HomeMy WebLinkAboutSoil Testing Results - 360 FOREST STREET 9/6/2000 Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
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APPLICATION FOR SITE TESTING/INSPECTION
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Applicant c
NAME ADDRESS TELEPHONE
Site Location
Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time !
C AIRMA , BOA D OF HEA
Fee Test No. 'Y 7
S.S. Permit No. �� � D.W.C. NO. C.C. Date Plbg. Permit No.
BOARD OF HEALTH TEL. 653-9540
MASS.NORTH ANDOVER, 01846
APPLICATION IL TESTS
DATE:
LOCATION OF SOIL TESTS:
Assessor's map & parcel number:_ I C&A
OWN R:_6ZE' Vlw e. TEL. NO.:.__ '
ADDRESS:—' 9T-ft
ENGINEER: ME k, U�TEL. NO.:_ 5
CERTIFIED SOIL EVALUATOR: �!I.-LL,- a-La �
Intended use of lanc/residential subdivision, single family home, commercial
Repair testing �a//'' Undeveloped lot testing
N. A. Conservation Commission Approval: w %° m ,m
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 2 S. per lot for a construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of JZQQ0 per lot for
repairs oo up rades.
GENERALjNFgRftATION
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 SOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
. Within 45 days of testing, a scaled plan (no smaller than 10-100') shall be submitted to
the Board of Health showing the iocation of all tests (including aborted tests),
7. Within 60 days of testing soil evaluation forms shall be submitted.
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Location:- (, Owner's Name: —
Map/Parcel:_ `r-.l I r)t_A r)Ri/- D Z Address:_ ?7LIZ K4!5`77 T- e
Installer: Tel u: ��'li�J`���'7 New 151501 Repair
Date: 9-Z7-cu- Wetlands -- Zane II r Soil Symbol
Soil Name C� Soil Class
Deep Observation Hole Logs
Elevation Depth Soil Horizon Soil Texture Soil Color Soil hlottlin; % Gravel,Stones,etc:
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Parent 1aterial Depth to Bedrock Standing Water in the Hole: Weeping from Pit Face ESHGtiY: �
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Parent Material bepth to Bedrock Standing NYater in the Hole: Weeping from Pit Face ESHG>Y:
Date -Z7- Percolation Tests
Observation Hole r P
Depth of Perc
Start Pre-soak-
Time at 12"
Time at 9" 1 41
Time at 6" 7.
Time (9't-6")
Rate Min/Inch I 95
Performed By Witnessed By