHUS��y Applicant �� N NAME ADDRESS TELEPHONE Site Location— Engineer �� NAME ADDRESS TELEPHONE Test/Inspection Date and Time 3 J CHAIR AN,BOARD OF HEALTH Fee Test No. 1670 S.S. Permit NO.—D.W.C. No. C.C. Date Plbg. Permit No. FORM 11 - SOIL EVALUATOR FORM Page I of 3 Date: // / 0 2-- No. Commonwealth of Massachusetts ^/a , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Date: ?-' Performed By: `�%`c�56'�v..... ..�.. .. � / P Witnessed By: ......... ....., ,• ' .. .4 .. .......,, '................ �� Locarion Address or / Address,Rnd Lot I Telephorc/ 9 tea, �,�j��+►�'—., ew Construction ❑ Repair Cpl 79 office Published Soil Survey Available: No ❑ Yes D �./��,... Soil Ma Unit p Year Published Age/............ Publication Scale ,� ... p Drainage Class !x/14.`-.'.......... Soil Limitations Surficial Geologic Report Available: No 5�1 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 ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) .... ........................ Wetlands Conservancy Program Map (map unit) . Current Water Resource Conditions (USGS): MonthT� Range :Above Normal ❑Normal QBelc�� Normal ❑ Other References Reviewed: ~� DEP APPROVED FORM•12107/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot On-site.-Review a Deep Hole Number D 2. Time: Date: Q� Weather / �Q .. /. // Location (identify on site plan) .V- Land Use Slope (%) Surface Stones . Vegetation Landform Position on landscape (sketch on the back) Distances from; Open Water Body 1100 feet Drainage way feet Possible Wet Area 'p... 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, low- pop (Perre.�� m�+rt�hl GParent Material (geologic) 7`:e-- DepthtoBedrock: _ Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water:_ DEP APPROVED FORM• 52107195 FORM 11 - SOIL EVALUATOR FORA Page 2 of 3 Location Address or Lot No. On-site Review � - 4D ° Deep Hole Number Date:.A0�Ild Ti e:.�l,.'Q� Weathe — urface Stone Location (identify on site plan) Land Use Slope (%) s Vegetation . .. .:.:. ,. .. landform .... :.,.. ,..... Position on landscape (sketch on the back) Distances from; Open Water Body 1 �a feet Drainage way feet Possible Wet Area /!-57.. feet Property line ..:�`J..... feet Drinking Water Well feet Other .. :....... , DEEP OBSERVATION LOG" Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(inches) (USDA) (Munseli) Mottling (Structure, Stones, Bounders, Consistency, y'.e f �j vJ L L Parent Material DepthtoBedrock: (geologic} ^+ � _---- —"" — ----- Death to G Weeping from Pit Face: Estimated Standing Water in the Hole: / — Estimated Seasonal High Ground Water: DEP APPROVED FORM. 12107/95 FORM II - SOIL LVALUATOR FORM Page 3 of 3 Location Address or Lot No. /P '114 Dvleke_ Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole • .. . inches inches R1 weeping from side o observation hole R1 h Depth to sail mottles inches M p ❑ Ground water adjustment ................... feet Index Well Number ................ Reading Date ................ Index well level 1 Adjustment factor .............•..••• Adjusted ground water level ... .................. ..................... Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervious o material exist system?to a��eas observed throughout the area proposed for the absorption If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection training, and experience was performed by me consistent with the required g described in 310 CMR 15.017. Signature Date DEP APPROVED FORM•12/07/95 I i _ 0 E.7:O I_°.710 N I_v I .r C,.1 1 l)(V) J;= I ; Cir =rz=r I°::z I : ®A r 7i M I II'vi:` S �f ho ir.f5 Fwff s ;M 1 11 � 1. �.. J �...... o'2 s t f 1 . / f ii i' l: / l i I I t d l � i 3 I - r,y t ? f 1i 7h F:i, t �rf r y ' n` . J