HomeMy WebLinkAboutSoil Testing Results - 295 FOREST STREET 11/4/1998 Town of North Andover, Massachusetts Form No. 1
NoRrM BOARD OF HEALTH
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'���AaEp AQpy�� APPLICATION FOR SITE TESTING/INSPECTION
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Applicant NAME ADDRESS TELEPHONE
Site Location
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Engineer (-m'e c) TELEPHONE
NAME ADDRESS
Test/Inspection Date and Time
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CHAIRMAN,BOARD OF HEALTH
Fee
X75 Test No.
S.S. Permit No. /6 D W.C. No.-4L C.C. Date Blbg. Permit No.
1
FORM 11 - SOIL EVALUATOR FORM
t Page 1 of 3'
No. Date:
Commonwealth of Massachusetts
, Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By:
......... r..//5.............Cr..'5.. Ss'�t.... Date: 1 .1171
`^ / c.rr Js...............-�.-..../7-�...... ......
Witnessed By: ..�� .t. .lc. ........l�.a�.u.�..�...........1..�}rC.....���------...........�..�....
Location Address or /—, 72, Owner's Name,
�
^`` '0 Address,and ( r'
Lot N /'! �
Telephone l r p
New Construction Repair ❑ �
Office Review
Published Soil Survey Available: No ❑ Yes ❑
Year Published .... Publication Scale Soil Map Unit .. ...
Drainage Class ell �P' '� � Soil Limitations .........._.................................................
Surficial Geologic Report Available: No ►2 Yes ❑
Year Published Publication Scale
GeologicMaterial (Map Unit) ........................................................................................................................... ..............................
Landform .... .....................................................................................................................................
4
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 ❑Belt v Normal ❑
Other References Reviewed: -
DEP APPROVED FORM-12/07/95
7,;.
—,`77T 77",—T-77-7-1-1
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot Igo. �3
On-site Review
Deep Hole Number /. ±� Date: Time: / 4 � Weather
Location (identify on site plan)
............:..
Land Use
kna S :.::. Slope M) Surface Stones
/ cztG��r°s
Vegetation ti
Landform /'l
Position on landscape (sketch on the back) ,e �° '
Distances from:
Open Water Body feet Drainage way feet
Possible Wet Area feet Property-Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE .OG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stoners, Boulders, Consistency, %
.e <
M.
S e-
4 0//i
6-_y
RINIMUM OF �e
Parent Material (geologic) 1 DepthtoBedrock: >
Depth to Groundwater: Standing Water in the Hole: !4•6
Weeping from Pit Face:
Estimated Seasonal High Ground Water:
DEP APPROVED FORA!- 12/07/95
FORM 11 - SOIL EVALUA'T'OR FORM
Page 2 of 3
Location Address or Lot No.
On-site Review
Deep Hole Number /?P-4_y Date: � ���� Time: Weather ell
Location (identify on site plan) 1.
Land Use ...���e?.e Slope (%) Surface Stones F a 4 C-f^
Vegetation . _ Cs '
Landform � /�... ��elf
9. 0
Position on landscape (sketch on the back) `
Distances from:
Open Water Body 140 feet Drainage way feet
Possible Wet Area X40 feet Property-Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE _OG�
h from Soil Horizon Soil Texture Soil Color Soil Other
Dept (USDA) (Munsell) I Mottling (Structure, Stones, Boulders. Consistency, %
Surface Dept (Inches)
,
V'L
4;
KA
F t L A �F
Parent Material (geologic) / �/ DepttttoBedrock:
Depth to Groundwater: Standing Water in the Hole:
Weeping from Pit Face:
i
Estimated Seasonal High Ground Water: f
DEP APPROVED FORM- 12/07/95
FORM 12 - PERCOLATION TEST
5
Location Address or Lot No. 47
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test*
Date: ...../ . /7/ - Time //,'._`
Observation Hole # �.
Depth of Perc
Start Pre-soak
End Pre-soak
Time at 12"
Time at 9"
Time at 6"
Time (9"-6")
Rate Min./Inch
* Minimum of 1 percolation test must bo performied in both the primary area AND
reserve area.
Site Passed � Site Failed ❑
..............................................................................................:......................................_.-.....__........
Performed By: S cad. ' Sir_::y C
Witnessed By: Ie le, ('J V% J-1 4f 14 J 1 4)j-77
Comments: ..::::::::::.::::::::....::::.:.:...:.........
.:
DEP APPROVED FORM-12/07/95
FORM 11 - SOIL LVALLATOIZ FORM
Page 3 of 3
Location Address or Lot No. f.' % /� _5 '
Determination for Seasonal high Water Table
Method Used:
❑ Depth observed standing in observation hole_.-... inches
❑ Depth weeping from side of observation hole -5/6" inches
® Depth to soil mottles inches
❑ 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? Y
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on. 161 Z (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 Date � �-'� 0
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DEP APPROVED FORM-12/07195
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