HomeMy WebLinkAboutSoil Testing Results - 835 CHESTNUT STREET 9/10/2002 BOARD CAF HEALTH
NORTH ANDOVE R, MA 01845
978-6$8-9540
PLICATION FOR SOIL TESTS
DATE: I ( �� 2 MAP &PARCEL: /07 G- °— 00
LOCATION OF SOIL TESTS: 635-
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OWNER: ',f)1,9 ti,v 6 C e K i E TEL. NO.:
ADDRESS: 09-: Ckf,!53 i u y i 5%mac; i
ENGINEER: /O Eut) c:A)6&19,v,`� G=,UCrI ✓/�"�-DING-TEL. NO.:
CERTIFIED SOIL EVALUATOR: �� h ��s�y�a� ��? 1���tfr,�� /�<.�s C
Intended Use of Land: Residential Subdivision Single Family Home j Commercial
Is This:
Repair Testing: "" " Undeveloped lot testing:
In the Lake Cochichewick Watershed? Yes No x
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$425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or
upgrades. (If time is not critical, fee for repairs is $75.00)
GENERAL INFORMATION
I. 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 I"-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.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval: .44"'
Date Received: Check Amount: � � Check 4te: 1' 104,
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FORM 11 - SOIL EVALUATOR FORM
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Location Address or Lot No. cYFr ,
On-site Review
Deep Hole Number !... ::: Date:: Time:. ?, Weather
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Location (identify on site plan) ..:.. ...:.: -,--..... .. . ..__.:: :
Land Use :... :..E Slope (%) `" ...: Surface Stones
Vegetation .. .. � ........ ,� . ... . ..::,:.:..: _...:., : .:.,
Landform
Position on landscape (sketch on the back) ...:..... � .: .:.
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Distances from:
Open Water Body feet Drainage wey 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)
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MINT999-7 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
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Parent Material (geologic) _ DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water,
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DEP APPROVED FORM• 12/07/95
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
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Location Address or Lot No. 6R
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On-site Review
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Deep Hole Number 2:. Datef` Time;.. WeatheT1/17
Location (identify on site plan) '. .L`..
Land Use Slope M Surface Stones
Vegetation
Landform .._ , . ..:.:.:.
Position on landscape (sketch on the back) r � �
Distances from:
Open Water Body feet . Drainage way:.:. feet
Possible Wet Area feet Property Line .:..: ..........:.: feet
Drinking Water Well feet Other ...................::::._.::::,::::::.,::::.
DEEP OBSERVATIOWHOLE LOG'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(Inches) (USDA) (Munsell) Mottling (St ructure, Stones,
Gravlegrs, Consistency,
Cf ,
pe
MINFMU"F 2 HOLES MOIRE-
Parent Material (geologic) Depthto6edrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: _.
Estimated Seasonal High Ground Water:
DEP APPROVED FORA/• 12/07195
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