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Home My WebLink AboutSoil Testing Results - 15 FOREST STREET 2/26/1999 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH %6ti00 1 19 Ot.. A APPLICATION FOR SITE TESTING/INSPECTION PATED AcHUSE��S Applicant J i4mea� ( "Vle-' v NAME ADDRESS TELEPHONE i Site Location g - &IL) 0 Engineer NAME i^'ADDRESS TELEPHONE Test/Inspection Date and Time � � '' CHAIR AN,BOARD OF HEA Fee Test No. _ S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. f BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01846 APPLICATION FOR SOIL. TESTS DATE: LOCATION OF SOIL ESTS: Assessor's map & parcel number: i L-) OWNER: TEL. NO.: ADDRESS: /* ENGINEER: TEL. NO.: CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision, single family home, commercial Repair testing Undeveloped lot testing N. A. Conservation Commission Approval: .' 1/k 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$75.00 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 V-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. DATE: LOCATION: y ENGINLEE F, B0H WITNESS: FERCOL^T10N T- 5 ST O i ONi D E IF TH 0 F PERC TIME OF SOAK.: _ � . (At leers; minutes Icrr,g) �---— TIME AT 2„ ,..,,. TIME AT 911 _ TIME AT CVE;�N IGHT SO A K T I i vlI E ST,=.r,TED NE" Y SOAK: TfivIE A T 1 2" TIME AT TIME AT DATE: _ LOCATION, EOH VVITNESS. PEz PC0LAT10N TEST BO-i i OM DEPTH 0 PEER TEST: TIME OF SOAK.: a �� (A� le st 1 minutes Icng) TIME AT li nm� A ti � " TIME AT ,.. TIME A T C�,'E;,NIG1-,T S0 K TIME NEXT D.�'-,Y SOAK: (,^ t ieES �iru:es; T!Iv1 E AT 12° TIMEr.T � TIME AT , FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 �. Date: No. /?s /, , 3 Commonwealth of Massachusetts , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal �? Qs -%2........... Date: Performed By: ck, Witnessed By: _.... .. �� J r�CS� ..ST�G % Owner's Name, G/y! Location Address or _ La X .,� Address,and Telephone / /L /V New Construction ❑ Repair 97�' � �- H�7� Office Review Published Soil Survey Available: No ❑ Yes c. Year Published � ..... Publication Scale / r� ...... ..y.... Soil Map Unitas Drainage Class Soil Limitations ✓� ......�c,.v� �o J Surficial Geologic Report Available: No K 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• 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. J,c /5�0- '&SF S%• /1/• �l�t l�UclU` itAA On-site Review J Deep Hole Number Date: 3(Z �yq Time: vo Weather Location (identify on site plan) k'�Lt Land Use u.w^ . Slope M 4 P�b Surface Stones Vegetation &rte sS- - Landform 0111i'-6's Position on landscape (sketch on the back) Distances from: _ Open Water Body Is00 feet Drainage way feet Possible Wet Area �O feet Property Line feet Drinking Water Well / 'G 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, % CO /0 3/Z — mu.ts%tic ri>q b/c, c. ,;2 4/ 3-7 —57 n 79 C {•�� Ji s-y /L tMMo7 mcv, MINIMUM Of 2-HOLES REQUIRED A I t:Vk:KY PROPOSED DISPOSAL AREA Parent Material (geologic) 12 ro4�iii� G'✓�LL/�fSf2 DepthtoBedrock: M Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: ,2Y hiUEP APPROVED F0101• 12/07/95 FORM 11 - SOIL F,VALUATOR FORM Page 2of3 Location Address or Lot No. /j �U/�c si s�= /1/c>2T7r j9 s�a�eC On-site Review Deep Hole Number / Date: 3l Z/q'� Time: /O'00 Weather Location (identify on site plan) Land Use <,wn Slope (%) 41 G Surface Stones Vegetation G-rrics Landform G(44f 0abin alaiN Position on landscape (sketch on the back) Distances from: Open Water Body 1320`' feet Drainage way feet Possible Wet Area //ZS feet Property Line z D feet Drinking Water Well >/au 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) 0612 e-5 /Z Ouse IR 7 jyR�/� a y /& � 444,e"'M d s7 -s G/3 M 4) Long 0,s7 REQUIRED AT EVERY PROPOSED DISPD-SAL AREA Parent Material(geologic) P1"3Vb;41C-W Gc'l W&&S/i DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: '13 Weeping from Pit Face: Estimated Seasonal High Ground Water: kiUEP APPROVED FORM- 12/07/95 FORM 11 - SOIL EVALUATOR FORM Pagc 2 of 3 Location Address or Lot No. L. /►�. d-Al>>00CX Qn-site Review Deep Hole Number �� Date: 3�ahf Time: /�' Weather Location (identify on site plan) 4.4-/-7 .Si044: Land Use ... Slope (%) /6i' Surface Stones e Vegetation 6'Pu*ss Landform e7v-%t 11-ask' Position on landscape (sketch on the back) Distances from: Open Water Body /S4� feet Drainage way /-S-c' feet Possible Wet Area feet Property Line :20 feet Drinking Water Well 7/00 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, % tcusc S Cy 2 rnc,q e,orn _ MINIMUWUF=LES REQUIRED AT EVERY PROP tU LAW-UbAL AREA any �%3 Parent Material (geologic) W ?sA DepthtoBedrock: L Depth to Groundwater: Standing Water in the Hole: 141y? r Weeping from Pit Face: y Estimated Seasonal High Ground Water: o� y DEP APPROVED FORM- 12/07/95 DORM II - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. /,S 1<,el57- Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole .... inches ❑ Depth weeping from side of observation hole . _. inches 14 Depth to soil mottles inches T/?s 112- ❑ 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? yP� -5 If not, what is the depth of naturally occurring pervious material? Certification I certify that on 4/,'&/ P? (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 LJ Date .5`- IP DEP APPROVED FOPM-12107/95 Page 1 of 5 9A -APPLICATION FOR LOCAL Up6RAD E APPROVAL Commonwealth o M ` North,Andover, `f assachusetts Massachusetts Application for Local Upgrade Approval DEP a , 310 CUR 15.000 pproved form required by 310 CMR 15.4 To be submitted to Local A 03(1) failed or non-confo rovin Authori Board of Health: compliance, as defined in 10 Clti a design For the u gn flow of<I 0,000 upgrade of a 5.404(1), is not feasible. mod' where full To be submitted to D design now of 10000 up to 15,000 pade of a failed or non-conform' where full compliance, as defined in 3 p CMF 15 u non-conforming system with a upgrade of state of federal facility, 404(1), i�nOt f easible. NOTE: Local upgrade approval includes the addition of app shall not be design granted for an upgrade proposal design flow above the existing ow to a cesspool or privy -tion that with either the 1978 g approved capacity of a system that d in accordance new Code or 310 CMR 1 S/000. ) Facility/System Owner: Tame: � Adress: Z- hone#: �f 1�5' s ��v2i7y ddress of facility: Applicant (if different from me: above) SH�t dress: )ne#: Type of Facility: _ Residential if _Commercial ci School __Institutional o. - T -