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Home My WebLink AboutApplication - 252 GRAY STREET 4/23/2004 Town of North Andover HE,ALTR DEPARTMENT �4Op° 27 Charles Street North Andover, 01845 978.688.9540 . health 1' orvn dover:corn SEPTH"' SUBMITTAL FORM ]DATE OF SUBMISSIONS SITE LOCATIONS l ,- ENGINEERS J NEB' PLANS: YES $225.00/Plan Check#: (Includes Is:(NewnrAry and one Re-Review Only) REVISED PLANS: YES $ 75.00/Plan Check#S SITE E`IALUATION FORMS INCLUDED: ..n YES__,) NO LOCAL UPGRADE FORM INCLUDED: YES NO Telephone #5 _ �� Fax# t w° HOMEOWNER NAME: OFFICE USE ONLY When Cite submission is complete (including check): I. - 'Date stamp plans and letter 2. � Complete and attach Receipt 3. �" " tlp Copy File; Forward to Consultant 4. Enter on Log,Sheet and Database FORA 1 SOIL EVALUATOR FUR 1I Page 2 of 3 Location Address or Lot No. "C ip r 4 T , On'sife Review _ Deep Hole Number Date: Time: Weather 7 C7 Location (identify on site plan) Land Use Lt/P a� � Slope (%) I= Surface Stones Vegetation �Qs+ir- 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 HALE LOG Depth from Soil Horizon Sol Texture Soil Color Soil Other Surface(inches) JUSDA), Wunsell) Mottling (Structure,Stones,8oOders,Consistency, % Graveq pyc 3/Z �p —`� ��✓ �5L oar ¢� � �� r,�-s�;v ,�-��.,g��-- S - l6 5 /-Z iN Parent Material (geologic) Death is Groundwater. Standing Water inihe Hole: Weeping firm pit face: /✓� Estimated Seasonal High t'around Water: � 8 F70RMi=77 �Y: . ✓P�-- S�7C r�.J�y7 �C �` E X e A VA 7-O r-Z /y7 �- Gd N f ?-�C o-e- 'r/ot,- DE.r APPRON'm FORM-12/07105 FORJNI 11 OIL EVALUATOR FORA I'age2of3 Location Address or Lot 11o. do 13 N0.. 779 P71e- On-site Review _ Deep Hole Number ? Q Dater -5�—.z 3 Q Z Time: Weather C'L. e7vz- 70 Location (identify on site plan) Land Use Slope (%) Surface Stones Vegetation ,Pi C 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 LOGS Depth trom Soil Horizon Sol Texture Sol color Soil Other Surface{Inches) (USDA) (Munseln Mottling (Structure,Stones,Boulders,Consistency, % Graven Q Parent Material(geologic) O�d�tot3adrndc: Depth to Groundwater: Standing Water in-the Hole: N 4 �l Weeping from Pit Face: /'y4r;Q,/9'-- Estimated Seasonal High t'iround Water: 'j- Y�� FOrRA/ev EXG�IVATo tiZ ; DEF APPxoN-U)Fowa-LV07195 _ FORM 12 - PERCOLATION TEST Location Address or Lot No. ERR _ - � Y S-rR T COMMONWEALTH OF MASSACHUSETTS /UD2Th' 4045vF_rL , Massachusetts P er Test* D ate: .:. Time:, Qbservatio,n Hole # 20 iq Depth of Perc = o - 2 . 20 38 Start Pre-soak i; I LI P r% I ; 3z P rvl End Pre-soak Time at 12" 1:4-7 Qru� Time at 9" 1 ; 52 PM Time at 6" I; 39 Time (9"-6") 5 5 mom Rate Mina/Inch Miinimum o'r 1 percolation test must be performed in both the primary area AND reserve area. Site Passed LJ Site Failed ❑ .............................................................................................................._._..----- Performed By; .l oC S�R�c�rrrlt A Witnessed By: W1 __T- Comments: ........... DEP APPROVED FORM-12/07195 �._. . ._._ ..:. . ... .... .-. .. ..............................................w_.. �...� ...... NEW ENGLAND ENGINEERING SERVICES . ..o �w January 14, 2005 Susan Sawyer North Andover Board of Health 27 Charles Street North Andover, MA 01845 .1l'd 1 1" 'a Re: Lot 4 Gray Street, North Andover Septic System Design Dear Susan: Enclosed are the following documents which are being submitted for the property referenced above, 1. (3) Copies of Septic System Design Plans. 2. Soil evaluator sheets. 3. Septic Plan Submittal Farm. 4. Check to cover the plan review fee. These plans are being submitted for approval. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Benjamin C. 0s,g od, Jr. P.E. President 60 BEIEClitdl/OOD DRIVE NORTH ANDOVER MA 01845 (978)686-1768 (888)359-7645 FAX(976)665-1099 Town of North Andover 'ALTIi DE PARTME NT 27 Charles Street North Andover,MA 01845 978.688.9540 SEPTIC PLAN SUBMITTAL FORM healtlydept(a�,trnvno nortltandover.cam DATE OF SUBMISSION: SITE LOCATION: C e .... ENGINEER: /0 C 0/-) i 7 (n� E P.JW NEW PLANS: YE S__Y, $225.04/Plan _ Check.#: (Includes 1 '0";Ur ' and one Re-Review Only) REVISED PLANS: YES $75.00/Plan Check#: SITE EVALUATION FORMS INCLUDED; YE,,S NO LOCAL UPGRADE FORM INCLUDED: YES " NO :> - .✓ "� Telephone 167 Fax#: E-mail: HOMEOWNER NAME: L OFFICE USE ONLY iI*en the submission is complete (including check) 1. Date stamp plans and letter 2. Complete and attach Receipt 3. Copy File; Fornvar°d to Consultant d. Enter on Log Sheet and Database FORM 11.- SOIL EVALUATOR FORM Page 1 of 3 No. I P 1, o Date: Commonwealth of Massachusetts �Uor�� 4✓1daJer , Massachusetts Soil Suitabilitv Assessment for On-site Sewage Disposal Performed B �h..ouM�.A.... y: ..... .. ,S ..o...Q .,.....T...("...�.�..o.��. Date: c ............. ........... Witnessed By: ..�4..... .ce�a..../vl...... .rQ. .. ..Y,. ilL....I tV..¢,<....... !►,Su.�. '+.�n�...................:. "don Address or O+ I V 7+rAY St tQe' �pwneis Name, Lot/ ! � ( ® Address,aid /�� r®4vj oj&. ° , e. /Vor4YN AA4over��'W► ®�B�C) Telephone/ rP? � ® FO A r,A D ew Construction Repair ❑ c 4, ®� �B Office Review Published Soil Survey Available: No ❑ Yes Er Year Published I.I.S1.... Publication Scale �� t.� v.. Soil Map Unit ... Drainage Class ................... Soil Limitations ........................................... ................................. surficial Geologic Report Available: No M Yes ❑ 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) VA................................................. Wetlands Conservancy Program Map (map unit) ...N ..............................................................................._._._... Current Water Resource Conditions (USGS): Month _ .................. Range :Above Normal ❑Normal 15Belcw Normal ❑ Other References Reviewed: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot tio. 1.0{ q Groq ` reef t Ay�vve,' On-site Review Deep Hole Number ® ":(.. Date:.:.�.l Time:.:11.:®:0.. Weather �® ... ......:... Location (identify on site plan) ... OT...Q ._ '� Rte+� v,� ::...:.........:. .... :.::.. . .. .,.....:... ....:......::: Land Use ..:. :....V...:.� ! ..... Slope (%) .. Surface Stones Vegetation .::...: . ..�.r�. ............ .. Landform ..:.::, .:. .... ..1�!. . . ..::. -.:. Position on landscape (sketch on the back) Distances from: Open Water Body : ® feet Drainage way feet PossibleMe> Area.:,/.4 :.: 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, Gravel) I®YRa f 57 413 5",K® 5-�I,�s Amy Cobb, Parent Material(geologic) �' ��L}`i2®� �` DepthtoBedrock: Death to Groundwater: Standing Water in the Hole: "®" ®Il g Weeping from Pit Face: Estimated Seasonal High Ground Water. 3�i° DEP APPROVED FORM-12107/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot iJo. 1-o° ®�.+ n zder On-site Review Deep Hole Number . Date:..:,1�, ..°. � Time:.:..��®® Weather _ �@ud o Location (identify on site plan) .:: >,6 Land Use :...:.. d: .:.._ `.::...:..._... Slope (%) ...:. ..: Surface Stones :. ,.:. ..._:....,! ?._.:.::...:. Vegetation Landform ....:. ..:. Position on landscape (sketch on the back) ..::•:.:...:. Distances from: Open Water Body :T ' �. feet Drainage way';l!?,P 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, °k Gravel) ® 10IR 34 t3 r5, L t YR �g'( Rob 45 b zv --Co� ,7h, c z_l C®arse DIM"i�� MINIMUM OF 2 HOLES REQUIRED-AT EVE-117 PRM�iL'u DISPOSAL A Parent Material(geologic) r"�'9e- / .bea®•; —rj..A.L_ DepthtoBedrock: Death to Groundwater: Standing Water in the Hole: °�' t� Weeping from Pit Face: Estimated Seasonal High Ground Water: tit) . 1a DEP APPROVED FORM-12107195 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot i4o. 10+ 4 ea y are- , orbx Kdever° On-site Review Deep Hole Number Da_te 1l!Q 96 Time:��. Weather Location (identify on site plan) .. '�'�.:.::. r ..:. !.:.:' .. ..: �?�1..E::. .Ipott- ... . . ....:.....:.: Land Use ..::.1P...:. .. Slope M Surface Stones Vegetation .:::�41 .N .. .;... . .. ......... .:.... .::::..:..: ..:.. Landform ..:. ::_% 8.®►2.. .® ' :. Position on landscape (sketch on the back) : ..::..- Distances from: Open Water Body :7 �f.,...... feet Drainage way 7,P.H.® feet Possible:Wet Area _...:L. ......: feet Property Line .:.:�� ..:. feet Drinking Water Well ::1....:®:.. 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) ® YR . 10 YA 19 . a MfHy Parent Material(geologic) gis.C4,vo 71LZ . DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: 11 Estimated Seasonal High Ground Water. _ 3� DEP APPROVED FORM-12107/95 ,FORM 11 - SOIL EVALUATOR hORM Page 2of3 Location Address or Lot i1o. �,�°� &CO-y Street On-site Review Deep Hole Number ® .:,. Date:. /4 Time::9�.0 Z> Weather Location (identify on site plan) r:......... .::..:: 6 .:::: Land Use ..:.,.. ! .:fe,E_.::::..::.._. .:. Slope (%) ... .. :. . Surface Stones... .:. :...:.:,..:..... ::. ..... ..... Vegetation .. ......... ::..::::,.:.:.:..:.:.:::::: . ..:..: Landform :.R: F1 ?, .::::. Position on landscape (sketch on the back) .._.:::.:. ...:.::. .:.:................:.::::..::..::.:.:.::.:.::...::..:::....::::....:::.::.:.::.:.::.: . ::,....:. .`E:.. :.:.::. Distances from: Open Water Body . ®.. feet Drainage way.).Y.,.:, feet Possible'Wet Area .- feet Property Line . ;...._. feet 'Drinking Water Well .: 1>®. 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, '/o Gravel) i s - . a 4®YRy,� / cC� v WAN MINIMUM OF 2 HOLES REQUIRE DPOSED DISPOSAC AREA nrsi7�c7`e Parent Material(geologic)—R0Lj4M6N t;,L_ DepthtoBedrock: Death to Groundwater: Standing Water in the Hole: 9 5-f� Weeping from Pit Face: Estimated Seasonal High Ground Water: _ DEP APPROVED FORD1-12/07195 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 6-ray fru+ ot-A Andover 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 "7-p® -?7 7-,P ® r,1,6 �®�y ❑ 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? Ye_S If not, what is the depth of naturally occurring pervious material? Certification I certify that on A10a /ITTS (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 (�f 4 " Date DEP APPROVED FORM-12/07/95