HomeMy WebLinkAboutSoil Testing Results - 915 JOHNSON STREET 4/2/1998 Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
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APPLICATION FOR SITE TESTING/INSPECTION
�it ORATED PPR�.��J
SSACHUS�
Applicant--- ez %
NAME j ADDRESS TELEPHONE
Site Location �JC
Engineer
NAME / ADDRESS TELEPHONE
Test/Inspection Date and Time /fL/�f
CHAIRMAN,BOARD OF HEALTH
Fee Test No. �`
S.S. Permit No. )IC l D.W.C. No. C.C. Date Plbg. Permit No.
NORTH
O L
BOARD O 'HEALTH
O rw
F- A
t i
30 SCHOOL STREET TEL. 688-9540
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE.- `t'—
f°rx ' ✓
LOCATION OF SOIL TESTS: Y/
Assessor's map & parcel number: 101 A. Z 1-74
OWNER: 4 �,
TEL. NO.: C S-j
ADDRESS:
ENGINEER: t tr J NO.:
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 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 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%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.
f /'�
DATE: I % — P '
LOCATION L� h�'1�
ENGINEER:
BOH WITNESS:
PERCOLATION TEST
BOTTOM DEPTH OF PERC TEST:
TIME OF SOAK: pav (At least 15 minutes long)
TIME AT 12"
f.
TIME AT 91, y `�
TIME AT 6"
OVERNIGHT SOAK
TIME STARTED
NEXT DAY SOAK: (At least 15 minutes)
TIME AT 12"
TIME AT 9"
TIME AT 6"
FORM 11 s SOIL EVALUATOR FORNI
page 1
Commonwealth of Massachusetts
Massachusetts
. . .
Performed Ry. d
, ................ ...................................
Witnessed I3 ::::::::.:.:.;..:..:n.::::::.::..:.....::,.:;.:::
ir41' Y: ..::::::::::......:::: ::.::::::::::......:.....:......................::::.:........................,............................................................. .....
......................................................
Lmilras Address a �� � �d�/�Jwv J / Owe'.Nam,
Address.aid t��J �g�p✓m S®.�✓ 7 _
Teleplwne
New Construction ® Repair
office Review
Published Soil Survey Available: No Yes
� � Publication Scale ...��`1 Soil Map Unit ...... ;J��
Year Published .,.1..... .
DrainageClass .......t6.. Soil Limitations .............................................................................................. ....
urficial Geologic Report Available: No Yes EJ
Year Published Publication Scale ..................
GeologicMaterial (Map Unit) .....................................................................................
..................................................................................................
Flood Insurance Rate Map:
Above 5 00 year flood boundary No El Yes
flood boundary Within 5 00 year y No Yes
Within 100 year flood boundary No Yes El Wetland Area:
National Wetland Inventory Map (reap unit) .................................................................................................................
Wetlands Conservancy Program Map (snap unit)...................................................................................................
Current Water Resource Conditions (U GS): Month ..................
Range : Above Normal Ej Normal El Below Normal El
other References Reviewed:
IDRAJ 11 - SOIL EVALUATOR FORM
Page 2
On-site Review
Deep Hole Number .. P''./..... Date: 44
O Time-../ Weather -4��:5°.....St`A.7...
0- -ff
Location (identify on site plan) ......... f.9 -......................................................................................................................................
Land Use ..........4.....�`..•................................ Slope (%I Surface Stones ...........................................................
Vegetation4.1 .......................................................................................................................................................................................................
Landform .............6rgkos ........... ...................................................................................................................................................
Positionon landscape (sketch on the back) .........................................................................................................................................................
Distances from:
Open Water Body .2. !.?.I. feat Drainage way feet
Possible Wet Area 210?�.. feet Property Line ..... i.:t feet
Drinking Water Well feet Other .........................................
DEEP 0 ERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
linchesi (USDA) (Munsalil (Structure,Stonac Gravel)BoulOars,
Consistency, %
0 Y7 7 cab v.- 4to
.................................................................
Parent Material (geologic) ............./?& L- ........................ Depth to Bedrock- .....h
Death to Groundwater: Standing Water in the Hole: ...2ov.)X-e-'Weeping from Pit Face: .....
Estimated Seasonal High Ground Water:
N'ORh1 11 - SOIL EVALUATOR FORAM
Page 2
On-site Review
Deep Hole Number . .. Date:4.:"/./'O Time:/� Weather .... So
Location (identify on site plan) ............... 9c ................................................................................................................................
� �..j....`
Lend Use .................0?-.k..f;.t......................... Slope M .C.?•'�.`4 - Surface Stones ........fr( .................................................
Vegetation ...........0 a.,.nn,/.....................................................................................................................................................................................................
Landform ...................C a- 0,�.......... - ^w..................................................................................,..........................................................
Positionon landscape (sketch on the beck) .........................................................................................................................................................
Distances from:
Open Water. Body ..10;?' feet Drainage way.r?!Y O... feet
Possible Wet Area ..?.!fir feet Property Line ... feet
Drinking Water Well .>.W'.. feet Other .........................................
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(Inches) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistenc , %Gravel)
6—&
" /�l_ T S•[� l o V lac J/� ��'"r"`r� Ci°`ha �°
(t�
Parent Material (geologic) ......................1 (......................................................................... Depth to Bedrock: .. ..
peath to Groundwater: Standing Water in the Hole: 6 .. Weeping from Pit Face: ... 1
c�
Estimated Seasonal High Ground Water: .... .
FORRZ 11 - SOH, EVALUATOR FORM
Page 3
Determination
'or Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole................... inches
❑ Depth weeping from side of observation hole ................... inches
7iv S
❑ Depth to soil mottles 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 all areas
observed throughout the area proposed for the soil absorption system? �—
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on ���� (date) 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 Date 5�� ! �'�
FORM 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test
Date: ...........`t`.-�`t � Time: .....I.f W47ft—
Observation Hole #
Depth of Perc �� a
Start Pre-soak
End Pre-soak
Time at 12"
Time at 9"
Time at 6"
Time (9"-61
Rate Min./Inch
Site Passed Site Failed ❑ .
.......................................................................................................... .......
Performed By:
Witnessed By: ��fi'19Lso
Comments: .................................................... .................................................... ......................