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HomeMy WebLinkAboutCorrespondence - 174 GRAY STREET 8/16/2006 oi- Professional Lend Surveyors & Civil Engineers ESSEX SURVEY SERVICE 1958- 1986 August 16, 2006 OSBORN PALMER 1911 - 1970 BRADFORD&WEED 1885 - 1972 Ms. Susan Y. Sawyer, Public Health Director Town of North Andover Office of Community Development & Services ���) � Health Department 1600 Osgood Street, Building 20 Suite 2-36 North Andover, MA. 01845 RE: F13877 LOT 15 GRAY STREET N. ANDOVER, MA. MAP 1.07D, LOT 6 Dear Susan: I've spoken to Joe Currier of the Litchfield Company as to final grading for L,ot 15. The plarmed schedule is as follows: • Final grading, loam and seed—2°a week of September • Final As-Built and certification from our office—3r i week of September • Anticipated closing date— September 30, 2006 We have worked up a breakout wall design for review by the Builder. Assuming he has no changes, I'll forward a plan to you the first week of September. If there are questions,just let me know. Thanks for your continuing cooperation in this matter. -V r truly yours, James MacDowelI IHM:aly CC: Litchfield Company Inc. 104 LOWELL STREET PEABODY, MASS. 01960 TELEPHONE: 978-531-8121 FAX: 978-531-5920 9�A ccc.vieuvu..,�9t �4CHUST-, PUBLIC HEALTH DEPARTMENT Community Development Division June 27, 2006 Jim Mac Dowell Eastern Land Survey Associates, Inc 104 Lowell Street Peabody MA 01960 Dear Mr. MacDowell, This correspondence is in regards to Lot 15 Gray Street, North Andover. Thank you for calling our attention to the unusual configuration of the trenches on this lot and the distance issue noted on your fax of June 22, 2006. The Health Department accepts your change, which moves a single trench, (trench#3) approximately 7 feet. A copy of this document will be attached to the approved subsurface disposal plan. Please make note in your file of this approval. Your effort to provide a properly functioning septic system for your client is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincergly; j San Sawyer, RS� S Public Health Director Cc: Litchfield Company 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnortliandover.com Jul 27 C10 10: 42a PITCHERVILLE 1970GG32705 p. 1 PITCHER VILLA'SAND GRAVEL CORP 11 Republic Road, N. Billerica Ma. 01862 Phone: 978-663-0035 Fax: 978-663-2705 To: N.AN.DOV,T', BOARD OFBT'ALTH Ate SUE, Fax 978-688-8476 Project: Litchfield—Gray Street Sample No. 072606 Location: Wilton NH/Upper Sail Description: Screened Septic Sand Test Date: July 26,2006 Sive Size Weight Retained Cumulative Weight Percent Retained Percent Passing Mesh (gm) ( �) (g►n) (gm) 1.5" F) } 1 3/8" 0 0 Lf #4 36 36 l 98 48 $4 (.. r" #16 104 188 #30 240 428 #50 206 634 , ems. g" #100 110 74 �� <l #200 22 766 98.45 1.55 Pan 12 778 100.00 0 Pit Locations: Rt. 31 Greenville Road Wilton N.H. - Rt. 68 Hubbardston Ma. ___._ Rt 2A Westminster Ma. Jul 27 06 10: 42a PITCHERVILLE 19786632705 p. 2 PITCHER VILLE SAND & CU VEL CO 11 Republic Road, N.Billerica Ma. 01862 Phone: 978-663-0035 Fax: 978-663-2705 To: N.ANDOVER BOARD OF HEALTH Ate SUE Fax 978-688-8476 Project: Litchfield—Gray Street Sample No: 072706 Location: Wilton NH/Upper Soil Description: Screened Septic Sand Test Date: July 27,2006 Sive Size Weight Retained Cumulative Weight Percent Retained Percent Passing Mesh (gm) (gm) (gm) (gm) 1.5" 1" 3�4 3/8" 0 0 0 100.00 #4 48 48 5.36 94.64 48 70 118 13.18 86.82 916 130 248 27.70 72.30 430 204 452 50.50 49.50 #50 294 746 83.85 16.65 #100 112 855 95.86 4.14 #200 26 884 98.77 1.23 Pan 11 895 100.00 0 Pit Locations: Rt.31 Greenville Road Wilton N.H. - Rt. 68 Hubbardston Ma. Rt 2A Westminster Ma. �r r \, 1� a imam _ t w L"I �j�Ij 2'�I o' t-A -0, j 9 A Lb(�p U Professional Land Surveyors & Civil Engineers ESSEX SURVEY SERVICE 1958- 1986 OSBORN PALMER 1911 - 1970 BRADFORD&WEED 1885- 1972 July 31, 2006 Ms. Susan Y. Sawyer, REHS/RS Town of North Andover Health.Department 400 Osgood Street North Andover, MA. 01845 RE: F13877 LOT 15 0 4 GRAY STREET N. ANDOVER, MA. Dear Susan: Accompanying this letter is the soil evaluation summary for the confirmatory test hole excavated on Lot 15 on July 24, 2006. Please do not hesitate to call if there are any questions. Very truly yours, h jamcs H. MacDowell JHM:aly Enclosure CC: Ms. fatty Schuler 104 L©WELL STREET PEABODY, MASS. 01960 TELEPHONE: 978-531-8121 FAX: 978-531-5920 F+, M 11 -SOIL EVALUATOR FORM M No. TP1-06 Lot tVGray Street,North Andovet° Date:July 24,2005 Commonwealth onwealth of Massachusetts North Andover, Massachusetts Site S Assessment or fin-Site sewage d is osal Performed By: Alexander F. Parker CSE Date: July 24,2006 Witnessed By: Town of North Andover Board of Health Agent, Location Address: Gray Street North Andover,MA New Construction X Repair❑ Published Soil Survey Available: No❑ Yes Year Published: 1981 Map Scale: 1:1.5,840 Soil Map Unit: CbB,canton very stony t§t Drainage Class:WD Soil Limitations: high groundwater,rocky. Hydrologic Group: B Surficial Geologic Report Available: No❑ Yes X Year Published: 1969 : Surficial deposits of the Andover Quadrangle Publication Scale: 1:24,000 Geologic Material Map Unit: Qt:glacial till Landform: ground moraine Flood Insurance Rate Map: Above 500 year flood boundary: No❑ Yes Within 500 year flood boundary: No X Yes❑ Within 100 year flood boundary: No X Yes❑ Wetland Area: National Wetland inventory Map(map unit): N/A Wetlands Conservancy Program Map(map unit): N/A Current Water Resource Conditions(USES) Month: July 2006 Range: Above Normal❑ Normal X Below Normal❑ DEP APPROVED FORM- 12/07/95 Fa AVl 1l -SOIL EVALUATOR F6:91tM Location Address or Lot No, Lot, , Gray Street, North Andover ON-SITE REVIEW Deep Mole Number: TPl-06 Date: 7/24/06 T rate: 10:40 Weather: Cahn,80's,sunny Location (identify on site plan): Land Use: Residential .slope(/): —0-1% Surface Stones: None Vegetation: Wooded & grass lawn La n(foryn: rolling ground moraine Distance froin: Open Water Body 150+ feet Drainage Way 50+ Feet Possible Wet Area 100+ feet Property Line 10+ Feet Drinking Water Well 100+ feet Other Feet DEEP OBSERVATION HOLE LOG Depth from Soil Soil Texture Soil Color Redoximorphic Other Surface Horizon (IJSDA) (EarthColors) Features (Structure,Kind&Grade,Consistency,% (inches) Gravel,Stones,Boulders...) 0 - 18 Fill Loam 1 OYR 3/2 ND Friable,granular(fine.),weak structure damp,tine to medium roots,tine grained. 18 - 26 Bw Sandy Loam 1 OYR 4/8 ND Friable,blocky(Fn.),moderate structure, damp.,fine grained,loose. 26 - 106"+ C Loamy Sand 2.5Y 5/2 q_,)2859 friable,damp,granular(hied.),moderate Lay?/1 strength, silty,gritty, 10%gravel& 7.5yi-5/8 10%stone,rounded to sub-angular clasts. (c,2,p) Geologic Parent Material: Glaciofluvial deposits and till. Depth to Bedrock: 1.06"+ Depth to Groundwater: Standing Water in the Hole 7fi" Weeping from Pit.Face 76" Estimated Seasonal High Ground. Water Depth: n,28" DEP APPROVED FORM- 12/07/95 F4- -M 11 -SOIL EVALUATOR FORM Location. dilr°ess or,Lot No. Lot , Gray Street,North Andover elenninaLion far Seasonal Hi h Water Table TP 1®06 Method Used. • Depth observed standing in observation hole: 76" Inches • Depth weeping from side of observation hole. 76" Inches • Depth to Redoximorphic features: 28" Inches ❑ Ground water adjustment: Feet Dgpilr of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in TPI-06? YES If not,what is the depth of naturally occurring pervious material? Cer•ti icatiorr I certify that on :rune 1998. 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 C.MR 15.01.7. Signature Date, 7/26/06 CDEP APPROVED F'r`DRM- 12/07/95 JUH-22-2006 08:58 FROH:EASTEMPJ I_A1,1E) SURUE'Y 1-978-551-5928 TPA 19786888476 P.2 d, 9wVw9w Professional Land Surveyors&Civil Engineers ESSEX SURVEY SERVICE 1958- 1986 OSBORN PALMER 1911 - 1970 BRADFORD&WEED 1885- 1972 June 22, 2006 Ms, Susan Y. Sawyer,REHS/RS � f Town of North Andover ; Health Department 400 Osgood Street North Andover, MA. 01 845 ?�� Dear Susan: Accompanying this letter is a sketch as to relocation of trench no. 3 so that all trenches are a minimum of 10.5 feet apart. If the trench is slid northerly(toward Lot 14)7 feet, it will still meet all setbacks. Trenches 1, 2 and 4 are unchanged. Please advise if this proposed minor change is acceptable. If there are any questions, please do not hesitate to call. Very truly yours, -`Tan I� I Mac.Dowell JHM:aly Enclosure CC: Ms. Patty Schuler Mr. Joe Currier 104 LOWELL STREET PEABODY, MASS. 01960 7� TELEPHONE: 978-531-8121 FAX: 978-591-5920 I \\ F �C C'12, 0'08\,, S NN is �� > r ADO l ri pv 0 0 ==� ( r„ N 61°16'17" W c AL nlr_nonooicr•nl ncxr.-.rcr_olr__r ,�n�r-IC n�.a-rl r.nr_u cu�.i in�i nr.nr-, nnn� -„ in� June 15, 2006 Mr. Joseph Serwatka, P.E. P.O. Box 1016 North Andover, MA 01845 VIA: FAX 978-683-6595 Re: Boston& Gray St.,North Andover, MA Dear Mr. Serwatka: Effective immediately, we are terminating your services with regard to all engineering work on any of the lots on Boston& Gray St., North Andover, Mass. We have met with the Conservation Commission Administrator and the Board of Health and they have agreed to allow us to make a change at this point in time. Your cooperation during this transition would be most appreciated. Sincerely, Gary J. Litchfield President Cc: Susan Sawyer, North Andover Board of Health Pamela Merrill, North Andover Conservation Commission Joseph Currier, Litchfield Company, Inc. Project Manager %40RT '� ayA cec.iei t++ica,49•. at &SACHUSr`�� PUBLIC HEALTH DEPARTMENT Community Development Division June 27, 2006 Jim Mac Dowell Eastern Land Survey Associates, Inc 104 Lowell Street Peabody MA 01960 Dear Mr. MacDowell, This correspondence is in regards to Lot 15 Gray Street, North Andover. Thank you for calling our attention to the unusual configuration of the trenches on this lot and the distance issue noted on your fax of June 22, 2006. The Health Department accepts your change, which moves a single trench, (trench#3) approximately 7 feet. A copy of this document will be attached to the approved subsurface disposal plan, Please make note in your file of this approval. Your effort to provide a properly functioning septic system for your client is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincerely; j �. an Sawyer, RS/RE1fiS � Public Health Director Cc: Litchfield Company 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com � P t_ TYPE OF SEWARGE DISPOSAL - Swimming Pools Tanning'Massage/Body Art i_- Public Sewer _ Tobacco Sales - Food Pacl<aging'Sales Well Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not kmle access to the guaranty hind Signature of Agent/Owner Signature of Contractor Plans Submitted Plans Waived ❑ Certified Plot Plan L� Si6m' ped Plans 'Xi THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION U ❑ COMMENTS ,!' ? DATE REJECTED DATE APPROVED HEALTH ' �e v._ ❑ -;' C COMMENTS Zoning Board of Appeals: Variance. Petition No: Zoning Decision/receipt submitted yes Plannim, Board Decision: _ Comments Conservation Decision: Comments Water& Sewer connection si;;nature&date Fie Department siTemp Dempster on site yes_ no nature date ✓/ Iding Permit :Approved and 1SSUed by: 44 '['OWN Ole NOFVIII ANDOVER O fi p S K,RVICVIS t I E A 1,111 1)F�PA RTM E NT 400 OSGOOD S"FRUJL"T NMI]I ANDOVER, 01,9145 979,689,9540—111101�e 1)�bhc �Icfflh 1)ileclor X7°78688,9542 VMK' October 23,2005 Litchfield Company 126 Cambridge Street Burlington,MA 01803 RE: Subsurface Sewage Disposal System Plan for Lot 15 Gray Street,Map 107D, lot 6,North Andover, Massachusetts Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans,for the above referenced property.These plans dated September 28,2004,final revision date of October 13,2005,have been approved for a five(5)bedroom,maximum 11-room home, Please note the conditions#2,3 below. As stated in the previous approval,the design has been approved for use in the construction of a new onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work,and a Certificate of Compliance must be endorsed by the installer,designer and the Town of North Andover. This approval is subject to the following conditions: 1. Title V regulation section 102C—requires 2 deep hole observation tests in the primary and secondary disposal areas. Lot 2 primary and secondary areas only have 2 deep hole tests,both on the north side.According to agreements between the SOH representative and the engineer, the onsite decision was made to reduce the required number of tests for each system. In this case,due to the lack of soil information within the system,this plan approval conditions that upon construction at least one or possibly 2 confirming test holes will be conducted prior to ,allowing the installer to move forward with the system construction.Please note;this criterion is given on this particular lot due the Health Department's lack of action taken on this plan's first review within the 45-day review requirement. This lack of soil test within the Soil Absorption System would not be approved otherwise. 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void,installation shall stop,and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 3. The issuance of the disposal works construction permit is contingent upon the receipt of a foundation as-built of the dwelling. The as-built must be in a scale of I"=20'. Also,if none exist within the building department,please submit a floor plan of the proposed home. 4. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission,Zoning Board,Planning Board, Building Inspector,Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. 5. The final As-built must meet the minimum requirements as found on the attached sheet. In addition, it appears that the grades towards the road may extend into town owned property to meet breakout. The applicant will be required to show final grades on this As-built. This is to ensure that neither an easement from the Town of North Andover is necessary nor a wall will have to be constructed to achieve compliance to the code regarding break out. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincere san Y. Sawyer,REHSIRS Public Health Director cc: Joe Serwatka,P.E. JLIN-22-2006 08:58 FROM:EASTERN LAND SIURUEY 1-978-531-5920 T0:19786888476 P.3 0 I d- ol r tJ � 1g16 LN yea � 6 cz ICI, of ' W W YYj.S\ \ \ � X, / °r, u, 0 1gb �, N R] q—1s �^ Q7 0 � •x ~~ I Lc... Joseph J. Serwatka, P.E. Post Office Box 1016 North Andover,MA 01845 (978)-6$3-6595 October 13, 2005 Mr. Susan Sawyer, Director North Andover Health Department 400 Osgood Street j North Andover,MA 01845 1 Re: Lot 15, Gray Street 1 1 Septic Plan Revisions .._ Dear Ms. Sawyer: Attached please find revised plans for lot 15,Gray Street that address most of the issues in your April 1.7, 2005 review letter.Per our conversations, the plans are "technically" approved, but we have agreed to address as many issues as possible to demonstrate our cooperation. The revisions are as follows. I. The titles on the sheets have been revised according to your letter. I The abutting lots are owned by Litchfield and.Stella. This has been added to the plan. 3. The foundation drain elevation has been added. 4. The witness name has been added to the soil logs, as well as observed water. 5. Percolation elevations have been added. b. The soil evaluator name has been added to.sheet 1. 7. The basement floor elevation has been raised. S. The distances are now shown on the plan, 9. The distance between the dwelling and SAS is specified as 20' and 22'. Any reputable installer will use stated distance before he attempts to scale the drawing and come to his own conclusions. 10. A benchmark has been added as requested. 11. The overdig has been adjusted to be away from the septic tank,although I am not sure this is a Title 5 requirement. 12. The soil stockpile area has been moved. 13. The effluent filter was added because we thought it would be a good idea. Typically the effluent filter is pulled out and hosed off whenever the septic tank is pumped. There is not special maintenance agreement, or manhole labelling required. We have removed the effluent filter to avoid complications. 14. The profile has been adjusted. 15. A note has been added to the detail that the tees must be located beneath the access covers. This will be verified during the multiple inspections during installation. 16. The design calculations have been revised to show 4 trenches. The 5.5 refers to square feet per foot, not width. 17. Although the contractor has no control over perforated pipe specs, the orifice size has been added to the plan. 18. A site inspection will reveal that the area is, for all purposes, very flat. We are limited by wetlands lines, breakout grading, and setback requirements. Further, the system has been designed at the required separation to watertable. 19. The plan states 10.5' feet between trenches, and that is what the contractor must follow. If he scales the plan, or comes up with a different number, the installation will not be approved. I have not had a problem with a contractor not being able to use the numbers shown on a plan. 20. Peastone has been specified as double washed. 21. Breakout elevation has been provided. 22. Finish grades have been added to the profile, as minimums. 23. The site plan has been revised. 24. Breakout has been revised. 25. The slope has been corrected. 26. The soils can be observed during installation. Additional perc tests are impossible, given the watertable. Should you have any questions concerning this letter, please contact me. Sinc Josep . matka, P.E. Cc: Litchfield Company, Inc. TOWN Office of CONI NI[JIN ITO'Y F I)NEOVKV1II,0I 1A1M N IIW)OIV' KIVI's 1) SIII' RVI( 1'S HEALTH DEPARTMEAIF' 400 OSGOOD SlIZEFT NORTH AINMONIFA, N4ASSACJWSFTTS 0 OW5 SUS,Wl Y SMVVCT. RJ'AAYRS 97UM,95,10 Phow� Public Hcakh Dircoor 7 8.6 8 8 �555,11 ,/ X , FAV April 13, 2005 ell Joseph I Serwatka, P.E. V R 0. Box 1016 North Andover, MA 01845 ei RE: Lot 15 Gray Street,North Andover, MA Dear Mr. Serwatka, The proposed septic system design plan for the above site location, dated September 28, 2004 with a revision date of March 1, 2005 has been reviewed. Unfortunately, it cannot be approved until the following items are corrected. Each item is followed by the specific section in Title 5: 310 CMR 15.000, or North Andover regulations which is not met by this design. 'I. The title area of the plan indicates"Lot 15", please add"Gray Street" or some other clarifying notation. -220(4)(u) 2. Please provide names of abutters to the property-N.A 8.020). 3. Elevation of foundation drain is needed. —NA8.02y 4. Regarding soil logs, the name of witness is needed. Also, the observed water, or lack there of, must be noted. And, 15-4 is missing sod class(LS)for C horizon, 220(4)(h)&(i) 5. Percolation test elevation needed. —NA 8.02n 6. Soil data should have name of soil evaluator(even though on sheet I there is certification statement). -220(4)0) 7. Basement floor elevation must be F above ESHGW. Both are at the same elevation per profile. —NA 5.04 8. Site plan must show distances between property lines and SAS and tank. —NA8.03 a-c 9. Distance between dwelling and SAS is 19' where 20' is required.-15.211, NA 5.02 10. A benchmark needed within 50-75 of the onsite wastewater system. The current benchmark is 130' to farthest end of SAS. -220(4)(q) 11. Septic tank is located within the 5' overdig. 12. Stock pile area is over the sod absorption system and could likely lead to inappropriate or accidental removal of soil horizons needed for the onsite wastewater system. Please move the location to a different portion of the site. - 246 13. Regarding the effluent filter, a maintenance schedule is required. Also, the name and type must be noted on the manhole cover. 14. The system profile shows less than 9" of cover over the septic tank. -228(1) 15. The septic tank detail does not provide for the inlet or outlet tee to be located beneath an access port. —227(1) 16. Design calculations show 3 trenches at 5.5' width while these dimensions are depicted differently on other parts of the plan. -220(4)(f), NA 8.021 17. The size of the orifices in the leach lines must be stated. -251(8) 18. All trenches should follow a topographic contour line, instead some of the proposed trenches appear to follow a wetland offset line. -251(2) 19. Trench spaces must be 3x width of trenches, or 10.5'. There is only 10' provided,- 251(l)(d), NA 14.01 20. The Peastone must be specified to be double washed. -247(2) 21. Breakout elevation(197.9) is not covered for 15 fi•om trench 4 on the site plan. — 255(2), NA 9.02 22. On the profile, please provide the finish grade elevations over the septic tank, d-box, and trench. —220(4),NA8.02 23. Please depict final grade on the site plan over the septic system. -200(4)(8) 24. It appears that breakout is covered for only 14' (15' required) from trench 3 to contour 196. —255(2) 25. 3:1 slope is not provided consistently. In some places only 5' horizontal separation is provided where 6' is required between contour lines. —255(2) 26t Otil last pit is located itt a l>m6or i t f'otic reserve leach �rcttt;li, dart] no l;ee-'c blafiofb tests are located iri the v i 6 iit y of the, proposed lt,aclt �tm(;ltes, Mt0e it ins 111 ely t lm site conditions are t;t7misteti flitabuj)J"soul fl'ie propose(] soil a9lbsorptiot"@ syste'tt"k alb-ea, �' test tioles and petcolatiori ���As will nee(l to be',g:)t,d bated prior ��ttltil�lrtt��tl r,tbttllt-t�t�t��tc�r, to plati al-tpmval. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, Susan Y. Sawyer, REHS/RS Public Health Director cc: Owner File Town of North Andover HEALTH DEPARTMENT 27 Charles Street North Andover, MA 0 845 978.658»9540 health(L )t q),owno hor°thandover:corgi SEPTIC PLAN ITBMITTAL FORM DATE OF SUBMISSION° " Ly ..,.. SITE LOCATION: K,"-2-16Z.-r ... ENGINEER: EElI.` NEW PLANTS: YES X $225.00/Plan Check#: 7"�.., (Includes Is"'?"'and one Re-Review Only) REVISED PLANS: YES $ 75.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO Telephone Fax#° Q E-mail: HOMEOWNER NAME: m., -1 . p µ � _ OFFICE USE ONLY When the submission is complete (including check): I. Date stamp plans and letter 2. Complete and attach Receipt 3. Copy File, Forward to Consultant 4 Enter on Log,Slceet and Database 7 !, M ((Z Lq 9 N CIS �r n o l � 0 cr- C� � a 0 C S) FOR1i 11 )1L EVALUATOR FOK11 Page 2 of 3 Location Address Or It tJo. ��•� t' j x"� On-site Review _ Deep Hole Number Date: ... ' P Time: Weather e : Location (identify on site plan) Land Use dU 4 VIE n Slope (%) Q 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 _ Meet Other _.. ._... DEEP OBSERVATION HOLE LOG' - Depth from Soil Horizon Sol Texture Sol Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Graven Puent Material(geologic) p og j DepthtoGroundwaier: Standing Water intheHole: �3 ` Weeping from Pit Face: -3r �rt1 Estimated Seasonal High Liroun0 Water: der i? �o �l a=v �y> ✓Q� -�T/c—' .4 DEP APPROVED FORM-11.2107195 FC III - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lpf On-site Review _ 0 Deep Hole Number-4�. Date:—'-5"/ Z 'Time: Weather Location (identify on site plan) Land Use wp0 f;2 S Slope M Q Surface Stones Vegetation ,'' .. As e 5Y Landform Position on landscape (sketch on the back) . ..... Distances from: Open Water Body feet Drainage way"°r feet Possible Wet Area feet Property Line 2 5 Meet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon Sol Texture Soil Color Sol` other Surface(Inches) {USDA) (Mtunsell) Mottling (Structure,Stones,Boulders, Consistency, % Graven 3ov 5-y eX Prront Material(geologic) De with to Groundwater; Standing Water in the Nole: c` rf - Weeping from Pit Face: J� Estimated Seasonal High Ground Water: VEr APPRO"En FotCM-t2107195 P X4 I l 1 E � r rFyp 6R l ti R. fill WSI i1 Off vi p 91.E n tea. 1