HomeMy WebLinkAboutSoil Testing Results - 287 FOREST STREET 3/24/1998 i
Town of North Andover, Massachusetts Form No'• 1
NORTH BOARD OF HEALTH
oy S�E� b%6 0 19
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APPLICATION FOR SITE TESTING/INSPECTION
Q�RATEU PPP .(5
�SSACHUS��
Applicant
NAME ADDRESS TELEPHONE
Site Location
Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee o 3 Test No.
iJ#
S.S. Permit No. D.W.C. No. Il9q C.C. Date Plbg. Permit No.
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FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
No. Date:
Commonwealth of Massachusetts
, Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: ......... ,,..x.�li..S..................... ........... � Date:
Witnessed Bar: .1. ../'.a� ...........tom. ........ ......._ ^....?..... ..?.........
lmiion Address or O Y^<.5 I S T Uwrcr s Norm, J 'e,1,P 1.� ✓"\ �/�'� C ''C.r
Lor t 1 C 6 Adams.sm ;t S ;41A^rIA�-• S�,
Telgxsone , , ,
New construction Z Repair ! i
Office Review
Published Soil Survey Available: No ❑ Yes
Year Published /. ?.1..... �:.`.��. 0
Publication Scale . . ....Y Soil Map Unit
Drainage Class k)e// br!:ii 4/Soil Limitations ...................................... _......... _.... .................... _
Surncial Geologic Report Available: No Yes
Year Published Publication Scale
GeologicMaterial (Map Unit) ................................................................................................................. .. ..... ......... .........
Landform ....................................................................
Flood Insurance Rate Map:
Above 500 year flood boundary No U 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 17Belc,.,/ Normal
Other References Reviewed:
DEP APPROVED FORM- 12/07/95
FOFM 11 - SOIL EVALUATOR FORM
Page 2 of 3
T
Location Address or Lot i�o. � /
r�s l
S
On-site Review
Deep Hole Number -/� Date: Time: j0;00
Weather
Location (identify an site plan)
��cenh . Slope (;�o) - Surface Stones /36iL)d-ers
Land Use ,
Vegetation
Landform e
Position on landscape (sketch on the back) %'LI���i✓1� S °��
Distances from: feet
Open Water Body /00 ? fee*. Drainage way
Possible Wet Area /on i`
feet Property Line feet
Drinking Water Well feet Other
DEED OBSERVATION HOLE .OG'
Depth from Soil Horizon Soil Texture I Sod Color eil) I Soil
Other
Surtace (lncnesi I (USE (Munsell) Mottling )Structure. Stones,Gravel)
Consistency, °%
I
�' ,adle
r^ati�r'ar 'ri^
�s5�r1� "i^) ie
a
;�- y 14.C. 13it,c:kk
zw
s y
Co ��
c rL.. et
• i rcH canc I tor. t t I, . I lui <
DeottitoBedrock: v
Parent Material (geologic) / r /I Weeping from Pit Face:
Depth=Groundwater: Standing Water in the Hole: �^
i�
Estimated Seasonal High Ground Water:
DEP APPROVED FORI►t- 12/07195
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot Igo.
On-site Review
cis «G�y
Deep
Hole Number "Date: /v�/�/� Time: Weather
Location (identify on site plan)
`)
Land Use Slope(%) 3-, Surface Stones BAn/�)Je r5
lt��.���f S. ,, .
Vegetation 06%_. K zj
Landform Till ,�j e- � S leJpI
Position on landscape (sketch on the back) °
Distances from: feet
Open Water Body /�� ' feet Drainage way
feet
Possible Wet Area %o -r feet Property Line
Drinking Water Well feet Other
DEEP OBSERVATION HOLE _OG�
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Mottling I (Structure, Stones, Boulders, Consistency,
Surface (Inches) (USDA) (MunselU Gravel)
I I
_ L [
� j-y� C rho lam 1/1 rr,a-h l
�a
F
111tis5i L'• rblc`,,
T'�`
30_ /0,4 5yc �uloh1Ys £ STL�eS
�'.C
a:sy
G
t t t
r i C L
C tH ��
.T l/ OeptMoBedrock:
Parent Material (geologic) /
riding Water in the Hole: h'>
Weeping from Pit Face: A
D th to Groundwater- �
Estimated Seasonal High Ground Water:
DEP APPROVED FORM- 12/07/95
FORM 12 - PERCOLATION TEST
Location Address or Lot No. I-e) 51
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test*
Date: ... 1 � )��'�' Time:,
Observation Hoie #
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, be performad in, both the primary area AND
reserve area.
Site Passed Site Failed ❑
..........................................................................................................................................._.......
.
Performed By:
Witnessed By: C'xr Jc le 73,-c(C" F'o r i ,� J`+4 rr��;5 CJ
Comments: ...... ..::.......:::::. w w �:.....:..:. ......... . :...
DEP APPROVED FORM-12/07/95
1y
J FORM 11 - SOIL LVALL:ITUIZ FUI�N1
Page 3 of 3
Location Address or Lot No.
Determination for Seasonal Hioh Water Table
Method Used:
❑ Depth observed standing in observation hole inches
❑ Depth weeping from side of observation hole inches
E' Depth to soil mottles 14- inches
Ground water adjustment .................. feet
Index Well Number ... .. ....... Reading Date .................. Index well level
Adjustment factor Adjusted ground water level
Depth of Naturally Occurrine Pervious Material
Does at least four
throughout thebarea proposed !the pervious
oil absorption risystem? my�all areas
observed through P P
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on /0 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.
Signature Date
DEP APPROVED FORM• 12107/95
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