Loading...
HomeMy WebLinkAboutSoil Testing Results - 27 BRADFORD STREET 10/22/2001 Town of North Andover, Massachusetts Form No. 1 NORTH A BOARD OF HEALTH 3�0� 1LED ,bq�OL C. 6^'4, �+ 4 y= ft D - y A0 ,m APPLICATION FOR SITE TESTING/INSPECTION 7,9 gDRATED�Pa,`'�� SSACHUS� �°° Applicant t T `t y � 1' veils- NAME f ADDRESS TELEPHONE Site Location r a /ro- Engineer. ._ '�_'�1 �� IVIC" NAME ADDRESS r) JV_i" TELEPHONE Test/Inspection Date and Time t CHAIRMAN,BOARD OF HEALTH Fee , Test No_ S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. IIOA IM OF HEALTH NORTH ANDOVE R, MA 01845 978-68$-9540 APPLICATION FOR SOIL TESTS OCT 2 tool DATE: MAP & PARCEL: _ ; LOCATION OF SOIL TESTS: �2 2 4!z? re e-c- OWNER: ' c;, 2 � . fi z i n i TEL. NO.: ADDRESS: ENGINEER: =,,� f',�r rr� ,yrY t ' =2"�Zi c�t TEL. NO. bra, - 1 F .. CERTIFIED SOIL EVALUATOR: 4a.. Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing:_,N Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM L 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 hales 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 hale inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep hales 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 farms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: e Date Received: Check Amount: � G�A '� Check Date: FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. / °z Date: Commonwealth of Massachusetts �� , ✓ � , Massachusetts Soil SuitabiIjU Assessment for On-site Sewage Disposal Performed By: _ _ -..� !`iTz1 _....... .. �/9 Date: Witnessed By: Lo uon Addrus or Lo(/ y ©. 7�,.,'/,isT> Address,and Telephone/ /��1•�/°'�Y' Pew Construction El Repair M / —J Office Review Published Soil Survey Available: No ❑ Yes Year Published 117011................... Publication Scale l�� �' '.... Soil Map Unit GUn C Drainage Class Soil Limitations ? !'��-. 7 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 9 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 a5��� Range :Above Normal ❑Normal ❑Belcjv Normal Q Other References Reviewed: -- DEP APPROVED FOP-M- 12/07/95 FORM 11 - SOIL EVALUATOR 110101 -- Page ? of 3 Location Address or Lot No. Ors-site Review Deep Hole Number Dater//��/�� Time: 9 �S Weather,�v— Location (iden ify on site plan) � . Land Use SiZ�6.�119� Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body /�®d feet Drainage way �✓r� feet Possible Wet Area >�oQ 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, io Gravel)4 jt �z O Parent Material (geologic);�l �C�C DepthtoBedrock: _ Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: �Q Estimated Seasonal High Ground Water: _. — — -- DEP APPROVED FORM• 12/07/95 FORM I SOI1, EVALUATOIt FOIt,�I f I agc , of 3 Location Address or Lot 1Jo. _ (r C��C '�, / X✓/� � —� On-site Review Deep Hole Number Date: ��/!. �� Time://0!5:�— Weather.�'�/%? t Location (identify on site plan) ' iT° Land Use % '' i�✓ 'G Slope M Surface Stones Vegetation Landforms�405� Position on landscape (sketch on the back) Distances from: Open Water Body/"04,7 feet Drainage way� � feet Passible 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, 9'a Gravel) Ail �n Parent Material (geologic) / '`"d ylG- DepthtoBedrock: — Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: N Estimated Seasonal High Ground Water: �� DEr'APPROVED FO101 - 12/07/95 `C.14Yt i. FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* I Date: Time., Observation Hole # l Depth of Perc i Start Pre-soak -� End Pre-soak Time at 12" Time at 9" 1c � Time at 6" , Time (9"-6") Efate Min./Inch Minimum or 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ❑ Site Failed ❑ ......................... Performed By: Witnessed By: Comments: i DEP'APPROVED FORA!•12/07/95 I FORM II - SOIL EVALUATOR FORM Pa: e 2 or 3 Location Address or Lot Ido. On-site Review Deep Hole Number � Dater°✓. ! ` %�� � Time: , /L Weather Location (identify on site plan} Land Ilse S)ope (361 Surface Stones Vegetation Landform Position on landscape (sketch on the back( . n:.... Distances from: Open Water Body feet Drainage way ` _ feet r Possible Wet Area �!"e' ' feet property Line _. feet r' Drinking Water Well feet 'Other < � a , DEEP OBSERVATION HOLE LOS Depth from Soil Horizon Sol Texture Soil Color Soil Other Surface (inches) (USDA) (Mun+sell) Monfing (Structure.Stones,43oulders, Consistency, % Gravel) I y i 1 t Parent Material(geologic) DepthmSedrock t Depth to Groundwater- Standing Water in the Hole: Weeping(tam Pit Face: Estimated Seasonal High rwound Water: DEP APPROVED FORM-12/87/93 FORLNI 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. f 11®Stte Review _ Deep Hole dumber — . a� .° L` %L' 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 way feet Possible Wet Area feet Property Line feet Drinking Water Well feet ether EP OBSERVATION HOLE LOG Depth from Sort Horizon Soil Texture .Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.Consistency, % Gravel) t r k / f Parent Material(geologic) 'i �fxoSsd<ock: ®entll to Groundeaa= Standing Water in the Hole: Weeping from Pre Face: ne Estimated Seasonal High Ground Water. DEP APPRON7M FORM-MOWN FORM 11 - SO1L LVALUATOIZ 1`0RNI Page 3 of 3 Location Address or Lot No, =� , G /�/�? •� �'� Determination for Seasonal Hizh 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 adju-stment ................... 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 aIJ 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 5 (date) I have passed the soil evaluator examination approved by the Ddphrtment 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 DEP APPROVED FORM• 12/07/95