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HomeMy WebLinkAboutSoil Testing Results - 517 JOHNSON STREET 7/9/2002 BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-6$8-9540 PLICATTON FOR SOIL T'EST'S DATE: 71 /70 MAP &PARCEL: LOCATION OF SOIL TESTS: geqC MCA OWNER: Ro4ey-r4 �'i ySSeII 06PWkIIEL. NO.: ADDRESS: 5"/7 T0gA�,,,v 5(re t ENGINEER: (f)ew 6Wi448 (-V6 aTEL. NO.: 1 768 CERTIFIED SOIL EVALUATOR: RICH-4(—c( C. '14-0,64 rd Intended Use of Land: Residential Subdivision �(�Single Family 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$425.00 per 10t.for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) 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 N.A. Conservation Commission Approval: Date Received: Check Amount: '6heck Date: it S6 'OBI Ivid HHS 9 OSZ .CS\ Z9Z Z Lz ` 7i�' LbZ 09Z 19Z ;ca\ sv 'Cl 50 xYS 9z /o. bt e l Z£I x4 s 1 0£I 9SZ 6ZI t , 7'lS5'CY es a,Q t z£ 'q` b Z i 6SI SSZ ctYSL �, �v LZI � Vz % LT I / �, t 9ZI ;11 OZ / ti b£ ut,L 06 LS T Vy 611 U01 r z1o1 S al / o (�\,: 0T£ DV 8z'E 5 OZ I s. , y ^ ti a 8L - l z 9SI R° £T£ ZT£ j IT£ y Stir y \\ r f/8 SLIhfIV (7vO'd H ,yvl 1 101 +�1. � 9vl " 0V PIZ 906 t; bSl 4 ee01 I zS l .dam L6I IE£ ZE£ ccc , rz o� I % .tis U801 z 961 8 �L01 9uzi•Wa L� � i T�---, 0S1 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH o E. 41 0 0 0 - - Z. Jr- APPLICATION FOR SITE TESTING/INSPECTION SS CHUS Applicant---) �r NAME ADDRESS TELEPHONE Site Location Enginee'r-111 -14/ NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No.-C.C. Date-Plbg. Permit No. FORM 11 SOIL EVALUATOR FORM Page 2 of 3 l /f Location Address or Lot No. On-site Review Deep Hole Number Date: G'! G.� — Time: le Weather (r� 7 Location (identify on site plan) Land Use / � Slope M - Surface Stones Vegetation - Landform Position on landscape (sketch on the back) Distances from: Open Water Body - feet Drainage way. :.... feet Possible Wet Area feet Property Line _...... 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, Sc Gravel) 7 h Y/I Parent Material (geologic) _ DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: l / Weeping from Pit Face: Estimated Seasonal High Ground Water: -- DEP APPROVED FO"I• 12/07/95 FORM 11 - SOIL EVALUATOR E OPM Page ? of 3 �` ! /� ` Location Address or Lot No. 7 U�� /56A/ 'J � �, , On-site Review Deep Hole Number Date:. i�z' Time::411'. Weather Location (identify on site plan) /T Land Use f Slope M r' Surface Stones Vegetation7_ Landform . ....:.:.:. Position on landscape (sketch on the back) Distances from: Open Water Body . feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other .. ::.::.:....,., DEEP OBSERVATION 'HOLE LOG` i Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, 1, j Gravel) j t� Z R 3 , w Parent Material (geologic) _ DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: e G) Weeping from Pit Face: r� Estimated Seasonal High Ground Water: - DEP APPROVED FORM• 12107/95 M �. e ....� . .. ... . .... — ... September 27, 2002 Sandra Starr, Administrator North Andover Board of Health 27 Charles Street North Andover, MA 01 845 Re: 517 Johnson Street Dear Sandra: Enclosed are the final soil sheets for the above referenced property. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, Benjan;W C. Osgo , Jr., EIT President 60 BC:ECHWOOD DRIVE - NORTH APVUC3VER, MA 0184:3-(978)686-17618-(888):359-7845- FAX(:378)685-1099 FORM 11 - SOIL EVALUATOR FORM Page I of 3 No. Date: Commonwealth of Massachusetts ZtV,-,, , Massachusetts Soil Suitability.-Assessment -for On-site Sewage Disposal PerformedBy: ........................ .. .......P..........C.......... Date: WitnessedBy: ............ ................ ... .. .............................................. ... . ........... ..... . Location Address or Owner's Name, Lot I Address,and No. e4w 4)(5P/'6z;0/ M4 Telephow 1 4 New construction ❑ Repair PO /19 Office Review Published Soil Survey Available: No ❑ Yes oil Map Unit ........ Year Published .................. Publication Scale ............... S Drainage Class �a.P fi/'&47.... Soil Limitations //X�w.... ................. Surficial Geologic Report Available: No [K Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit) . . ...................................................................................................................... ....... ............. Landform ..................................................................................................................................................................--1...... Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes 9 Within 500 year flood boundary No Dyes ❑ Within 100 year flood boundary No Dyes ❑ Wetland Area: National Wetland Inventory Map (map unit) .......--...... ................. .......I--.......... Wetlands Conservancy Program Map (map unit) ............................................................................. Current Water Resource Conditions (USGS)- Monthe_�'�x Range :Above Normal ❑Non-nal ❑13elcw Normal Other References Reviewed: DEP APPROVED FORM•12/07195 FORM 11 - SOIL EVALUATOR FOIZNI Page 2of3 Location Address or Lot No. On-site Review Deep Hole Number _: Date:. Time:. ?'' Weathe���—�� Location (identif on site plan) Land Use A17W4 Slope (%) Surface Stones. r Vegetation �� ... Landform Position on landscape (sketch on the back) ' Tad - Distances from: Open Water Body %'f?O feet Drainage way. `s. feet Possible Wet Area feet Property Line . .... feet Drinking Water Well 715P 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) Ll5 cZ Lis � ��� � , --MINIM0 5F 2 HOTES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material (geologic)_ Gz�<� ^�<L_.L DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: /c® Weeping from Pit Face: ii Estimated Seasonal High Ground Water: 11:�� I DEP APPROVED FORM- 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. M. On-site Review o Deep Hole Number ? Date:. 1 Time:�d. "' Weather �2 Location (identify ton_ site ,.plan) .... � ' Land Use .' '- iVTfgL Slope (%) Surface Stones Vegetation �? Ol!1 a/Zl /�tJ4 Landform .. . . .. /Jw rte.:... Position on landscape (sketch on the back) Distances from: Open Water Body 7°v feet Drainage way 7°c' feet Possible Wet Area Ov. feet Property Line feet Drinking Water Well .715-0 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) -3y —r-MMIMUM OF 2 HOLES REQUIRED A I EVERY PROPOSED DISPOSAL AREA Parent Material (geologic) � De thtoBedrock: - Depth to Groundwater: Standing Water in the Hole: � Weeping from Pit Face: / r Estimated Seasonal High Ground Water; --- DEP APPROVED FORM- 12107/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Determination -for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole......... . . inches ❑ Depth weeping from side of observation hole . .. inches IR Depth to soil mottles . ✓ inches ❑ Ground water adjustment ................... feet `- 2© � 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 al 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 / 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 Signature DEP APPROVED FORM•12/07/95 L OC =. 101\1: SO 'vv;-1 ,\i E-S S. PC 1" . C:= OL-.i ION = 1 I Oivl mac.i OF r_r;C i �T- 50 Ul 6 i iNIE ! ! 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