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Home My WebLink AboutMiscellaneous - 36 PATTON LANE 11/23/1998 Town of North Andover, Massachusetts Form No.2 oe 00RTH, BOARD OF HEALTH oa®'�. 19 a p '' of DESIGN APPROVAL FOR 4{9 •ono '�� SsACHUSES SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant rr Test No, Site Location Reference Plans and Specs. E R DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Fee 1.17�0 Site System Permit No. FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. Date: Commonwealth of Massachusetts A),� 4-,4j Do✓,5r— , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: J- /?ZE7- Date: Witnessed By: Locatan Aaarus« / (� r D iA f V Z—, &A La Ad&esz.ud rckphwn 1 -7,6 ew Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes Year Published )19 / Publication Scale V15-��Y6) Soil Map Unit ��... Drainage Class 14 ......... . Soil Limitations ........................................ .. ............. ..... ........ Surficial Geologic Report Available: No ❑ 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 ❑Yes ❑ Within 100 year flood boundary No 9Yes ❑ 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: DEF APPROVED FORM•12/07195 FORM 11 - SOIL EVALUATOR FORNt Wage 2 of 3 Location Address or Lot No. _?j Qq.�-�®N Z1_1 Opt-site Review Deep Hole Number 7--/ Date: Time: 9 4 , /)1- Weather ��6 'u ic/iV Location (identify on site plan) Land Use /'j Slope (%) Z Surface Stones Vegetation 6 KA 15 J Landform O u-1 wit ; t—/' Position on landscape (sketch on the back) Distances from: Open Water Body 7(b D feet Drainage way feet Possible Wet Area Tipp feet Property Line 60-2� 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) 3/2 Z-4— V,6!P Y4- C, 5,4 AJ 19 Parent Material (geologicl 2,Q-7—LlJ l7 _ Depthto8edrock: /Q 6 Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: 2 i OEF APPROVED FOFNt•1210719S 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 10 Depth to soil mottles 62—' 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 aIJ areas observed throughout the area proposed for the soil absorption system? -S If not, what is the depth of naturally occurring pervious material? Certification I certify that on t I I qq (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 I DEP APPROVED FORM-12107/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. N - COMMONWEALTH OF MASSACHUSETTS A)6, Ve7 iC , Massachusetts Percolation Test` Date: Time: Observation Hole # / Depth of Perc 3d 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 performed in both the primary area AND reserve area. Site Passed Site Failed ❑ ..................................................................................... ....................................................._.. Performed By: 5-c—f9W DL r=P c.-u -z eA Witnessed By: 5 i_D Comments: :.._::....::.. DEP APPROVED FORM-12/01/95 l l\ r L L i �� I I •� I I � I � � i I I I •I\ it ��. � I`v;- i.l\ I I� � Ir�y I -r- -L - -i-1 - - - L- -�-' - i I _ I �- L--! --L--- -r- !- DATE: LOCA i I• N: - ENGINESL — - - - V\ - BOH W i � c TrSS: - PERCOLATION TEST G BOiii OM DEPTH OF PERC TEST: � � 157 Z TIME OF SOAK: /,�9 minutes Icnc) TIME AT 12„ TIME AT c„ _ ;.) l e TIME AT F CVE=; NIGHT SOAK TIME STARTED ED NEB T eEs; 1 = r iru:es) TIME AT 1 TIME ,"-.T TIME ATS