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HomeMy WebLinkAboutSoil Testing Results - 796 WINTER STREET 4/18/2001 Town of North Andover, Massachusetts Form No. 1 pORTH BOARD OF HEALTH S1=O��.LEO Ib q'IrOG 9 max.j & APPLICATION FOR SITE TESTING/INSPECTION 7.9 RATED SSACHUS� Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH s Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. y ri ` l BOARD OF HEALTH rtu.�1,OF NORTH DO + , A 01845 978-688-9540 APR I ?_ 01 APPLICATION FOR SOIL TESTS DATE: !11 1-2) i MAP &PARCEL: /011 Z? /X S LOCATION OF SOIL TESTS: OWNER: cl ait�4 VJ,0 pg,,> TEL. NO.: mil - 7gl-j- -/3z ADDRESS: 1 ENGINEER: Ai ( 6 - TEL. NO.: CERTIFIED SOIL EVALUATOR: Poe i46ay C Ttij&-,u t" ��� C a-zf-v o _—Y& Intended Use of Land: Residential Subdivision Single Family`Home Commercial Is This: Repair Testing:_ ``( Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No �( THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 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$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarian and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line " "^ (10",(40", BONI'D IFrr( N.A. Conservation Commission Approval - Date Received: Check Amount: Check Date: c i i 1 f t I � ' FmL.;7,7 E:CTION pLAN 5' NDIZTH A,NbOVE:2WM. DEC, 14,I?93 � aouN E:SNELLING ASSOCIATES PeOF€SSI.ONAL LAM SuPveym LoT G. 4rAVUE RR LING®cN,M4ss, � 43,597 Sa F'T, •, `� �``�,, .ter �,, �•..., pR/4�u E h 9 �2k 3?it A {�12v usC c� -f e!> 1 tsar 1a LOS ( �`� ,A``• WINTER STREET PLAN REFERENCES: -PLAN NUMBER 7588, LOT 6. -PLAN NUMBER 11671, DRAIN EASEMENT, THIS MORTGAGE INSPECTION PLAN AND CgRYIFICAYIONS ARE MADE FOR THE USE OF THE PRINCIPAL FINANCIAL CROUP, FOR MORTGAGE PURPOSES ONLY, THE OFFSETS SHOWN ON THIS PLAN ARE NOT THE RESULT OF AN INSTRUMENT SURVEY AND UNDER NO CIRCUMSTANCES ARE TNF,Y TG BE USED FOR DETERMINING THE LOCATION OF PROPERTY LINES OR ESTABLISHING THE RE THEY OF E USE OFO RASED ON M7 KNOWLEDGE, INFORMATION AND BELIEF, i CERTIFY THAT: - THE 'BUILDING CONFORMS TO THE FRONT, SIDE AND REAR YARD SETRACR REQUIREMENTS AND THE LOT CONFORMS TO THE AREA AND FRONTAGE REQUIREMENTS OF THE ZONING BY-LAWS OF THE TOWN OF NORTH ANDOVER, HAS$, THE STRUCTURE IS NOT SITUATED WITHIN THE SPEr,IAL FLOOD HAZARD ZONE AS SHOWN ON THE FEbERAL ENERGENCt MANAGEMENT AGENCY MAP ANDOVER, HAS$, 1983). TOWN OF'NORTII (COMMUNITY-PANEL NUMBER 250098, FLOOD IN OF THE TOWN RATP MAP EFFECTIVE DATE JUNE 15, FL OREUM w 4OD81 Y i • FILE lIQ,49A• . ZaplQl ZZZ99Lf9L6 YHd Zb'9T i1HL TO/ZT/tO FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. °2--- Date: Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewaze Dt.Mos t � � Performed By: �. ..... ..... lz ........... ........,, ...... ....4 �.....,.... Date: WitnessedBy: ........... ... '` ......7. ......................................... ......................... ...... .... ... Cncation Address Or ,(/`^$ Owxr's Na» �/� j�i'� 11Z L/jGC�Pi� Lot A /� �/ �� Address,o ne I T 17,Z r depM mawom{'!it/r . .CI�4Dvdd,�/ eW Constructlon ❑ Repair ® -'3Z z Ofce Review Published Soil Survey Available: No ❑ Yes Year Published ••••..••••... Publication Scale �' Soil Map Unit Drainage Class .................. Soil Limitations ..........,-rr�p.....,... .............. ,r................. ........ _. .. ..._.......` 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 Dyes ❑ 3} Within 100 year flood boundary No ❑ ❑Yes l Wetland Area: National Wetland Inventory Map (map unit) :...: Wetlands Conservancy Program Map (map unit) :.....•......... ..... . Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ®Belay Normal ❑ Other References Reviewed: DEP APPROVED FOILM• 12/07/95 r FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On-site Review Deep Hole Number / Date:.: j Time:.: /' WeatherCi � � Location (identify on site plan) Land Use � S� wT�L Slope (%) Surface Stones — Vegetation °m- �- Landform Position on landscape (sketch on the back) �� Distances from: Open Water Body < -5� feet Drainage way l5� feet Possible Wet Area 1-9,!51 feet Property Line 2-�. feet Drinking Water Well 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) 7r:.5 G� Parent Material (geologic) ��i,,� L' Dept oBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: y Estimated Seasonal High Ground Water. DEP APPROVED F0101• 12/07/95 ��� ���T.t/cl — FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot Igo. On-site Review Deep Hole Number Date: �1 e02 Time: 9' Weather[./�,�� �© Location (identify on site plan) .:.:..:. . . Land Use � 'y`,✓ � Slope M _ Surface Stones Vegetation ...... ,:. :. Landform �o � /�Ct1�. . IOTA,¢/�tl . . Position on landscape (sketch on the back) Distances from: Open Water Body 2$� feet Drainage way feet Possible Wet Area feet Property Line .:.��..... feet Drinking Water Well X15 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) MINIMUM OF 2 H0LES REQUIRED AT EVERY PROPOSED DISPO LAHEA P Parent Material (geologic) L epthtoBedrock: Depth to Groundwater: Standing Water in the Hole: _ Weeping from Pit Face: ,i Estimated Seasonal High Ground Water: 6 DEP APPROVED FORM• 12/07/95 '37TJC C% FORM 11 - SOIL EVALUATOR EOM4 ' Page 3 of 3 Location Address or Lot No. ,Determination or Seasonal .Hi h Water Table Method Used: ❑ Depth observed standing in observation hole................... inches F-1 Depth weeping from side of observation hole .......... inches IR-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 I areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on 4 (date) 1 have asse p d 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 �� ate / o . � / DPP APPROVED FORM•22/07145 i OCA. ION =COL TI 0 N i i I T�. CIS ,_„C T: 1 TIME C- :-GA.K: _ ._ L ` l Q ice_= �I� •C -� IME . i _ z T; I 12 T iNI` i i WE A. 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