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HomeMy WebLinkAboutSoil Testing Results - 28 JERAD PLACE 8/17/2001 ................. BOARD F HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 19 11� APPLICATION FOR SOIL TEST'S DATE: —L- r 0 r _ LOCATION OF SOIL TESTS: ,; w� ..r� L. j lCf r Assessor's map & parcel number: 4L(_,, OWNER: r TEL. N0.' ei 7,,.> 9 ADDRESS: ENGINEER: � T!FL. NO.: 2 1 t� L"J C6 CERTIFIED SOIL EVALUA TOR. r^ .. }y ( r a. Intended use of land: residential subdivision, single family home, commercial Repair testing 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 2$ 75.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of JZ5.00 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 SOH 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. Q W � t MM `V £'VP6z 9975 _ - - - - - - - - _ 0 o O �' o Lr) ao J a� � W V � o `V -- i FORM II - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot loo. ` x T On-site Review Deep Hole Number Dater, Time: � Weather Location (identify on site plan) Land Use (A-/ Slope (°.b) i Surface Stones �10 Vegetation Landform j Position on landscape (sketch on the back) . ,,... ' Distances from; Open Water Body o!L feet Drainage way 2 feet f Possible Wet Ares feet Property Line ,.��� feet Drinking Water Well � �i e'ti� feet Other r(, � ,. DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Sol Texture Sol Color Soil Other ` Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consisten4. % Graven . 1 w� \ Pavant Material(geologic) 0wpthto6edrtx*: , Depth to Groundwater; Standing Water in the Hole_ �'^ � 1 "-' - Weeping from Pit face: Estimated Seasonal High Ground Water: DEF APPRONIM FORM-12107 195 FORUM 11 - SOIL EVALUATOR FO1111 Paae 2 of 3 I Location Address or Lot iJo. On-site Review _ Deep Hole Number Date: _/. ! X"2 Time Weather Location (identify on site plan) Land Use — rr4 ' Slope Surface Stones Vegetation `a Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area c', feet Property Line .__ feet Drinking Water Well �. feet Other I DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Sol Texture Sol Color Soil Other Surface(inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, % i Graven (:j s, cl Is Kati I 9 � t Parent Material(geologic) p.Pdxog*drtx*: Depth to Groundwater, Standing Water inthe Hole: ,fir�1� �,y Weeping from Pit Face: 3 Estimated Seasonal High Ground Water: DFJ APPROVED FORM-1210719S FORM 11 - SOIL EVALUATOR FORMM Page 1 of 3 No. / Z Date: Alrl Commonwealth of Massachusetts Massachusetts Soil Suitabili Assessment for On-site Sewage Disposal Date: Performed By: ..... _ ......... . . .../........... Witnessed By: _ L/�,�,L.r/... _, �.v,¢x/ - Location Address a Addrus.s / Tcicplsorc 1/ New Construction ❑ Repair 21 _Office Review Published Soil Survey Available: No ❑ Yes © C Year Published ............... Publication Scale -% �.... Soil Map Unit � ... Drainage Class L.L...........- Soil Limitations ./ j.� ��1 -.. Surficial Geologic Report Available: No [K] Yes 1-1 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: National Wetland Inventory Map (map unit) - .. ....- -- -- Wetlands Conservancy Program Map (map unit) ... - - ...— - - Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal MBelcw Normal ❑ Other References Reviewed: kiDEP APPROVED FORM- 12/07/95 FORM 11 - S01L EVALUATOR Foj1 N1 Page 2 of 3 Location Address or Lot i�o. I On-site Review Deep Hole Number 1.:..: Date: / Time:.� W©ather, '2 Location (Identify on site plan) ��,...: .w �..... •..,..•��,. ••�.......•.••-..•,. ... Land Use Slope M Surface Stones Vegetation .. :, :. . . .......:..:,., Landform Position on on landscape,(sketch on the back) •.�?��.. • � ' Distances from: � Open Water Body feet Drainage way. .. ..o feet Possible Wet Area feet Property Line .... ..:.... feet Drinking Water Well,>�-�-P feet Other ....::...... DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munaeli) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) ova ' 5 ✓1D BGD� Parent Material (geologic) Cj TiL DepthtoBedreck: Depth( Groundwater: Standing Water In the Hole: Weeping from Pit Face: Eslimated Seasonal High Ground Water: DEP APPROVED FOKM• 11107195 FORM 11 - S01L EVALUATOR ],'OR 11 Page 2 of 3 Location Address or Lot No. On-site ,review q a Deep Hole Number ,. Date:... .9 >>�o� Time: Location (IdeD Ify on site plan) ;P57e!7- G T Land Use ....� ��/� T/�G Slope M Surface Stones Vegetation .. .�� .. s.... Land form : Position on landscape,(sketch on the back) ..T �.... 1-0 -_.. _.._.,.. . Distances from: Open Water Body Drainage way���� feet Possible Wet Area ���.. feet Property Line . ... feet Drinking Water Well,>/S� feet Other ....::.. DEEP OBSERVATION HOLE LOG' .............. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munaell) Mottling (Structure, Stones, Boulders, Consistency, Gravel) ic Parent Material (geologic) ® �i�7 GT / / L L DepthtoBedreck: Depth to Grovndwaier: Standing Water In the Hole: Weeping from Pit Face:_ _^ Estimated Seasonal High Ground Water. hi DEP APPROYED FORA►• 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. zo Ngo On-site ,review Deep Hole Number .. Date:... Time..�'��7.� Weather ��—'�o Location (Identify on site la ) °ice- ..,.G ... Land Use Slope M Surface Stones Vegetation .. 5 ...... . Land form Position on Iandscape,(sketch on the back) Distances from: Open Water Body�-5��c5:' feet Drainage way. ��� feet Possible Wet Area feet Property Line ..ls.. feet Drinking Water Well��✓`� feet Other .....:. DEEP OBSERVATION HOLE LOG' i Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munseil) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) Z/y Parent Material (geologic) Z 77/—,/-- DepthtoBedrock: Depth to Groundwater Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water. DEP APPROYED FO"J• 12/07/95 FORM 11 - SOIL EVALUATOR Foj} j Page 2 of 3 Location Address or Lot No. I) On-site ,Review L� Deep Hole Number .....%.. Date:. �� Time:- .'.. 45 K`/ Weathel; -� Location (I tlfy on site plan) ' �,-1577- _ Land Use 7TH Slope (%) Surface Stone ... ��� Vegetation Landform Position on landscape,(sketch on the back) . .. ` ... 1-�?� ... ....... Distances from: Open Water Body/3� 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, °ro Gravel) Ice ?V11 LIP Y'C Al Y � � / o � / 4 Parent Material (geologic) mm, ` L L DepthtoBedrock: Depth to Groundwater; Standing Water In the Hole: 9 Weeping from Pit Face: Es(imated Seasonal High Ground Water:_�� DEP APPROVED FOKM• 11/07/95 FORM 11 - SOIL hVALUATOR Fop Page 3 of 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 IN Depth to soil mottles .:.:. inches ❑ Ground water adjustment ............I...... 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 II 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 � (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. Si nature `� ate DEP APPROVED FORM- 12/07/95 FORM 12.- PERCOLATIO- TEST Location Address or Lot No. 2- V COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test` Date: t Time:, Observation Hole # Depth of Perc _ Start Pre-soak End Pre-soak Time at 12" I Time at 9" Time at 6" Time Rate Min./Inch Minimum of 1 percolation test must be performed in both the rimer area reserve area. primary ea AND Site Passed Site Failed ❑ Performed By: _ ....................-- ---- - Witnessed By: Comments: aE P AMOVID roRl►t-E:n,ns