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HomeMy WebLinkAboutSoil Testing Results - 333 RALEIGH TAVERN LANE 3/17/1998 4ARTN o BOARD 0 SACmUSfuti� 30 SCHOOL STREET TEL. 688-9540 NORTH ANDOVER, MASS, 01845 APPLICATION FOR IL TESTS DATE: C ' �- ��b LOCATION OF SOIL TESTS: ( 7 _ .. c� ; L Assessor's map & parcel number: 4w .- ce( 1 - OWNER; TEL. NO.: ADDRESS: 5, L V�",LR ENGINEER; � ��,,L�,�,Qo�a�� r , TEL. NO.: CERTIFIED SOIL EVALUATOR: ciclle-4 Intended use of land: residential subdivision, single family home, commercial 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$175.00 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 EOH 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. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH Al 0 19 � APPLICATION FOR SITE TESTING/INSPECTION "7 pDRATED PPP .�f"J �SsAC HUS�� Applicant � �z '" - NAME ADDRESS TELEPHONE Site Location ' Engineer �r NAME D RESS I ELEPHONE Test/Inspection Date and Time X i xl'l- I CH MAN,BOARD OF HEALTH Feel Test No. S,S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. FORM 11 R SOIL EVALUATOR FORM Page I of 3 No Date: Commonw Ith of Massachusetts . � Ale. A 2)O' Massachusetts ,Soil Suitability Assessment for On-site Sewage 12is osal Performed By: -..........................-.7-...... .... ........... Date: Witnessed By: .............. ...................... ................ Dy-stion Address or W I ell Address,and Trkphom I New construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes R Year Published / .......... Publication Scale Pr/. Soil Map Unit Drainage ClasVO-e-e 7—VZ Soil Limitations ....... Surficial Geologic Report Available: No EE Yes ❑ Year Published 1-I.....,... - Publication Scale GeologicMaterial (Map Unit) -1-1-......•............................... ........ ............................... Landform ...............11.......................................-............... .............. ....................................................-......... a Flood Insurance Rate Map. Above 500 year flood boundary No E]Yes ❑ Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No D'Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) .......-.... ............................... ....................... Current Water Resource Conditions (USGS): Month Range :Above Normal RINormal EhelcwNormal ❑ Other References Reviewed: DEP APPROVED F01W•12/07/95 FORM 11 - SOIL II VALUATOR FOItn1 Page 2 of 3 Location Address or Lot i�lo. ` � 7�'` 'r( ��(� � �l ,<�✓'=" On-site Review [jeep Hole Number -Date:�(�/ Tim©:l�' . Weather �������� Location (identify on site plan) ' %�' .,..,..,....::.:........::.::.... Land Use / �` %�'T-�G Slope (%) eer Surface Stones .:. . Vegetation : ..:...:.:... ...: .. . ... . . .. ...::.......:......:::::... . . . . ... . Landform ..:::. .. Position on landscape (sketch on the back) .. � � Distances from: Open Water Bod y Drainage way. 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) 4/� MINIMUM Ut-Parent Material(geologic)�� C� DepthtoBedrock: _. Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Esjimated Seasonal High Ground Water: _ .--- DEP APPROVED FORM-12/07/95 FORM 11 - SOIL, E;VAL.UATOR FOttIN1 Page 2 or 3 Location Address or Lot lqoa�3-- A0 '4 . On-site Review Deep Hole Number Date: � /� Time:l° ,� Weathers-ate r Location (identify on site plan) Land Use . :... .....:..:. �� Slope (°10) .....: : Surface Stones / 1 ... ..... Vegetation :G =--�.:.. :... , Landform Position on landscape (sketch on the back) : ... � . Distances from: Open Water Body ��feet Drainage way. .:. feet Possible Wet Area feet Property Line .. . .......... feet Drinking Water Well feet Other . :,.... DEER OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) M[NIMUM OF 2 HOLES-REQUIRED AT-EVERY PROPOSM—MSPML AREA Parent Material(geologic) ?k�G4 Z?2 < ,�7� s{ DepthtoBedrmk: Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face: r Estimated Seasonal High Ground Water: f DEP APPROVED FORM-12107/95 FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot NO. On-site Review .. s Deep Hole Number `--� ... Date: � Time: Weath'er�7��°�. .... .� . Location (identify on site plan)/�i� .. �G ..,. : .,.:....:. ............. :...:.........:............,....... . :. Land Use Slope M <505 Surface Stones : ...: Vegetation .. ....:. :. .... ...: :......: . ..:....:.:::... ...., :. Landform Position on landscape (sketch on the back) : Distances from: c Open Water Body Drainage way ® 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) (Munseil) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) ..41—5-5 cot Z- :5 �✓� /I ��`�/Z �f � �CdaY/ /y <Z�, z ri Parent Material(geologic) _ DepthtoBedrack: Depth to Groundwater: Standing Water in the Hole; Weeping from Pit Face: Estimated Seasonal High Ground Water; --- ,� -5/- DEP APPROVED Fount•12i07/95 FORM 11 - SOIL LVA.LUATOR FORM Page 3 of 3 Location Address or Lot No. ew ��,C �/� /VU Determination or Seasonal Hieh Water Table Method Used: ❑ Depth observed standing in observation hole................... inches ❑ Depth weeping from side 9f observation hole .................. inches ® Depth to soil mottles . .:::`� . . inches 4�/ �N ❑ 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? ,Vo If not, what is the depth of naturally occurring pervious material?_o-/ �� 28 p Certification I certify that on O/ 9� (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 ate DEP APPROVED FORM-12/07/95 Y DATA: LOCATION: r�.. .. s _ ,4 ENGINEER: ..., l BOH WITNESS. PERCOLATION TEST I# _ BOT i OM DEPTH OF PERO TEST: TIME OF SOAK: a h (At least 1 J minutes Icng) TIME AT 12" TIME AT d r� TINIE AT c" r OVE WIGHT SOAK TIME STARTED NEXT D,4,v SOAK. 4 lean 1 v minuses) n IME A TINIE AT F'