HomeMy WebLinkAboutSoil Testing Results - 166 REA STREET 5/17/2001 Town of North Andover, Massachusetts Form No. 1 BOARD OF HEALTH NORTH 3�O�'l . /6A�0 19 L O ut Cts� A Ir *A 0 * APPLICATION FOR SITE TESTING/INSPECTION 7�A"'AT-PPP ( �SSACHU5 Ap pl i cant �d4ll%- f .�.� /� � °} NAME ADDRESS TELEPHONE Site Location r - � _, �%' ,.� >- -� .'3j ' 9 �,., u-�i.�`����;y��l'���� _ -'i�i��° � ✓t�' './ f'C✓r�T r Engineer ✓ r � q DRESS TELEPHONE NAME C Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test N o. Z;�r I", S.S. Permit No. / D•W.C. No. C.C. Date Plbg. Permit No. { i fiJ�R��/,. BOARD OF HEALTH a v� ItJ19�4; �uCar o�� t NORTH DOVER9 MA 01845 BaC� ��sp OF 978-688-9540 � _ 1- APPLICATION FOR SOIL, TESTS DATE: J MAP & PARCEL: LOCATION OF SOIL TESTS: OWNER: R'a('w'T `1 TEL. NO. ' ' 6,21- 16,a?Q E�.V1 . ADDRESS: G ENGINEER: New England Engineering Services TEL. NO,: 978-686-1768 CERTIFIED SOIL EVALUATOR: Benjamin C Osgood Jr and Richard C. Tangard Intended Use of Land: Residential Subdivision Single Family Horne Commercial Is This: Repair Testing: V 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$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. 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 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. .'M`j#0� Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: v "'77777777711 r u u r-a � t�s F 9au#�'�.YO✓�%OC�' °tom !�F!+/.L�/� ,r s .n C 1 ��iTyr•��+' t l '� ,3' a � �4'jkr,�sy-' � s� t3 t_r i rte. t j`r-43. �t � i t t 5-�t.�Il�.•�� IF a ' ;Jr 9Az t y�z II Q .�LCl {\ to !� rt ,S9G%/sd �v %SOOO. i3000 T Im 3 e2d' PZa..' sao � VIA r i t �`7v (- �J+- §9 `.is r3 ;}i # k - r 7 i o F •,—j , � n � ' r si i98 tr i 5O �p i /✓�D 5 but i � r .s' r ui 5 �, _ r: ' .s'•� rt 100 r j r d 'ir:56 v2 y T 7i �r r �E ��t�r.Y- �t ¢ i 7 7 + r'{dy t•T'1�"{''SX",.4 & ' t' s 2 4• r t s r t a�(1'' 3 f 4"�JiS° '�bpd '� d r <+ c. P "•° a 1.. t akl`�'ts• ;t,k• .� 7 +t'*it�f�j}t � siE �ti� `�` .:fi,`'4� �•}=74�r '.�5� O '.Q t � ",'��t,isR}�c..5+ + . - " {O - �' t" a,'_-�r c t � ._.'Irtc�r•,S7G.v�'Z./�/— 1 ' � � t p .{ r t ion FORM 11 - SOIL EVALUATOR FORM Page l of 3 No. ( --- Date: Commonwea th of Massachusetts Massachusetts of luitabil' s e me or n- rte Sewagg Disposal e 2'......,..... ./,.... T�� Date: �°/'/ . . .. ..... Performed By: ............ � WitnessedBy: ........... ........ ! ............................................................................................... ............ Location Addrett of (p ;77—>j! r, ,tnd ®���i- ew Construction ❑ 'Repair1 • �'7t� 6�7 76 zr Office Review Published Soil Survey Available: No ❑ Yes Year Published `� Publication Scale ���� "� . Soil Map Unite Drainage Class Soil Limitations 1ALI .. ..........;��P`�C .. ........ . Surflcial Geologic Report Available: No R] Yes ❑ Year Published publication Scale �..�.. GeologicMaterial (Map Unit) -- .............................................................................................................. . ....... ... Landform ............................................................................................................................................................................... Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes M Within 500 year flood boundary No [Dyes ❑ 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 / Rangc :Above Normal ❑Normal 1SBelc-,.v Normal ❑ Other References Reviewed: —` - -- DEP APPROVED FORM-12/07195 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Can-site Review Deep Hole Number .:,.:1 ... Dat Time:.. f''"� Weather /.V- 66 0 De p =. Location (identify on site plan) Land Use Slope {%) .....--r . Surface Stones _..: ::... .. Vegetation ���~ '� ..:.....::.. :..: .. . .....: ..... .....:.:.. ...:.::.: ....: Landform ...G ? :.: ?�IO..� rt/ .:...::. ... .. Position on landscape (sketch on the back) �...: G`r' Distances from: Open Water Body/' � feet Drainage way- 7 .o Possible Wet Area feet Property Line .R.,4,.,,. feet Drinking Water feet Other ...... .:......:' DEEP OBSERVATION HOLE LOO' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) �P G rnNC> Parent Material (geologic) �./� 77/—C.. D pthto9edrock: r Depth to Groundwater: Standing Water in the Hole: r Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED F0101• 11107/95 -_5 71-Al C-r i FORM 11 - SOIL EVALUATOR I.O1tM Page 2 of 3 Location Address or Lot No.�� ' �1• �;�`��` On-site Review yy Dee p Hole Number Date;'. � Time:.. <.c. Weather�/.�-- Location (identify on sit e plan) p ) ., "���.�.���.-,.,�:..,��•-,,./...� ?'h.,:..:v,,::._:.,...,.�,. ...,:::. -....: .. .. . .... Slope (%1 surface Stones Land Use :,...,..,:-� ...:..:,:...., Vegetation : ... ,r ' J•''r..,..... .,..:,....:... .... .........:..r...,.:.:.,:.,... ........:...:.:... .........,.:..:..:,._.::...:::,...:. ...,..:... . . . Landform ,..... 'c�h'i,�l ..:...��11l�hLL.X/ ... h,... . ..... .....,... .... .. . ... . ., ... . ..... .. Position on landscape (sketch on the.back) . ::.:::.:::.•• Distances from; Open Water Body . feet . Drainage way:..........:. feet Possible Wet Aroa .��feet property Line ,:, °.:. feet Drinking Water Well/.,.F,'' feet, Other .,..,.. ...,...:.,,..,..,.,...,.,.. DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon. Soil Texture SoTColor; Soil Other surface(inches) (USDA) (Munsell) Mottling (Structure, Stones,G alders, Consistency, % a /jo /!. L 5m 'Le �A er- Parent Material(geologic) ' t-' — DopthtoBedrock: Depth to Groundwater: Standing Water in the Hole:_ Weeping from Pit Face: © y _ Estimated Seasonal High Ground Water: - -- DEP APPROVED FORM• 12/07195' , Location Address or Lot No. Rete1m&gdgn far-Seasonal High VyWP Table Method Used: ❑' Depth observed standing in observation hole.-.......... . inches ❑ Depth weeping from side of hole .................. inches °Q Depth to soil mottles .—.:........., inches ❑ Ground water adjustment " . .................. feet •-�Z= � 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 49 areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? _-- Certification 1 certify that on$2�1l /4^fdate) I have p as sed 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. Signa#ur ��� Date DEP APPROVED FORM•12107195 v qy„ J dY Y �{r n s MEN NOMMM ON MEM OEM NIMIN ON ONME NO MEN MEN MEN mm NO INS SEE ON NOM Ste= �. NIONOM EME i _. ' LC)CA.710 N O L",i I O N i i .= ECI 1-1-01M JC, I Cr _, C -TEO I TIME ic..T CVERNIG iIIMEE i= NEXT ( iNIE A. i = \ TWE AT LO C,-. I 10 r\1. �K =':,OL',i ICN i=S i I I I O N I J.'=. 1 CI k C I I , I M,E`_- C.,= �r.ri,. �,� .., (r,i I c c 5 i � �1,7, ,E S C"y I I IME A I _ IiN'i I T IINiE I J 0�� "/Vii NESS. 1 r / iME - - ji(vlE .=.i I T I E I f I IV I` =. i - iiN/1E I