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Home My WebLink AboutSoil Testing Results - 206 FOREST STREET 12/17/2001 Town of North Andover, Massachusetts Form No. 1 NORTly BOARD OF HEALTH /,•t �1 {/ 0 O q �QADRATEDFPPRy^`5 APPLICATION FOR SITE TESTING/INSPECTION �SSACHUG Applicant_ NAME ADDRESS TELEPHONE Site Location (✓ 1 Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Al RMAN,BOARD OF HEALTH Fee 0� Test No. / --2. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH NORTH OVA , MA 01845 978®688-9540 APPLICATION FOR SOIL. TESTS DATE: 1/ G� MAP &c PARCEL: P 6 9 LOCATION OF SOIL TESTS: bA(I r-- _ Y4 D OWNER: A 42- TEL. NO.: ADDRESS: ENGINEER: ��`Z TEL. NO.: °,, CERTIFIED SOIL EVALUATOR: `— Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? "Yes No 2001 THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan &r 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 L 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. Please Do Not Write Below This Line MAR 6 f . . Conservation Commission Approval: Date Received: Check Amount: 'Aaol Check Date:,J FOILN1 11 - SOIL EVALUATOR FORM Page 2 of Location Address or Lot vJo. Orr-site Re�i�sa� ' Deep Hole dumber _ Date: ✓ �'�,'� Time. Weather Location (identify on site plan) ...w.,Na.. _ Land Use Slope (°i6) _ Surface Stones Vegetation Landform Position on landscape (sketch on the back) a... Distances from: Open Water Body . feet Drainage away - 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) 1USDA) tMuruelq Mottling (Structure,Stones;Boulders, Consistency, 96 Caravel) n � t n „ , 4 i Parent Material(geologic) Death to Groundwater: Standing Water inthe Hole: Weeping from fait Face: Estimated Seasonal High Ground Water: DEl APPRON70)FORM-1210719S i I FORUM 11 - SOIL EVALUATOR FORNj Page 2 of 3 Location Address or Lot v4o. On-site Review _ Deep Hole Number Date: Time: Weather Location (identify on site plan) Land Use Slope (%) Surface Stones _ 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 LOGS i Depth from Soil Horizon Sol Texture Sol Color Sol Other Surface)Inches) (USDA) (Munseln Mottling (Structure,Stones,Boulders, Consistency, % Graven o r, L Parent Material(geologic) DwpdXoBadrodc: Depth to Groundwater: Standing Water in the Hole: Weeping fiorn Pit Face: ,r Estimated Seasonal High Ground Water: DEF APPRON71)FORM-1210710s 1 . FORM 12 - PERCOLATIO.N TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test' Date: .. .. . Time:, Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" f 1 Time at 9" Time at 6" Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed in both the primary reserve area. P y area AND Site Passed 0 Site Failed ❑ Performed By: . ............................................ ............................. Witnessed By: Comments: t DE P APPROVED FORM.UWIVS FORM 11 - SOIL EVALUATOR FORM OF NOR€4A;'d'D Rj- Page 1 of 3 JUN No. _ Date: i Commonwealth of-Mas �t --- NO fz-T- 1t A rQ* 1>0v ; . Massachusetts Soil Suitability Assessment 'or On-site Sewage Disposal Performed By: tom' t ,a�°/ 'l ..`i Date: 2 Witnessed By: ;y.{ .? a e p ... .......I........... . . • ,,� o.n,�rt rl>m. Addrat,a,d New construction M Repair Office Review Published Soil Survey Available: No ❑ Yes Year Published 1 Publication Scale �� ` . Soil Map Unit Drainage Class P..... . Soil Limitations .......................................... .. ............. .... ........ .... .. . . . . Surficial Geologic Report Available: No ❑ Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit) .......................................................................................................................................................... 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 El Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ....................................................................... ............_................. .... Wetlands Conservancy Program Map (map unit) ................................................................................................- Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Below Normal ❑ Other References Reviewed: DFp A?MOVFD FORM. 12/07/95 FORA 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On-site Review Deep Hole Number Date: �� :.'ice-'.'-y ;:'. Time: J7"f,,j , Weather ' v Location (identify on site plan) Land Use d W t'l Slope (%) Surface Stones Vegetation -- ' , �i - ,:. { Landform Position on landscape (sketch on the back) Distances from: Open Water Body �D' 1 feet Drainage way >, feet Possible Wet Area (,� feet Property Line Go feet Drinking Water Well :;o fir;feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munselll Mottling .Structure,Stones, Boulders, Consistency, % Gravel) 1 fA - r F' E� i u#AA 4a [ MINIMUM 0 SAL APLEA - � C Parent.Material )geologic) i�1��a OepUxoBedcock: > Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: i i DPP A-PVROVED FORM. 11/07/➢5 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No On-site Review Deep Hole Number Date: .'i r_„ - ` . Time: ! +` i;',I. Weather Location (identify on site plan) Land Use ?,. <l ti .y Slope M Surface Stones — Vegetation c,•°' Landform Position on landscape (sketch on the back) Distances from: Open Water Body -,,- 100 feet Drainage ways 50 feet Possible Wet Area ``)' a., feet Property Line feet Drinking Water Well tia Meet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USOAI (Munselll Mottling .Structure,Stones, Boulders, Consistency, % G(avel) TqF ray Fg t'•�� e° 4� t� ff 1 lip r.a Parent Material (geologic! :4_ k 4 OepttRO8odrock: u 11,14L Depth to Groundwater: Standing Water in the Hole: ° Weeping from Pit Face: ...� Estimated Seasonal High Ground Water._ i DEP APPROVED FORM- 12/07/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS r Massachusetts Percolation Test` Date: _ Time: Observation Hole # Depth of Perc , Start Pre-soak End Pre-soak Time at 12" % � Time at 9" Time at 6" b. Time (9"-6") Rate Min./Inch * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed � Site Failed ❑ ............................................................ ................................................... ...... Performed By: "J Witnessed y; Comments: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 -3 Location Address or Lot No. 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 �(:; 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 tl (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 ry Date DFP APPROVED FORM- 12/07/95