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Home My WebLink AboutSoil Testing Results - 82 RALEIGH TAVERN LANE 12/7/1999 Town of North Andover, Massachusetts Form No. 1 NORTH q BOARD OF HEALTH /b46,v'D 19 7RA�RATEO PQa.c5 APPLICATION FOR SITE TESTING/INSPECTION �SSACHUS�� Applicant ,J627-6 x)61 NAME ' ADDRESS TELEPHONE Site Location TA)V 1- Engineer ��- ��✓�, ��' NAME ADDRESS TELEPHONE Test/Inspection Date and Time 7 1�( i -CHAIRMAN,BOARD OF HEALTH Fee d Test No ► `" S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF LT � .X9540 NORTH ANDOVER, MASS. 01846 BOAR D 0 F APPLICATION FOR IL TESTS 0, Y DATE: g�- �15 LOCATION OF SOIL TESTS: .l Assessor's map & parcel number:_ —1622A Z 16 t OWNER: ALZL&L ; I �a � � L. NO.: --97 ADDRESS:j2k7e,eALL,jera Ll q :. , ENGINEER: �� °EL. NO.: ?7t-"5' CERTIFIED SOIL EVALUATOR: _ OA L,L- � " Intended use of land,/residential subdivision, single family home, commercial Repair testing Undeveloped lot testing N. A. Conservation Commission Approval: 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 2 5.00 per lot for ew construction. This covers the minimum two deep holes and two percolation tests required for each disposal area, Fee of$Z5,QO per lot for re airs or uporades. 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 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 A-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. FORM 11 - SOIL EVALUATOR FORM Page 1 Commonwealth of Massachusetts Massachusetts Foil Suitability Assessment for On-site Sewage Disposal Performed By: ............................ Witnessed.B.....................::::.:.:::::::::::::......�� ::::::::::::::::::::. ..H.:::::::::::::::::::::::::.:::.:::::::::::::.::.............................................................................. �?�' Vll�d�t rI^ ��v Lr,,, �. o .N—Av� % may �Ju�4�y� .� Loaiian Addrtsi a 0 La/ 0 Address.ud VVI I� � Tckphone/ GUD �t7'ZO io _ (�l8<f0 -rV Id New construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes lam' Year Published ... Publication Scale .J.....yOV0 Soil Map Unit .......... .. lop Drainage Class .....�` ....... Soil Limitations ........................................................................................��"1.. ... ..�ki ' Surficial Geologic Report Available: No 9/ 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 D/ 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: 0 S61 c 1,-0"j 11 SOIL EVALUATOR FORM Page 2 La Deep Hole Number Date:J2,.-2j7 Time:Jb'e-�qw Weather . ........ ................... ................................................................... Location (identify on site plan$ P.A� (%10- -&?`................................................................. 'Ny�ftl........................... Slope Land Use ........... .. Surface Stones Vegetation ........... R.1 ................................. ........................I.................................V,........................................................ Landform ...............6.6b,"IX..... I�..... Position on landscape (sketch on the beck) .................................................................................................................................... ................ DIBtencas from: Open Water Body Z.1.02 feet Drainage fast, Possible Wet Area ..la-'t feet Property Una fast Drinking Water We lost Other ......................................... IDE EP OBSERVATION FIME LOCY Sol Color Sol Mottling Depth from Surface Soil Horizon Soil Taxtura M Surface Imunsell) Istructurd,Sum,Boulders, jincheal (USDA) Consloteriov, Orwell— /0 q4 Parent Material (0601091CI ............... ........................................................................... Depth to Bedrock: .......... Standing Water in the Hole: /?� e Weeping from Pit Face: Estimated Seasonal High Ground Water: 37 ti FORM It SOIL EVALUATOR FORM Page 2 Onnsite--Rev>reW Deep Hole Number ...!�A! Time: /LIW47cl Weather �4e�k7l ..........4.&,..pl."14.................................................................................... ............................. Location (identify on site plan) kze--4�........................................... Land Use ...............................I.......... slope .. ..(4, surface Stones Vegetation ........... .................................................................................................................. Landform ............. ....lwoote.. . Position on landscape (sketch on the back► ...•.•••.••••••••••••••••••••••••••••••••••••••••••••••••............................................................................................... Distances from: feet Open Water Body Zwo feet Drainage way 1,2pt Una 2V.1--"ke•••• feet Possible Wet Area loot Property Drinking Water Well feet Other ......................................... IBMR-VATION ROLE LOG Soil Color soil mottlIng 00w Depth from Surface Soil Horizon soil Taxture (structure,Stam,Boulders, (inches) (USDA) (MunsaIll Ep—th:Iro�n:�urf Consists 1i Onveq 16 Y/f �Y/( `� S� 4 rs6- Z.,5 36— -177 -7 rlx,* Parent Material (geologic) ................ .................................................. Depth to Bedrock: Standing Water in the Hole: ......Z.. Weeping from Pit Face. ......... • Estimated Seasonal High Ground Water: FORNI 11 ® SOEL EVALUATOR FORS Page 3 Determination for Seasonal T'gh WWer Table Method-Used: ❑ Depth observed standing in observation hole inches ❑ pth weeping from side of,observation hole inches 3 !V Depth to soil mottles Inches ( S ❑ Ground water adjustment feet Index Well Number Reading.Date Index.well level ...........�....... Adjustment factor Adjusted ground water level ........................................................ pepth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in ail areas observed throughout the area proposed for the soil absorption system? e5 If not, what is the deptli of naturally occurring pervious material? Certification certify that on ��5 Nate► 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 /-,Data FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test Date: / -? Time: ..................................... Observation Hole # Depth of Perc Start Pre-soak End Pre-soak `Z,;ev Time at 12" Time at 9" Time a� 6.. �d Time W-6"1 Rate Min./Inch 10 Site Passed 12 Site Failed ❑ ...................................................................................................... .. Performed By: Witnessed By: Comments: ...................................................................................................................... 1 '. /L7 U u Y ✓✓. „ 9 f � H J / l ' v 9 / z /r/ rs 11 ,„,, ..' . ,,, l f t ✓ r 4, Y'1R x s � , i . , .r?' ., ,, .,, "r Y' ” r, y / f : •_ f / _ 1 s W r' / __11 J11 9 I" __ F __ "r P J l ", „ 3 ,.r, i _ F :n 1: ,. r P rf r , r !p / F _ 4 c3a3ct,1� r D�,e TICS 1 4. t v Frr — f � J-1 3 NT i ��;�