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HomeMy WebLinkAboutSoil Testing Results - 1499 SALEM STREET 2/7/1997 NORTH .?tio BOARD L �. •'"ll 's 146 MAIN STREET TEL. 688-9 540 �SSACHUS�t NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: 2--7— 9' LOCATION OF SOIL TESTS: / �, 5-; CZ ( Assessor's map & parcel number: OWNER: TEL. NO.: 69-5—V sue ADDRESS: /5-1S SALCA&- �► N�' ��n�,���9 M � ENGINEER: aT�'V� �1 UR5 TEL. NO.: -3 �8 7�- CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision, single family home commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $175.00 per lot for new construction. This covers the two deep holes and two percolation tests required for each lot. 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 Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system. 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. Town of North Andover, Massachusetts Form No. 1 NORTh BOARD OF HEALTH O m lK A°Q °°° APPLICATION FOR SITE TESTING/INSPECTION 7 AORATEO pPa.(5 �SSACHUS�� Applicant `.1JVV�✓�. 1 � � r� °t ri NAME ADDRESS TELEPHONE Site Location_ L4 Engineer— NAME ADDRESS TELEPHONE Test/Inspection Date and Time U� 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 Location Address or Lot No. On - ►S'ite Review Deep Hole Number Date ;G Time Weather Location(identify on site plan) Land Use Slope(%) Surface Stones Vegetation Landform ` a Position on landscape(sketch on the back) Distances from: Open Water Body feet Drainage way-7 feet feet Possible Wet Area ���/� feet_ Property Line I 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) h9w A/ tic/ r os Cap "MINIMUM OF 2 HQLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) /�1 Depth to Bedrock: Depth to Groundwater. Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: 76 DEP APPROVED FORM-12/07193 wilevil�un b° FORM 11 - SOIL EVALUATOR FORA1 Page 1 of 3 No. Date: Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By Date: Witnessed By. RJ laauon Addrcsr or 0wrtr'f H&rc. l.a Addrnt.ud . Teleplorc/ ' New Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes — Year Published ®'� Publication Scale ej Soil Map Unit / /� Drainage Class _ Soil Limitations _......_ Surficial Geologic Report Available: No ❑ Yes Year Published Publicatic i Scale Geologic Material (Map Unit) t Landform _......................./'r. ...... .....................................'............_............................. ............. .. ..._.................. Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ®Y-es ❑ Within 100 year flood boundary No l°J 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: DEP APPROVFD FORM• 11/07/95 FORM 11 SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On-site Review Deep Hole Number Date: Time: Weather 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, % Gravel) MINIMUM OF 2 HOLES REMIREDT-1 EVE:KY PROPOSED 151SPOSAL AREA Parent Material(geologic) �' Deptf-rto8adrock: Dtleth to Groundwster: Standing Water in the Hale: Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM• 12/07/95 �I FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 r Location Address or ( e Blietermindfig' 'n for Seasonal Rkh Water Table Method Used; ❑ Depth observe,' ' Landing in observation hole................ inches ❑ Depth weepin' 'from side of observation hole ... ... .. _ inches Depth to soil mottles 74" inches ❑ Ground wafer adjustment ......... feet Index Well Number .. .......... Reading Date .................. Index well level Adjustment factor .... ... ` LL' Adjusted ground water level ........................................ l� Depth of Naturally Occ r Oer�vious Material Does at least f : r feet of naturally occurring pervious material exist in all areas observed throu 'b`'A the area proposed for the soil absorption system? 'if not, what is t ' pth of naturally occurring pervious material? Certificat"'n' certify that o f //.�. y (date) I have passed the soil evaluator examination approve' �th _ar rent of Environmental Protection and that the above analysis was perf&med t,1 °consistent with the required training, expertise and experience described in 310,' P 15.017. Sig k&e . Date ; DEP APPROVED FORM•12/07/95 FORM 12 - PERCOLATION TEST u"4�2 Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS �r Massachusetts Percolation Test* Date: Time: i Observation Hole# Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" L 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 171 Site Failed F Performed By: r Witnessed By: Comments: DEP APPROVED FORM-12/07/95 PectatSAM I , II il � ") ZED!! f �� - s_y �� V r I J r � TpN 5 I I- pp O' t 1 I i G � l li f PRICE 1 11l01,1 �J1�3111 1 .. 1111111111111111111111111 1111 11�1���►111111111111111111111111 1!1!1.�1l1��,1� ��lJ1111111�11 111111111111C���IL�1�1111 111 i ,: '- 111111111 � -�-Ir n 111111111 A - � � /1111/11 _ ► �: : �1 , IIIIIAIIIII�II�IIIIIINIII�i IIgINM11�1111111�i 1�► 1111© � 1�11�11�1 �� rF IR-I�JI��l1! r" 111�1�1�11 �s r IQIOI� ! �11M11�1 z eeee��elce - 11, Illlllll�r� n ■�lirw � n 11111111-� �'IIN 1111 �I �y:, ' 11111111111M111�11�111�11 1 Il� C 11�11�11 111 y' ew- ilsl-l111►� �©NII 1111 1�11e1111l- _ � C� -► INIIIIIIII�1 1�ilIIIIIIE.-.�Ia�11NN111111111 1 v• c