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Home My WebLink AboutSoil Testing Results - 67 RALEIGH TAVERN LANE 10/25/1996 Town of North Andover, Massachusetts Form No. 7 NORTH BOARD OF HEALTH OCj ,6 q�0 h S Ir?Rr1 1 g °Q APPLICATION FOR SITE TESTING/INSPECTION 7�AORATE°PPR��S 'is CHUS� Applicant 1 1 C�Irti P G� COLA � NAME ADDRESS TELEPHONE Site Location-16` C� �C?� kA_,�--:- �,J_ Engineer NAME ADDRESS TELEPHONE Test/I nspection Date and Time A16 CHAIRMAN,BOARD OF HEALTH Fee Test N o. P)V S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. FORM 11 - SOIL EVALUATOR FO Page I Date.A.'.A No. ............. ................... A commonwealth of Massachusetts , Massachusetts Issessment for Qn-site Sem e is sal-a �p PerformedBy: ....... ................U. ....... .........................I............. ........... ........ .. . . ..... .... Witnessed By: ............ ........ ........ ....... -...I................... ............ ....................-................................ ................. ................................... Location Address or V2 alle-1 /A- 7—ave-14, Owner's Name, "e A, Lot# Address,and 4V , Telephone# 3c, New Construction ❑ Repair Office Review Published Soil Survey Available: No El Yes EEr/ Year Published Publication Scale I,* YO Soil Map Unit(,A--;4 Drainage Class Soil Limitations ...... ....... ......... Surficial Geologic Report Available: No Yes El. Year Published Publication Scale .................. GeologicMaterial (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 ❑ Below Normal ❑ Other References Reviewed: FORM 11 - SOIL EVALUATOR FORM Page 2 On-site Review Deep Hole Number .D./...n.l Date: Time: Weather C� i2K1.... s ........ Location (identify on site plan) ....... ... / !-<............................................................................................................................................ Land Use ........—V................................... Slope (%1 0:`.� Surface Stones ......M n`` ......................................................... Vegetation ....0 ."n..4............................................................................................................................................................................................................... Landform ......1171............... .... .................................................................................................................................................................................................... Positionon landscape (sketch on the back) ......................................................................................................................................................... Distances from: Open Water Body tom.`.... feet Drainage way....JCV.t.t feet Possible Wet Area .l>!kr. .. feet Property Line ....Z92.. feet Drinking Water Well feet Other ......................................... DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency, %Gravel) fir �2.,Z-s'" /✓l�,,, �. 5��._ Z•S Y `''lY — mss �«b� , �l� G �VK. Parent Material (geologic) ............... ?..tJ............................................................................... Depth to Bedrock: ...hc!�.v ..... Depth to Groundwater: Standing Water in the Hole: h'L< Weeping from Pit Face: h r� Estimated Seasonal High Ground Water: ....�� FORM It - SOJL EVALUATOR FORM Page 2 On-site Review Deep Hole Number .. �`� Date:... Time:.....!�� Weather ........ .... G Location (identify on site plan) .............G,�. o°�. � ....................................................................................................................................... ° � ...................Land Use ...... .1.:................................... Slope (%) ...v:.:.�.� Surface Stones ................................................................. Vegetation .............. ..............................................................,................................................................................................................................... Landform .............. . . ....... . ....................................................................................................................................................................................... Positionon landscape (sketch on the back) ......................................................................................................................................................... Distances from: Open Water Body ..?!.°..`.'.t. feet Drainage way...f�L.�.'�. feet Possible Wet Area ....q.�"� feet Property Line .. feet Drinking Water Well ..1•fro.'... feet Other ......................................... DEEP OBSERVATION-HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other pnches) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency, %Gravel) V (7 b �, /e'SL. 9b Y��i13 °r,.,�. 9.cr•- r xckl Parent Material (geologic) Al..(................................................................................. Depth to Bedrock: ... Depth to Groundwater: Standing Water in the Hole: . :. f\. Weeping from Pit Face: . .3tvii ) Estimated Seasonal High Ground Water: .. ...... .. FORM 11 - SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole................... inches ❑ Depth weeping from side of observation hole ................... inches Depth to soil mottles . ..... inches �v ❑ 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-;v- observed throughout the area proposed for the soil absorption system? l � Pat- If not, what is the depth of naturally occurring pervious material? Certification certify that on (date) 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 15.017. Signature Date 0'