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HomeMy WebLinkAboutSoil Testing Results - 385 RALEIGH TAVERN LANE 6/22/2001 BOARD OF BE ALTH f NORTH ANDOVER, MA 01845 . „F 978-688-9540 2001 APPLICATION FOR SOIL T'EST'S DATE: �;7�r�! MAP & PARCEL: ft's LOCATION OF SOIL TESTS: OWNER: J \,A A TEL. NO.: ADDRESS: 385 �` ��� ';� r ,1 AJ ENGINEER: IMew V,,,'1,,j ;� ', e'ts.� ._= TEL. NO.: CERTIFIED SOIL EVALUATOR: Veml J--a- C' Intended Use of Land: Residential Subdivision Single Farnil'y Home Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No X 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 repairs 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"-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. Please Do Not Write Below This Line N.A. Conservation Commission Approval , . Date Received: Check Amount: Check Date: ° f oil Uf s�9r PALeJ414 TAve.p j a C No, Aiu MASC.: 1i 1 r3AROA,AU a `No 464 Kid. 47, ?6 7 4�e,4 7 �ioo tu ARFA r' 2 :ern__.n•.aw.u�+�:: .�rv..i.. _ �`''�°��u..'._�_-- .�.�e. _..a^+,�'v.-'..---`-..�g�• �-��°'.ra.��-_-� •-�._ �-:.a_-�'+....::_.._.�...%cam...._...L.vas.....v.ri^..aa�.�°..'!i°�.°"°'r°� �� Town of North Andover, Massachusetts Form No.2 v4ORTM BOARD OF HEALTH #o ° DESIGN APPROVAL FOR • 9.'b4ATp P�•`� ss"�FJU5E11 SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant ° L I _ Test No. lei Site Location � e, C / �imA44' Reference Plans and Specs. ENGINEER) DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee ! Site System Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 0 17(� b16 0 APPLICATION FOR SITE TESTING/INSPECTION AORATE° SSACHUS� Applicant NAT C It ADDRESS l TELEPHONE Site Location 1A, ri �+ ", Engineer i ' �r �t Dim_. _ t `�` NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee -f(tl, Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. FORM 11 SOIL EVALUATOR FORNI Page 2 of 3 Location Address or Lot No. 73"6"t, On-site Review Deep Hole Number Date:. Time: Weather Location (identify on site plan) Land Use Slope M Surface Stones Vegetation 7 %! L andform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line ,z feet Drinking Water Well fleet Other AV' DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, % Gravel) -OF 2 HOL-ES-REQUIRED AT EVERY PRoPuStu 51brubAL AREA Parent Material (geologic) DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: J Weeping from Pit Face: Estimated Seasonal High Ground Water: DLP APPROVED FORM-12107195 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 A, Location Address or Lot i�o. On-site Review Weather Deep Hole Number Date:. Time: Location (identify on site plan) Land Use Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: feet Open Water Body feet Drainage way feet Property Line feet Possible Wet Area Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG Soil Horizon Soil Texture soil Color Soil Other =Depth from Boulders, Consistency, % a,x (USDA) (Munsell) Mottling (Structure,Stones, Surface (Inch=es) Gravel) O�"'I'*'V'0 0, Al 91 MINIMUM UF Z UL DepthtoBeI Parent Material (geologic) Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: ----------- DEP APPROVED F01101•12/07195 FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On-site Review Deep Hole Number Date: .�/"e""'/'� Time: Weather '? Location (identify on site plan) Land Use Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: 0 Open Water Body f eel Drainage �ihjay "I'll' feet Possible Wet Area 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,GBoulderavel)rs, Consistency, % L ''fir;i 11595POSED DIS? UWMUM UF Z HULE REQUIRED A "I Parent Material (geologic) DepftoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: 1WDEP APPROVED FORAI-12/07/95 FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. 7111 On-site Review b@ r 4a Deep Hole Number 9 Date: Time: Weather Location (identify on site plan) Land Use Z Slope M) Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage ways feet Possible Wet Area 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) MININIM OF 2 HDffrA=RFDA1 —1— 1 1-1 USLU DISPOSAL AREA Parent Material(geologic) DepthtoBedrock: g Depth to Groundwater: Standing Water in the Hole: Weepin from Pit Face: Estimated Seasonal High Ground Water: kiDEP APPROVED FORM-12107/95 F OR 112 - PERCOLATION 'FES7 r Location Address or Lot No, COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: _ Time:, , Observation Male # Depth of Perc Start Pre-soak End Pre-soak ) Time at 12" 0 Time at 9" Time at 6" - Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed tom'_ Site Failed El .........................__ Performed 6y: Witnessed 6y: Comments: DEP APPROVED FORM•12/07/95 V FORM 11 - SOIL EVALUATOR FORMM Page 1 of 3 No./LO2 Date: o� Comm nweal h of Massachusetts �/arlr ��i�o , Massachusetts Soil Suitabili Assessment for On-site Sewage Disposal Perfor ed B : . �... Date:711: flee m .. ._ . WitnessedBy: ..........................................................................._._.. ... Locuion Addrus or C, �`�j 4V Owner's Name, Lo /�C�,er,��Nf"' Address,and ✓CT��/ �/ �'���K Cam/(/ ifs ddr Tcicphone! + COI ✓,�� �� �� �`��J— New Construction ❑ Repair _Office Review Published Soil Survey Available: No ❑ Yes Publication Scale l• Soil Map Unit Year Published � j............. ..... ... m��o�5 Drainage Class �........... ....... Soil Limitations .Z 6I�P ........................................................ 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 ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ........... - ................ Wetlands Conservancy Program Map (map unit) .. Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ©Belcw Normal ❑ Other References Reviewed: -- DEP APPROVED FORM•12107!95 r ' r FORM 11 - SOIL EVALLIATOR,,PO"k X,, Pagc 2 df 3' Location Address or Lot ido. T On-site ,Review o ° Deep Hole Number Date:� .. Tl e:. :... Weath �/r ' Location (Identify on site plan) .��.�... . .�...v.. .. ,:,�.,.�... ,•...... .,,,.-.._�,.. ..,.,. .:.�.,.....:... Land Use .1�}� / � Slope (%) Surface Stones . ... ..... Vegetation Landform ,.:::...,/..X �.....,.... ,.... . .,.., :: �� ., ...... . .......,.,.. m� Position on landscape,(sketch on the back) . . � • .•.• .:•..,•. ••.::•....�• Distances from: Open Water Body Apo feet Drainage way °. feet Possible Wet Area feet Property Line .2`�.., feet Drinking Water Well 7/•`. � 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 4— 17- vy Parent Malarial(geologic) �i��a����� � L� DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: r" Weeping from Pit Face: Es(imated Seasonal High Ground Water: /y/0 Wa'%"�Jos DEP APPROVED FOPhl-12/07/95 i FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. /�i �z / h. -�l'`� ' On-site ,review / --�� Deep Hole Number 1" Date:.. �"7.� Time. 2 � Weatherl¢IV ," Location (Identify on site plan) C ' Land Use � `! ��G Sloe % v�v�v�,�` /.e .,.... - p ( } . �. . Surface Stone��c�. ..„ ,.G��,�•�� Vegetation Landform Position on landscape,(sketch on the back) ! .. ... Distances from: � Open Water Body feet Drainage way.".T.... feet Possible Wet Area feet Property Line ...J , feet Drinking Water Well�h� 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) . o 3 /X/cr �^ o Parent Material(geolopict '/ DepthtoBedrock: Depth to Groundwater: Standing Water In the Hole: Weeping from Pit Face:! —^ Eslimated Seasonal High Ground Water: DEP APPROVED FORh1•12107/95 I FORM 11 - SOIL EVALUATOR FOkN1 Pagc±216 3 Location Address or Lot N,a a On-site ,review f, o Deep Hole Number `3 ..: Date.. Tlme,�-�,.-45 Weather Location (Identify on site plan) Lam/ Land Use ..r ! TW4. Slope M . , . . Surface Stone;; � �� - Vegetation .,� a :.....,.�..r�::. . . . .. ..:. ......:.........: :.......... :..,. Landform ,.::..,.. ...l ... :: .:....._... .... Position on landscape,(sketch on the back) , . �1 ".......,.. . Distances from: Open Water Body � feet Drainage wayf�J�. feet Possible Wet Area l2� 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) Parent Material(geologlcf'7 L1 "��"l�{� DepthtoBedrock: Death to Groundwater; Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM•12107195 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3' Location Address or Lot igo �i � ��• � �� .' On-site Reiiew Deep Hole Number .: Date:,. Tlme,Z, s Weather Location (identify on site plan) Z3� •.:...w .-'...•�f� '...m Land Use .- L Slope Surface Stones4- .-�� Vegetation . � . .:..,N......�.::. . . . .. ...:..w.,................:..,..-,... :.r. . ,.....,:....:�...:......:..:.. Landform ..::: a.......:: :..... . ..... :: :.......... ............... :. Position on landscape ,(sketch on the back) , .• �� "•. • 0!aLG..:......... . •. ..... Distances from: Open Water Body 2� feet Drainage way . feet Possible Wet Area feet Property Line ............,. feet Drinking Water Wellr'�(52 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) 2a— �' y �is01W,7 Parent Material(geologic) 2W L5 DepthtoBedrock. Depth to Groundwater: Standing Water in the Hole: '' Weeping from Pit Face: _ Eslimated Seasonal High Ground Water: � !✓ _ —._ DEP APPROVED FORNS-12107/95 FORM 11 - SOIL LVALUATOR''FOR, Page 3 of 1 T 4 Location Address or Lot No. �°� 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 .:.:::,.:' :. 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? .A-4o If not, what is the depth of naturally occurring pervious material? Certification I certify that on l (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 15.0`17. ' Signatur G� ! '" Date DEP APPROVED FORM•12/07/95