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HomeMy WebLinkAboutSoil Testing Results - 223 FOREST STREET 4/14/1999 Town of North Andover, Massachusetts Form No. 1 �NORT bra BOARD OF HEALTH 01 D WIA sr 41 APPLICATION FOR SITE TESTING/INSPECTION A�RATEO PV 11(c� �SSACHU5�� Applicant QCIE 96-06&X NAME ADDRESS TELEPHONE Site Location Engineer ��� NAME ADDRESS TELEPHONE Test/I nspection Date and Time CHAIRMAN, BOARD OF HEALTH Fees Test No. � i S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH TEL. 666-9540 NORTH 9 MASS. 1 4 APPLICATION IL TESTS DATE: LOCATIO OF SOIL TESTS; Assessor's map & parcel number: OWNER: Ii�, � �� p�' o �It°�� TEL, NO.: ADDRESS: p ENGINEER: �t,���.�.., 1":�� bt . l) .�� ,.` r K �,,,. TEL. NO.: ei C? Vic CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivision, single family home, commercial Repair testing IN 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$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 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. vp ILI, Elm% ® vk,q ap AD i Mz ex r _.;� � �._'_ ,_ c_.._.�_.-_,gip,,. ,r;;-�-.. .1.�. r fx•.,�,,d � ,r�s, � a>����'I ri{�+t�'��r r kr�.��'� � `. /Zy � 5 ---- r� � .. . ....... «\\^ �\ �, y« . \ \\�« ��\ � � ` � � :\ «/� c ��/d� �® . I i FORM 11 - SOIL EVALUATOR FORM Page 1 or 3 n .` Date: b Zia No. 7-,F• 1 Commonwealth of Massachusetts , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal ter a Irtn s�v�,�S� Date: Performed By: O _,/..... .. ....._._ -C Q✓ Witnessed By: S�> .�,,._._...... .. _i �T�' Owners Name, I'jW2 CJ o (�•VB �C/l✓ Location Address a 2 2 3 rU�Z f ( >'I t/ Address,a,d La M V n/ �Ns7�)U� /`� Ol��/� Telephom/ / :44 New Construction ❑ Repair q18- 6t3,21- by Office Review Published Soil Survey Available: No ❑ Yes Year Published 198 1... ... Publication Scale /��✓ � Soil Map Unit CSC. Drainage Class GU �t -... . Soil Limitations Surficial Geologic Report Available: No ® Yes ❑ Year Published _ Publication Scale Geologic Material (Map Unit) - - ...... .......... Landform .... . ....... .... ...._.. a ........................ . Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑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 .)-p 1Z' - Range :Above Normal ❑Normal ❑Belc�v Normal Other References Reviewed: — DEP APPROVED FORM- 12/07/95 FORM if - SOIL E?VALUATOR FORM Page 2 of 3 Location Address or Lot No. 22 3 Ui2L-5T oil-site Review . - I y Deep Hole Number T��, ,31/ Date: 3 f`9 Time: ����� Weather Location (identify on site plan) leea 147 Land Use Slope ( /ol / Surface Stones Vegetation Gf/o00 FO Landform GlLo✓N0 /1'40,2i9-t'V E Position on landscape (sketch on the back) Distances from: Open Water Body �0" G feet Drainage way Zv v feet Possible Wet Area 3 00 feet Property Line feet Drinking Water Well /3 0 feet Other DEEP OBSERVATION HOLE BOG` Depth from Soil Horizon =SoilTexature Soil Color Soil Other Surface (Inches) (Munsell) Mottling (Structure,Stones,GouVedl,rs, Consistency, % -3 7" 13 /5 ILS/d tGb>c ty�f0 l U/a co 1, �-; bs t�cr• � (�� ,S�JW S 5`y �l3 tnep d,%T Co-v%_ It Parent Material (geologic) DepthtoBedrock: J Depth to Groundwater: Standing Water in the Hole: .-. Weeping from Pit Face: -- Estimated Seasonal High Ground Water: UEP APPROVED FORM- 12/07/95 FOIZNI 11 - SOIL EIVALUATOR FORM Page 2of3 Location Address or Lot Igo. on-site Review Deep Hole Number Date: -�-IIYIIV Time: /0" 00 Weather S +y Location (identify on site plan) gea,-, �T Land Use Slope (%) Surface Stones /yfAti'y Vegetation vjoo")e-o Landform 6-Yl4D(-)^ 0 /Vic, �9t Position on landscape (sketch on the back) Distances from: Open Water Body /000 feet Drainage way 0-100 feet Possible Wet Area 3ev feet Property Line 5 feet Drinking Water Well ).30 feet Other _ DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon Soil Texture Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones, Bounders, Consistency, % Surface (Inches) �vy,�3/_3 io p n 5�+��ow0 17c'c� DepthtoBedrock: Parent Material (geologic) Depth to Groundwater: Standing Water in the Hole: --� Weeping from Pit Face: — Estimated Seasonal High Ground Water: r DEP APPROVED FORM- 12/07/95 f DORM 11 - SOIL LVALUATOIZ FORM Page 3 of 3 Location Address or Lot No. c;2.�2 3 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole - inches ❑ Depth weeping from side of observation hole inches ® Depth to soil mottles 37 inches 7-, i' ❑ 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 &60 1 `-!2 (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 15.017. Signature / Date DEP APPROVED FORM-12/07195 FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. Date: Commonwe Ith of Massachusetts /Q/ �X���- , Massachusetts Soil Suitabilitv .A.ssessinent-for On-site Sewage Disposal Performed By. �< < !(�. . . .. �........'�-� Date: Witnessed B �Ci _ _........... ...... ......... .... By: .......... ................... ... .. .. .............. ...................... . L04 I n Address a cell ��A Addras,ud .7 Z La I a /O �1�'� Tckphom/ �" Lew Construction ❑ Repair Office Review Published Soil Survey Available: No El Yes Year Published If . ............ Publication Scale / . Soil Map Unit _- Drainage Class Soil Limitations �r�..... / �L.T7� . ..... . . .. Surficial Geologic Report Available: No R1 Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) ........I....................... ..._.._......_ ......... Landform .......... ..................... ...... ...._ _........... Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No Dyes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) .._.........•........•................. Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belau Normal Other References Reviewed: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FolzN1 Page 2 of 3; Location Address or Lot iqo. /1—Z3 On-site Review Deep Hole Number ... -::. Date:. /...'..1� �/ Time:"""/5 Weather� 0 Location (identify on site plan) Land Use /�r �L Slope Surface Stones IW� Vegetation Landform Position on landscape (sketch on the back) . .: � Distances from: Open Water Body feet Drainage way Z` feet Possible Wet Area feet Property Line Imo.. 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) MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material (geologic) 7—L L-- DepthtoBedrock: _ Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: _ �6 Estimated Seasonal High Ground Water. _ --•— — DEP APPROVED FORM-12107/9 DORM II - SOIL LVALUATOIZ IiORM Page 3 of 3 Location Address or Lot No. Determination for Seasonal Hi h Water Table Method Used: ❑ Depth observed standing in observation hole..... inches ❑ Depth weeping from side of observation hole....,... inches © Depth to soil mottles - 9 �' inches T,p*`Z F-1 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 as 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 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. Signature �/ ate 414z DEP APPROVED FORM• 12107/95 •y • FORM 11 SOIL EVALUATOR FOIZ(1I Page 2 or 3 Location Address or Lot No. Ott-site Review Deep Hole Number Date:.' . _ Time: Weather / Location (identify on site plan) ` - ~ - -^�r� Slope (%) / Surface Stones Land Use ....�.= Vegetation Landform _ Position on landscape (sketch on the back) .. - Distances from: Open Water Body feet Drainage way 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) pffffW177017 2 LU5 REQUIRED AT EVERY PROPOSED DISPOSAL AREA 4�L r Parent Material (geologic) DepthtoBedrock: _ De)� tr h to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water:� 2 -- — — DEP APPROVED FORM-12/07/95 DATE: LOCATION* ��� ,.. L=NGINE F'. , ., f BOH WITNESS: PERCOLATION TEST r BO TT ONI DEPTH OF PERC TEST:.. .° w f TIME OF SOAK.: _ . eGms, minutes Icrc) TIME AT 12" TIME AT TIME ATE CvE=;NIGH7I SOr,K T IME S T A FTED NEXT DAY SOAK: (.,t ,eEs 1 inute�! 1iMEAI i2 T I Ni E T TIME AT u"