HomeMy WebLinkAboutSoil Testing Results - 444 SALEM STREET 3/15/2000 Town of North Andover, Massachusetts
"°oT"gtio BOARD OF HEALTH Form No,
h 6 O
�9SSACHUS APPLICATION FOR SITE TESTING/INSPECTION
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Applicant .c
NAME
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, / . ADDRESS /
Site Location '^z'�f`Z /V J t % TE
) LEPHONE
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Engineer `7 - �
NAME `� --��.
/ADDRESS
Test/Inspection Date and Time C3 TELEPHONE
Fee CHAIRMAN, BOARD OF HEALTH
Test No.
S.S. Permit No.-.p.W_C_ No.
C.C. Date________plbg. Permit No.
BOARD OF HEALTH TEL. 636«9540
APPLICATION NORTH ANDOVER, MASS. 01846
I TESTS
DATE: ° ✓ '
LOCATION OF SOIL TENS: '
Assessor's map & parcel number: -rm 33 r / -rt.
OWNER: - TEL. NO.:
ENGINEER: o C i° 6 A TEL. NO.:
CERTIFIED SOIL EVALUATOR: k
Intended use of land: residential subdivision, single family home, commercial
Repair testing Undeveloped lot testing
N. A. Conservation Commission Approval:
THE FOLLOWING MUST BE INCLUDES WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of$216.00 per lot for aqw 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 rades.
GENERAL INFOR Tl N
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 SOH 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.
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F011M 11 - SOIL EVALUATOR trolth,
Page I
Data
No. ...................................... Commonwealth of Massachusetts ............
Xko� Massachusetts
ParfomedBY: ........ ...............I....... ...................
Witnessed By:
.......................... ............................................................................ ............I.............. ............... ............ ..................
Lot#
7-2-
New construction Repair
Published Soil Survey Available: No El Yes Er'
Year Published Publication'Scale /225 oil MOP Unit...................
Drainage Class 1,22.... Soil Limitations .........................................................
Surficial Geologic Report Avallible: No yes El
Year Published .................. Publication Scale ..................
GeologicMaterial (Map Unit►....................................... ..........................................................................................................
Landform ....................................................................................................................................................-.....................................................
Flood Insurance Rate Map:
Above 600 year flood boundary No El yes
Within 600 year flood boundary No Yes
Within 100 year flood boundary ' No Yea
Wetland Area:
National Wetland Inventory Map (map unit►.......................................................... ................. ...............
Wetlands Conservancy Program Map (map unit)................................................................................................
Current Water Resource Condition's (USGS): Month ... 7
Range Above Normal Normal Below Normal El
other References Reviewed: V
tronj It m SOIL EVkWATOlt p(jpM
Page 2
Deep
Hole Number Data:11� Weather -e,
AfV on site plant Location (Ideni
Land Use Slope(%I Surface Stbnaa .......0'1 ..........
.......... ..........
Landform ..............................
position on landscape Watch on the backi
Distanoas from-
Opisn Water 0odV feet ofalosoa wav-:t±�- feet,
possible Wet Area feet Property ufta,s��feet
DrInkiria Water Wall fast Other
DIE IM&TION ROLE G
Depth#(am W&CO Sam HOW= GaT 6d MAtdkV
Onahasl MA"I a
Rut
Ott �5 l Yk,z/-Z,
lo Y&
Ll
lt40vir in-t,537.—
parent Material(060100101 Depth to Bedrock:
StandIna Miter In the Hale: Zk Weeping from Pit Face: ....... ........
Estimated Seasonal High around Water:
FORM 11 ® SOB, EVALUATOR FORM
Page 3
nptPnrninnNnn r ,Sp�rnnal ��� WatPp Table
.r...sr.r.. m -
[� Us
❑ Depth observed standing in observeitlon hate.. - . inohes
❑ Depth weeping from side of,observation hole _ Inohes
Q Depth to soil mottles . 4 Inches l
❑ ground water adjustment - feet
Index Well Number Reeding.Date Index well level .
AdJustment factor Adjusted ground water level _� .....��.
napth of Naturaliv Ooourrina Pervious MetO
Does at least four feet of naturally occurring pervious material exist in.eli areas
+ observed throughout the area proposed for the soil absorption system?
If not, what is the-depth of naturally occurring pervious material?
1 certify that on S Idetel I have passed the 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 16.017.
Signature w Date 7 �
FORM 12 - PERCOLATION
COMMONWEALTH 'OF MASSACHUSETTS
luG('Y�4 471144—, Massachusetts
Pemolatf on Test
Date: Titre:
Observation Hole
Depth of Pero
Start Pre-soak
end Pre-soak
Time at 12"
Time at 8"
Time at 6"
Time W-B"I
Rate Min./inch
l
Site Passed tom' Site Failed ❑
Performed By:
Witnessed By:
Comments: ....................................