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Home My WebLink AboutSoil Testing Results - 350 FOREST STREET 9/21/2001 Town of North Andover, Massachusetts F N° OORTH BOARD OF HEALTH � 0L O � M� APPLICATION FOR SITE TESTING/INSPECTION poRATEO �SSACHU5�� Applicant NAME A�DjDJZESS TELEPHONE Site Location Engineer TELEPHONE NAME ADDRESS Test/Inspection Date and Time 'CHAIRMAN,BOARD OF HEALTH Fee Test No. /r � S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. ,> BOARD OF HEALTH NORTH ANDOVE R, MA 01845 978-6$8-9540 APPLICATION FOR SOIL. TESTS DATE: _ t C i MAP & PARCEL: % , 1 q LOCATION OF SOIL TESTS: ? ',f ,�_. � OWNER: 31,,A TEL. NO.: c�1 t;C; - F ADDRESS: ` Ys ENGINEER: 1 4 "y`ca1�r�t� � `r e�< r�t TEL. NO.: CERTIFIED SOIL EVALUATOR: 'u- Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No 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 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, Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: — -- _– Check Amount. , ' Check Date: EXHIBIT "A" r t f ",• �• � 130 / \,1 N QI n a1 1 2 z /b T OPTION TO EXCHANGE OR SWAP PARCEL "A" FOR PARr,EL 14. °v� BOARD OF HEALTH NOR'T'H ANDOVER9 MA 01845 978-6$8-9540 APPLICATION FOR SOIL TESTS � DATE: �t'(�C r MAP &PARCEL: t J �`t LOCATION OF SOIL TESTS: 3.& -rz c + ` tJ r.'`1� r A/, OWNER: 31 AA, 60 vi d k06-Au TEL. NO.: F IV ADDRESS: 1� ,Ze5,`;m �5;7.. '°1/ ENGINEER: .� v ,��ryn a g`+. ec itt TEL. NO.: �t`l✓ � ; . 1'7� CERTIFIED SOIL EVALUATOR: !�a'�-�cr,•r� (' �-�� a= �'� Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No 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 1. 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 l"-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: Date Received. 6) / 0 61Check Amount: 0 0. Check Date: --- -- EXHIBIT "A /SO Fr, EBONY, ON FOiQCST. STREET (Pus w,c). K..,,• s. i et.}.• . { iw 140 AF :1 —'` -- AWL = 130 N I PR RCr N yAR�'EC�:. A y y „n OPTION TO EXCHANGE OR SWAP PARCEL "A" FOR PARCEL "B" FORM 11 - SOIL EVALUATOR FOR NM Page 1 of 3 Date: No. Commonwealth of Massachusetts IVd. ��> �' , Massachusetts `oil Suitabili A gessment or On-site &wwg e .Disposal 4555 1> Date: Performed By: ._...................... ............. ......... - Witnessed B ............. ... -� �J�°�'.�'�" 4wrcr's Narrw,��.e�� '�' /�'�✓Y� G, X"z�t"rY L,ocaiion Address a Address,and f ✓/ ,,y Lor X / C. / / Telephone, e Repair X office Published Sail Survey Available: No Yes , � -- � Soil Ma Unit Year Published �� ...... Publication Scale � .G,............. Soil Limitations ,<....'..f,.... . ..,.... . !. Drainage Class ❑ Surficial Geologic Report Available: No ® Yes Year Published Publication Scale Geologic Material (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 ❑Yes ❑ Wetland Area: ry ma unit National Wetland In vento Map (map Wetlands Conservancy Program Map (map unit Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belcw Normal _ Other References Reviewed: kiDGP APPROVED FORM• 12(07195 FORM 11 - SOIL EVALUATOR FORA Page 2 or 3 Location Address • r Lot loo. On Review Weather Deep Hole Number Date: Time: �,�✓�� ........... Location (identify on site plan) ,� Slope (%) � Surface Stones -' Land Use - Vegetation Z� ' Landform Position on landscape (sketch on the back) Distances from: .?p,17 feet Drainage way feet Open Water Body Possible Wet Area .f2� feet Property Line ._✓`" feet Drinking Water Well /. O . feet Other DEEP OBSERVATION HOLE LOG` Soil other Depth from Soil Horizon So(USDAIre Munselll) Mottling (Structure, Stones, Boulders, Consistency, Gravel) Surface (Inches) �w /off apthtoBedrock:__ __ ------"-- Parent Material (geologic) W8eping from Pit Face: --- Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: DEP APPROVED FORM• 12/07195 FORM 11 - SOIL EVALUATOR 1F0I0I Page 2 of 3 Location Address or Lot No. On-site Review Ol Time D Weather Deep Hole Number z Date:. ��/�9� Location (identify on site plan) - Land Use . ' � � ✓� Slope (%) Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: �j.D feet Open Water Body Drainage way Possible Wet Area /:?--o feet Property Line J,� feet Drinking Water Well//,4v o feet Other . DEEP OBSERVATION HOLE LOG Other Depth from Soil Horizon SoIUSOA)Texture Munselq Mottling (Structure, Stones, Boulders, consistency, -7,4 Y21 iL Surface (Inches) vc� APyy REA �`x�'G �G L )epthtoBedrock:__---- — Parent Material (geologidl �-- Weeping from Pit Face:_ -- Depth to Groundwater: Standing Water in the Holei� " Estimated Seasonal High Ground Water: ��Ov DEP APPROVED FO"t• 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Determination for Seasonal High Water Table Method Used' ❑ 'Depth observed standing in observation hole - -- inches ❑ /bepth weeping from side of observation hole .- inches Depth to soil mottles .::..:: ' inches Z ❑ Ground water adjustment feet � �Z'" 68 Index Well Number .................. Reading Date .................. Index well level Adjustment factor ................... Adjusted ground water level ..____ . ... ... Depth of Naturally Occurring Pervious Material Does at least fourut the area occurrin the pervious material soil b o ption system. in a I areas observed througho proposed If not, what is the depth of naturally occurring pervious material? Certification I certify that on 6)a44�(date) I have passed the soil evaluator examination approved by the rtwith then equ red Protection training nexpe tise and experience was performed by me consistent described in 310 CMR 15.017. Signature Date DEP APPROVED FORM-12/07195 FOIaN1 11 m SOIL EVALUATOR 1°ORNI Page 2 of 3 w Location Address or Lot n 1o. O11-5'lfe �I�IeIt' r Deep Pole number __ Date: �':. . `time: Weather Location (identify on site (plan) Land Use ` � Slope M Surface Stones — Vegetation Landform , Position on landscape (sketch on the back) Distances from: � Open Water Body — feet Drainage wary m feet Possible Wet Area feet Property Line rest Drinking Water Well -_. feet ether DEEP OBSERVATION HOLE LOGS Depth 4rorn Soil Horizon Sol Texture soil Color Sol Other Sur9ace (inches) IUSAAi (Mursell) Mottling (Structure.Stones.�ftulders. Consistency. % I P,arernt Material Igeoiogicl Dg2 h to Groundwater: Standing Water in the Hole: Weeping from Pit Fare: Estimated Seasonal High Ground Water: VEr ArpROS'ED FORM-12107/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot Ido. On-site Review _ Deep Hole Number Date: %' ' fr 1 Time: Weather Location (identify on site plan) Land Use Slope (°.6) 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 i DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Sol Texture Sol Color Sol Other Surface (inches) (USDA) (Mumeln Mottling (Structure,Stones,Boulders, Consistency, % Graven MINIMUM OF 2 HOLES REQUIRE5 AJ tVtfiY rhu)POSED DISPOSAL AREA Parent Material(geologic) DaP&X08*&oak: Depth to Groundwater, Standing Water in the Hole: Weeping tiom Pit face: Estimated Seasonal High Ground Water: DEF APPROVED FORM-12/07/95 FORN1 12 - PERCOLATION TEST d , Location Address or Lot No, COMMONWEALTH OF A 11 TT Massachusetts Percolation Test Cate: � / "time:, Observation Hnle # Depth of Perc � 1 Mart Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed El' .,Site Failed .............. .......... ....... ............. ........... ................. _........... ....... .. Performed 6y: " Witnessed 6y: Comments: DEP APPROVED FORM.12,07195