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HomeMy WebLinkAboutSoil Testing Results - 878 WINTER STREET 3/24/2000 BOARD OF HEALTH TEL, 688-9540 NORTH ,A DOVE ASS. 01845 J,FOR SOIL TESTS APPLICATION,F_1 -91J DATE: LOCATION OF SOIL TESTS: Z 3 LAJ a,; /K 11 (9-7 C Assessor's map & parcel number: b i J (Z OWNER: TEL. NO ADDRESS:-- TEL. NO.: S,31 ENGINEER: CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision, single family home, commerciald Repair testing —X-1 Undeveloped lot testing N. A. Conservation Commission Approval: 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 1275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75. per lot for repai u?gLqdes. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. o deep holes and at least one percolation test, at the 4. Repairs require at least tw discretion of the BOH representative. testing. 5. Full payment will be required for all additional tests within two weeks of 6. Within 45 days of testing, a scaled plan (no smaller than 1 11-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. :,4 r A� S LO 11 �. � s � Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH �Oz,t�eo ,6 6 0 3 ) Cd j ^� APPLICATION FOR SITE TESTING/INSPECTION A CH 115���� Applicant TELEPHONE `NAME ADDRESS Site Location A . Engineer A ADDI �SS TELEPHONE Test/I nspection Date and Time _ CHAIRMAN,BOARD O EALTH Fee �' Test No. d S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. LOC,�`,'71ON ES T E0 T-1 R C TIME Cr- TiME r.T 2" TIME C\� T I v i T I F ;-00L"T 10N THE 0 T1M E C —— a I 1_ T _ i 1im E 4 : C.v E ,�a I C- —.K IN T i Af } y b} r� � -c 7yJ-/, C�6 J , 5 C L� Hai .a �} �x s 1 *t. A fi ' a WO To akin s s s l 7 ' t d y 3 , f CtC loom, £ ^j A t I ffiay'9 �� i i MEN, � l z2p 1 i i VIA lots, } t - � 3 :s — d fin, i � '� F ;:'� �$'?+ PAR t i i ,i, m yeM. FROM : R.C. TANGAP,D PHONE NO. 781 334 0115 FORM 11 SOIL ENALLIATOR I Page DRAFT v ry Location Address or Lot No. -Qn-sit Mop Deep Hole Numbsr I Date:- /5 Time; 7 . Location (Identify on site plan) /.�. Ar.� Land Use s ..' Slope toQ).,,..77 , ..„Surface Stones.. .: r.��;.,. ..... ....... . Vegetation 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 ... ,. . , I -- -- DEEP OB$EkVATIO N HOLE BOG* Depth from Soil Horizon $0 Texture Soil Color Soil diner Surface(Inches) (tl$DA) (Munseil) Mottling (Structure,Stone&,Boulders, Consistency, °fo Gravel) 1-4 I//ryyy Orz -� - zy -7S ej 1'3I 7 Y'Ya t" MINIMUN Parent Material(geologic) DepthtoBedrock: _ - Dabth tbGroundwater: Standing Water in the Hole: _ Weeping from Pit Face: Estimated 5ea'sonal High Ground Water:,,V ot+P APPROVED FORM-13107195 APR. 6.2000 9:47PM P 2' FROI`1 R.C.. TANGARD PHONE NO. 781 334 0115 FORM 11 - SOIL EVALUATOR I�,OR'i17 t Page 2 of 3 Location Address or Lot No. 4148,-,t � 2 �/ Deep Hole Number �, Date:-7`.� '' 6 r �Tlme: 'I U s. Weather(: Qx/ Q Location (Identify on site plan) ,c, 6c��.`. .GF✓ �..,,��..,...... v.,�..� ...�..w. ......,. Land Use - -X—tG fl!914KpAC Slope M . .. Surface Stones , r . • , . ..... .. Vegetation • _Vo6t7,0 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 DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) Wunsall) Mottling lStrueture,Stones,Boulders, Coneloency, % Gravel) . I I Piste. Parrot Matrrial(aeoloo(c) Depthto8adrock: Death to groundwater: Standing Water in the Hole: _ Weepina from Pit Face: EsUmdted Seasonal High Ground Watar: 2� DEP APPROVED FOMI-1210719S FROM R.!'.. TANGARD PHONE NO. : 781 334 0115 ' a D"'R A RIO FORM 11 - SOIL [,"VALUATOR !Flail Page 2 of 3 Location Address or Lot-No. � / ���,• 011-site Review �7 .� Deep Hole Number •,, w Date:,: . .. Time: �G ; �� Weathet�A Y'� Location (identify on te plan) 'L2..�:.,(�.,rZCPGI;7... ..: r-�,.4,11L ..••�. ... . ...., . ..... Land Use Slope (%1 Surface Stones . .,..w Vegetation . ., .' . Landform ......,. . ... . ..F... ...^. . :.... „ Position on landscape (sketch on the back) ,.. . Distances from: Open Water Body feet Drainage way feet Possible Wet Area fe©t Property Line feet Drinking Water Wo(I feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil—t7thar Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, % Caravel) s � cd CuFnst' 4`7,0 Parant Material(Geologic) _ DepthtoBedroO , t oeptn to Groundwater: Standing Water in the Hole. _` Weeping from Pit Face:�� _ �•_ ,i Es(imatod S0296AAI High Ground Water: ti DOP APPROVED Foal,(•1110719S FORM 11 - SOIL EVALUATOR 1+ORM Page 1 of 3 Date: :, No. Commonwealth of Massachusetts Massachusetts ®zl Sui gbili or° On-si e Sew rs sat Date: Performed By. /� � ........ . ........ r (.... .. / ....... .. .......... Witnessed B ,�� �' o�ncr•a tJamc, ����h',��✓� ���,-vim. L4calinn Address or �,p/�,�'S Address,and ��,u/ i "��l c••�'�r (` / ✓ Lot.X }( . WAIT '��� /�/ Telephone X ew construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes / 1,,.,..••.,.,... Publication Scale , Soil Map Unit ���....._.....,..,, Year Published C1%,l� EGG Soil Limitations ............................................. Drainage Class ...... Surficial Geologic Report Available: No Yes ❑ Year Published ....:....:v:.:„.:. 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: Map ...:...................................................................... M National Wetland Inventory ;p Wetlands Conservancy Program Map (map unit Current Water Resource Conditions (USGS): Month Range :Above Normal (Normal ®Belcw Normal ❑ Other References Reviewed: DEP APPROVED P'ONM•12/07/95 l FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot Iqo. on-site Review Deep Hole Number .. � ... Date: . �`'� Time:��:�� Weathe4ily—`?`.% Location (identify on site plan) ............................::.. .... .... ...::..:..:..::.,...,:..:..... ....: ....... . .... IT T/9G Slope M Surface Stones :.:.:. :... Land Use ....:. ....: ..: :.... Vegetation Landform ..— ��c� :.. .::... . .:. Position on landscape (sketch on the back) ... ... Distances from: Open Water Body /Oc> feet Drainage way feet Possible Wet Area ��''� feet Property Line . ........ feet Drinking Water Well . . ._ Meet DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders,Consistency, % Parent Material(geologic) 7% Depthto8edrock: r' Depth to Groundwater: Standing Water in the Hole:_ Weeping from Pit Face: ��f I Estimated Seasonal High Ground Water: mac`. � ••---•— DEP APPROVED FORM•12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2of3 _ Location Address or Lot No. 25r �'��� ��✓���� I On-site Review 0 /�o1oO /D.Q?O WeatheKL-�>/-"��... . Deep Hole Number � ::: Date: : Tlme: Location (identify on site plan) �m.,.- Land Use .. � 71'4 Slope (%) Surface Stones Vegetation*.. Tom, :.: .....:: . ..::...... .. Landform:.. :: /�l//?7C�i� Position on landscape (sketch on the back) 7G0 Distances from: Body �oc� . feet Open Water feet Drainage way Z3 Possible Wet Area .��J� feet Property Line ..... feet Dunking 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, Bounders, Consistency, % Grav o q 4 1 14 1-9RTWVTT-2y�LES REQl 11 AREA Parent Material(geologic) 2L��� G L DepthtoBedrock: - Depth to Groundwater: Standing Water in the Hole:_' Weeping from Pit Face: EsEimated Seasonal High Ground Water: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page,2 of 3 Location Address or Lot iqo.�� On-site Review b �� Time G /' Deep Hole Number Dater �� ¢ Location (identify on site plan) Z:..::::...:... ..:..... .".,. .:: ,..:.:...:.:............. ....:._. ... .... ...::...: .. :. ,...... Land Use ...,� ���z/7 /T�9G Slope (%) Surface Stones Vegetation . ....... ..:...: . .:...::.::.: ::.::.. Landformi�.�1�/G/1�/ 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 . ......:.:::::.:.:::..:..:::. DEEP OBSERVATION HOLE BOG" Depth from Soil Horizon Soil Texture Soil Color Soil Other o Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, /o Gravel) Sys � c Parent Material(geologic) L C— DepthtoBedrock: r Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: -- DEP APPROVED FORM•12/07/95 FORM 11 - SOIL EVALUATOR FOB Page 3 of 3 Location Address or Lot No. 7� T Determination or 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 _ Z ❑ Ground watet adjustment ................... feet w 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 a I 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 /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. Signatur �,2;W' Date �o DEP APPROVED FORM•MOMS y