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HomeMy WebLinkAboutSoil Testing Results - 767 JOHNSON STREET 9/9/1997 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 05,s,E 6 -o< -19 0 N APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUSE�5 Applicant NAME ADDRESS TELEPHONE Site Location_ —7 G —) Engineer &V1 NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee l,5 Test No. 9 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. .. .... BOARD OF HEALTH 146 MAIN STREET w TEL. 688°9 540 �ssacrau5f- NORTH ANDOVER, MASS. 01345 APPLICATION I TESTS LDOCATI N F S®IL TESTS: c� Assessor's map & parcel number: OWNER: TEL. NO.: ADDRESS' ,,. , �° ENGINEER: , err �a TEL. NO.: ..,, _ CERTIFIED SOIL EVALUATOR: x, °�= " 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 r 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. w • '�"�-37"x,""^�'�=a xa Y. S; i r � i �a r ✓"I T � , " i -- s� �I I i ✓ � I i I � � I —r- � I T :S s j ' v _? 2=. 71 r'f— �S4 --L-- � d I _ I I i I a DATE: lb - n LOCATION: -7 -2 ENGINEER: fi2L � BOH WITNESS: PERCOLATION TEST# BOTTOM DEPTH OF PERC TEST: TIME OF SOAK: (At least 15 minutes long) TIME AT 12" TIME AT 9" TIME AT 6" OVERNIGHT SOAK TIME STARTED 7 NEXT DAY SOAK: (At least 15 minutes) rp TIME AT 12" / TIME AT 9" TIME AT 6" DATE: LOCATION: ENGINEER: BOH WITNESS: Cwt • �,.� c��act- TEST# PERCOLATION BOTTOM DEPTH OF PERC TEST: TIME OF SOAK: (At least 15 minutes long) TIME AT 12" TIME AT 9" TIME AT 6» 4 �� ✓ ' c �i -OVERNIGHT SOAK TIME STARTED NEXT DAY SOAK: (At least 15 minutes) Q ®C� TIME AT 12" a� TIME AT 9" f TIME AT 6" FORM 11 - SOIL EVALUATOR FORM Page I of 3 1 . � Date r/z/____� No. l Commonwealth of Massachusetts , Massachusetts or on-g�te �S e W�ae�D i s�Q s d oil Suitabi P Date: ...... Performed By: i1 ........ Witnessed By: ....... - --57– —1 L.c.don Addfus Of / r Address.and –7&--;;P Telephone I L-1 A/�O /"/0, Imew Construction ❑ Repair Office Review Published Soil Survey Available: No El Y es &��........ Publication Scale Soil Map Unit Year Published ................................ Drainage Class .... Soil Limitations Surficial Geologic Report Available: No E!9 yes ❑ Year Published Publication Scale Geologic Material (Map Unit) ......................................................................I........... ....... Landform .... .......................................................................................................................... 4 Flood Insurance Rate Map: Above 500 year flood boundary No []Yes Within 500 year flood boundary No Dyes ❑ Within I oo 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 01—'7C456--� Range :Above Normal ❑Normal ❑helcw Normal Other References Reviewed: DEP APPROVED FORM-12107/95 FORM 11 o SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot loo. On-site Review Weathe l/z— Deep Hole Number Date.... ..:: . Time �. :.. Location (identify on site plan) Land Use ..r�<��//'r�4i�li'.�� Slope (%? -2. Surface Stones Vegetation : J :.::.... ....:..:..::...,..... Landform .... "� �%'tJ... .. ::....::.....:..::..... :. , .... .. ......... . Position on landscape (sketch on the back) ! . Distances from: Open Water Body feet Drainage way. : ��.. feet Possible Wet Area Z'4n feet Property Line ... s... feet Drinking Water Weli'l�d feet Other :. . DEEP OBSERVATION HOLE LOG" Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones, Bounders, Consistency, % C& s/ dye <12 u� y 6/ Parent Material (geologic) _ —T"��'�Y G ?G L DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: — Weeping from Pit Face: Estimated Seasonal High Ground Water: '� -- 1)GP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. GAWAWN e,4l 5T Iv,44 Z)06'!� On-site Review Deep Hole Number ..... Date:.:. ..:... 7 _ Time:.6 /� WeatheR Location (identify on site plan) .......... ..... Land Use Slope M .: .. . Surface Stones Vegetation .. � ::... :....:.::... ......:::.. :..:.:::..... .::..:.:.: Landform .... ��t/ra?L✓.. /... ... :: :.:..::::....::......:.::..... :. . .... . jii�r �PLC Position on landscape (sketch on the back) Distances from: Open Water Body l2 feet Drainage way—F...... feet Possible Wet Area 0 feet Property Line .. �... feet Drinking Water Well 7a?O feet Other :. . DEEP OBSERVATION HOLE LOGr Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface llnches) (USDA) (Munsell) Mottling (Structure,Stones, Bounders, Consistency, % O �r 5L 4 /�O V/L �Z�i 2C�`�O � /L�ls S '� Parent Material (geologic) i4��� / L L DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: — DEP APPROVED FORM-12/07/95 FORM 11 - SOIL LVA.LUATOR FORM Page 3 of 3 Location Address or Lot No. Determination for Seasonal hTi Water Table Method Used: ❑ Depth observed standing in observation hole... ............. inches ❑ Depth weeping from side of observation hole .... ...... _ inches � r © Depth to soil mottles .,.:.:.: inches , 4 ❑ 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 y (date) I have passed 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. 17. Signature � Date ©4 g DEP APPROVED FORM•12/07/95 I i I 4•� cil Ti. I I I I I I i i�r I j i r :.3