HomeMy WebLinkAboutSoil Testing Results - 75 STERLING LANE 9/27/1999 Town of North Andover, Massachusetts
Form No. 1
BOARD OF HEALTH �. _,/
OF NORT e fF
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APPLICATION FOR SITE TESTING/INSPECTION
pDRATED P?p�.��J
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Applicant � � , TELEPHONE
pp NAME D
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Site Location
�, .�_. //4 ._ TELEPHONE
Engineer NAMEDDRESS
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Test No. 17
Fee
S.S. Permit No.____—___11Z)6 D.W.C. No. _C.C. Date Plbg. Permit No.______—
MEMO
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...... . BOARD OF HEALTH
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30 SCHOOL ,STREET TEL. 6�8-9540
.NORTH ANDOVER, MASS, 01845
APPLICATION FOR SOIL TESTS
DATE: / OF SOIL r7
LOCA ION
L TESTS: :,
Assessor's map & parcel number: '
OWNER �'� � nc , M, TEL. NO.
ADDRESS;
ENGINEER: TEL. NO .v._
CERTIFIED SOIL EVALUATOR
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 $175.0 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.
BOARD OF HEALTH
NORTH ANDOVE R9 MA 01845
978-688-9540
APPLICATION FO SOIL IM-1S
MAP &PARCEL:
DATE:
LOCATION OF SOIL TESTS- 15,
TEL.NO. ER
OWNER ' :
: 4 ,n4,1�e.2,
ADDRESS:
To .
TEL.
ENGINEER:
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision Single Family Home Commercial
Repair Testing: Undeveloped lot testing:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
1. Proof of land ownership (Tax bill, or letter from owner permitting test)
2. plot plan
3. Fee of$275.00 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
up-grades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections' esign septic plans.
2. Only Mass. Registered Sanitarians and Professional Engineers can d
3. At least two deep holes and two percolation tests are required for each septic system disposal
area.
4. Repws 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 111-100') 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:
Check Date:
Date Received: j Check Amount:
PARCEL 8
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REFERENCE N ® 1
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Sep-28-99 10n01A Paul D. _rurb°ir e, PE/PLS 508-465--0313 P . 02
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MIMI 11 SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot No. 67- -S71
On-site vi
Reew
Deep Hole Number Date:. Time: 2,00 Weather S wl
Location (idertify on site plan)
Land Use Slope C ,-"?) Surface Stones
Z'Y
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
DEEP OBSERVATION HOLE LOG*
Depth from Soil=Horizon Soil�Texture Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, %
Surface (Inches) Gravel)
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(!,(.)A4114,0,AJ
C"' o poop
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HOLM ff
Parent Material (ge ologic) DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole: nO WE Weeping from Pit Face:
Estimated Seasonal High Ground Water:
—01C, 1,10twil
�k D EP APPRO vr�FPRNt-12/07/95
FORM 11 -SOIL EVALUATOR FORM
Page 1 of 3
No. Date:
Commonwealth of Massachusetts
Massachusetts
syil ►�uitabili �Assessment�or On-site Sewag asnosal
Performed By I fit. ' ,:. ) Date:
�:�
Witnessed By: r �
Location Address or Owner's Name
Lot# Address and /G a
Telephone# /
-7
New -fir
New Construction Repair
Office Review
Published Soil Survey Available: No F-71-7 Yes
Year Published Publication Scale �' c�� j' Soil Map Unit
Soil Limitations
Drainage Class
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 Below Normal l�
Other References Reviewed:
DEP APPROVED FORM-17/07/95
FORM 11 -SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot No.
On - Site Review
Deep Hole Number r' Date Time j) )<°1 Weather
Location(identify on site plan)
.r x .
Land Use Slope(%) Surface Stones ti
Vegetation ,: � �_ ��' �. � ��'' �'' V
Landform
Position on landscape(sketch on the back)
Distances from:
Open Water Body fr,�.�; feet Drainage way 0 feet
Possible Wet Area ),',J feet. Property Line „' feet
Drinking Water Well 77A- 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)
C"
( fg
'MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material(geologic) Depth to Bedrock:
Depth to Groundwater. Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water: , °
DEP APPROVED FORM-17107/95 soilw�l.aun
FORM t 1 -SOIL.EVALUATOR FORM
Page 3 of 3
Location Address orLotNo..
etermination for Seasonal High Water Table
Method Use
aDepth observed standing in observation hole - inches
Depth weeping from side of observation hole inches
a
Depth-to soil mottles inches
Groundwater 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? 7 1
If not,what is the depth of naturally occuring pervious material?
Certification
I certify that on 't/ 'f (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.
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Signature � �-� � fir,,���,� �� Date
DEP APPROVED FORM-MOMS toilev�l.aua
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FORM 12 - PERCOLATION TEST
Location Address or Lot No. J- )
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test*
Date: .„ f Time:
Observation Hole#
Depth of Perc /Y >'
Start Pre-soak n
End Pre-soak
Time at 12”
Time at 9"
Time at 6" r ..m
Time (9"-6")
Rate Min./Inch `1 `
*Minimum of 1 percolation test must be performed in both the primary area
AND reserve area.
Site Passed Site Failed
Performed By:
Witnessed By:
Comments:
DEP APPROVED FORM-12/07/95 Pmtm SAM
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PERFORMANCE p p CURVE SECTION 3A
Series: S ,®.4 HP, 1750 RPM PAGE 23
DATE 7/93
REPLACES 7/92
TOTAL HEAD
MTRS FT
9 30 _ _ _ _ STANDARD IMPELLER SIZE
Pump HP Imp. Dia.
0.4 5.44
8 5.44"
25
7 5.00"
6 20
4.50"
r
15
4 -
3 10 -
2 - - - - -- -
- --
5
1
U.S. GALLONS 25 50 75 100 125 150
PER MINUTE
LITERS 1 2 3 4 5 6 7 8 9
PER SECOND
Testing is performed with water, specific gravity of 1.0 @ 68°F, other fluids may vary performance.
BARNES PUMPS, INC. SAW t��1110�""r
A Burka Pumps, Inc. Company MADE IN THE U.&A.
Distributor Sales&Service Dept. Special Bids&Project Sales
420 Third Street/P.O.Box 603 1485 Lexington Ave.
Piqua,Ohio 45356-0603 Mansfield,Ohio 44907-2674
Ph: (513)773-2442 Ph: (419)774-1511
Fax: (513)773-2238 Fax: (419)774-1530