HomeMy WebLinkAboutSoil Testing Results - 140 BRADFORD STREET 11/20/2017 TOWN OF NORTH ANDOVER
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Cotntnunity & Economic DeveloprrleIlt
HEALTH DEPARTMENT J
> 120 Mainn Street
NORTH ANDOVER, MASSACHUSETTS 01345
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978.688.9540—Phone
'lip� 978,688.9542—FAX
liciltliclept@iiortliatidovet-m,,i.gov
northandoverma.gov j
www.northandoverma,gov
APPLICATION FOR SOIL TESTS j
DATE: 6/27/17 MAI'&PARCEL,: 061.0-0004
LOCATION OF SOIL TESTS: Front yard-_failed system
OWNER., Dominic Guglielmi Contact#: 781-858-9829
APPLICANT:Philip Christiansen Contact 11:978-373-0310
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ADDRESS: NSA Or
ENGINEER: Phlip Christiansen _ Contact#: 978-373-0310___
CERTIFIED SOIL EVALUATOR: Philip Christiansen
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Intended Use of Land: Residential Subdivision Single Family 1-10111c Comincrcial
Is This: Relrah Testing:X Undeveloped Lot'I"estiug: Upgrade for Addition:
In the Lake Cocluchewick Watershed"? Yes No X
j THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
Proof of land ownership(Tax bill,or letter faona owner permitting test)
> 8 S"a 1X"1'/c1t p11rn&Laclrtian of 7ev111rx(Alc'ns e hidicnte test nit silos on the n/nn)
)> Fee of$585.00 per lot tot new construction, This covers the imnimum two deep holes and
two percolation tests required for each disposal area. Fee of$4411.00 per lot for repairs or uperades,
GENERAL INFORMATION
i
> Only Certified Soil Evahiators may perform deep hole inspections.
)O� Only Mass,Registered Sanitarians and Professional Engineers can design septic plans.
D At least two deep holes and two percolation tests are required for each septic system disposal a►°ea.
> Repairs require at least two deep holes and at least one percolation test,tit the discretion of the BOH
representative.
➢ hull payment will be required for all additional tests within two weeks of testing.
➢ Within 45 clays of testing,a scaled plan(no smaller than I"-100')shall be submitted to the Board of Health
showing the location of all tests(inClUding aborted tests).
Y Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.11. Conservation Conunlsslan pruval Dutc'r
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Commonwealth 6i Massachusetts
City/Town of
Form I I - So il Suitability Assessment for On-Site Sewage Disposal
A. Facility Inf6rination,
L
Owner Name
CDC It C, L3 /V)A P rc� 6 P,119 L,L
` , Street Address Map/Lot
A-
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city i
State Zip Code
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B. Site Information
1. (Check one) j El New Construction F-1 Upgrade Q Repair
2. Soil Survey Avail6lble? [ Yes El No If yes: jy C's
i Source Soil Map Unit
FAX-it44 FT c Sp/vby Ls"Al'.1
Soil Name !, Soil Limitations
L D Rvff%L,_Tw9, �-i
Geologic!Parent Material Landform
1; 1
3. Surficial Geologica[ Report Available? [/Yes ❑ No If yes: /In _t'7 11 L.
: IYear Published/Source Publication Scale Map Unit
4. Flood Rate Insurance Map
Above the 500-yearood boundary? E3 Yes Ej No Within the 100-year flood boundary? 0 Yes E:1 N o
If Yes,continue to#a
5. Within a velocity zone? 7 Yes Eq/No
6. Within a MappeLl
cietland Area? Yes No MassGIS Wetland Data Layer:
Wetland Type
7. Current Water Res 6urce Conditions (USGS): —7 ( t Range: ❑ Above Normal EO/Normal Ej Below Normal
Month/Year
8. Other referencesl:r 'viewed:
t5forml 1.doc-rev.8115 j Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page I of 8
Commonwealth of Massachusetts
City/Town of
_a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
v C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observatio Hale Number. ` 9I
Date Time Weather
I'
1_ Location
Ground Elevation at Surface of Hole: r Latitude/Longitude: 1
feet
Description of Loc tion: (° A--u f
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2. Land Use V LC7
woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(Cir.)
4 tW
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body Drainage Way Wetlands
feet feet feet
Property Line t Drinking Water Well Other
„ feet feet feet
4. Parent Material: y. Riz LL , �i ttk ''trN's Z?Lr= Unsuitable Materials Present: Yes [ No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: n Yes ErNo If yes:
r }t Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater:
inches elevation
L
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t5forml 1.doc•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal Page 2 of 8
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Commonwealth b Massachusetts
City/Town of
Form 11 - Sail Suitability Assessment for On-Site Sewage Disposal
C. On-Site Revi w (continued)
Deep Qbservatio',n Hole Number:
Ftedoximorphic Features Coarse Fragments
ala by Volume Soil
Depth Fn. Soil Horizon!Soil Matrix:Color- Soil Texture Soil Structure Consistence other
p } Layer 1 Moist(Munsell) (USDA) Gobbles (Moist}
Depth Color Percent Gravel 8 bbnes
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Additional Notes
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t5fonn1l doc-rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 5 of 8
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Commonwealth . f Massachusetts
m /P City/Town of
Form 11 - Soil Suitability ,assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation ?_� �
l,Hole Number: � � f /V r',y
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: U'ts— Latitude/Longitude: /
feet
2. Land Use ))FV F Iz !150 --i T i l
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope
�Yegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body Drainage Way Wetlands
feet feet feet
Property Line l^' Drinking Water Well Other
feet feet feet
4. Parent Material: Lo Am t {;r �9 lr�t �>� Unsuitable Materials Present: ❑ Yes No
i
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes 2-IN0 If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth�J.High Groundwater: C ii Cl
inches elevation
l
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t5form11.doc•rev.8115 Porm 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 4 of 8
I .
Commonwealth laf Massachusetts
City/Town of
=4 Form 1 - Soil Suitability Assessment forOn-Site Sewage Disposal
C. an-Site Re�ibw (continued)
I
Deep Observation Hole Number:
Redoximorphic Features Coarse Fragments Soil
Soil Horizon/'Soil Matrix:Color Soil Texture la by Volume
Depth(in.) Layer 1 Soil Structure Consistence other
y Moist(Munsell) (USDA) Cobbles
Depth Color Percent Gravel �Stones (Moist)
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f ! ,
7
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Additional Notes
t -7 Z'vC t
11
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t5form11.doc•rev.8115 ! Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
i'
Commonwealth'ofMassachuse tts
City/Town of
Form 11 - So'ijl� Suitability Assessment for On
Sewage Disposal
r {
C. On-Site ReVilew (continued)
Id
Deep ObservattonHole Number: , c �t-7 Cf
1 Date Time Weather
I_ Location ;
r
Ground Elevation!ai Sur-Face of Hole: CL Latitude/Longitude: I
feet
2. Land Use j ;� VES " �'VC �C!
(e:6.1 woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g_,cobbles,stones,boulders,etc_) Slope
j L /V
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from j Open Water Body Drainage Way Wetlands
feet feet feet
�I Property Lines` Drinking Water Well Other
w _ feet feet feet
4. Parent Material C ! j-1 f'A,i L -kJnsuitable Materials Present: ❑ Yes EK
If Yes: ❑ Disturbed Soil ❑ Fill Material E] Impervious Layer(s) ElWeathered/Fractured Rock ❑ Bedrock
1�
5_ Groundwater Observed: ❑ Yes No If yes:
f Depth Weeping from Pit Death Standing Water in Hole
Estimated Depth to High Groundwater:
is
inches elevation
H3
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t5form11.doc-rev.8/15 I Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8
F I
\ Commonwealth('of'IMassachusetts
City/Town of
Form i i - S61,11 Suitability Assessment for Cin-Site Sewage Disposal
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C. On-Site Rev:i`ew (continued)
Deep Observation dole Number:
Coarse Fragments
Redoximorphic Features Soil
Soil Horizon!So oil Matrix:Color-' Soil Texture �o by Volume
Depth{in.} Layer ,' I Mois#(Mansel[) (USDA) Cobbles Soil Structure Consistence Other
Depth Color Percent Grave[ g,Stones: (Moist}
I
II I
Additional Notes;:I
I. : r dal) -Tc It,\
3
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EE
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� 3
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t5form11.doc-rev.8115 j Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal Page 3 of 8
is
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CommonwealthofMassachusetts
CitylTown of
_ Form 11 - Soil Suitability /assessment for On-Site Sewage Disposal
C. On-Site Reui'lew (continued) `7 ��
Deep Observati,Iii[lHole Number: t ; i?11-7 ff fir'#
Date Time Weather
i il'I 1
li
1. Location
Ground ElevatlonlatSurface of Hole: [n6, 7 Latitude/Longitude: J
feet
:`
2. Land Use 1 I"t,)G V E L'C:- ?i=0 L-W iy`� -
(e.g.;woodland;agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope
j t A 1--
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body Drainage Way Wetlands
feet feet feet
Property Line ^ ` Drinking Water Well Other
E ; . feet feet feet
4. Parent Material I 3 i lc r/-i tf 0&nfFa Lt, Unsuitable Materials Present: ❑ Yes Flo
II,
If Yes: ❑ Dis urbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Ob's'erved: ❑ Yes NAO If yes:
1l�' Depth Weeping from Pit Depth Standing Water in Hole
Estimated DeptKio High Groundwater:
inches elevation
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is II
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t5forml1.doc•rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal Page 4 of 8
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: \ Commonwealth'Of IMassachusetts
gz GitylTQwn of
+ Form 11 - Sail Suitability Assessment for On-Site Sewage Disposal
G. On-Site Review (continued)
Deep Observatio 1 ole Number:
j !Coarse Fragments
Redoximorphic Features
Depth(in j Soil Horizon/Soil Matrix:Color-! Soil Texture °j by Volume Soil
Layer , „ Moist(Munsell) (USDA) Soil Structure Consistence Other
! ! DeptColor Percent Gravel Gobbles
Depth (Moist)
&Stones
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Additional Notes'
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t5form11.doc rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal Page 3 of 8
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Commonwealth of Massachusetts
.. ........ ....
City/Town of
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine-the form they use.-,--
Important:When A. Site Information
filling out forms
on the computer,
use only the tab Dc" L G_I/ ......--.....w..._
key to move your Owner Name
cursor-do not D 5
use the return Street Address or Lot#
key.
City/Town State Zip Code
I V� z Contact Person(I f different" ._from-Owner)-- `--..- -Telephone Number
—B. Test Results
7/1 7/�Szt -7
Date Time -date Time
Observation Hole ft
..
Depth of Perc .........
Start Pre-Soak t------- ......
End Pre-Soak
Time at 12"
Time at 9"
Time at 6" -7 1 13
M1 /V /"I--) JV
Time(9"-6")
Rate (MinAnch)
Test Passed: D/ Test Passed:
Test Failed: ❑ Test Failed:
H S_Ll6
a'�_ —
"
C-
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Board of Health Witness
Comments:
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t5formI2.doc-08/15 Perc'rest-Page 1 of 1
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Commonwealth of Massachusetts
�MVWZ City/Town of l
Form 11 - Soil. Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
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1. Method Used: Obs. Hale# Obs. Hole#
1� Depth observed standing water in observation hole
inches inches
❑ Depth weeping from side of observation hole
inches inches
Depth to soil Iredoximorphic features (mottles) F 1= 5c 2 t �,r G—
inches inches
❑ Depth to adjusted seasonal high groundwater(SF,)
(USOS methodology) inches inches
I ;
Index Well Number Reading Date
i
Sh= S.—[Sr x OWE—OWmax)/OVV,-]
Obs. Hole# SC Sr Ow, OWmax ow, S,
Obs. Hole# S. Sr Ow, OWmax OWr S„
E. Depth of Pervious Material
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1. Depth of Naturally Occurring Pervious Material
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a. Does at least:four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
( Yes ❑ No �Y
SI r tri t3'
b. If yes, at what depth was it observed? Upper boundary: Lower boundary:
inches inches
c. If no, at what d I pth was impervious material observed? Upper boundary: Lower boundary:
inches inches
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t5form11.dac-rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 6 of 8
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Commonwealth ' f Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment forOn-Site Sewage Disposal
F. Board of Hea'(th Witness
Name of Board of Healt'I Witness Board of Health
G. Soil Eva[uor Certification
I certify that I am isrently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil
evaluations and th It the above analysis has been performed by me consistent with the required training, expertise and experience
described in 310 CIVIR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form,
are accurate and,in accordance with 310 CMR 15.100 through 15.107.
-7/t Zit
Si Pure of Soil Evaluator Date
Typed or Printed Na "of Soil Evaluator i license# Expiration Date of License
Note: In accordance with 310 Ctv1R 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing,and
to the designer and:the property owner with Percolation Test Form 12.
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t5forml 1.doc-rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
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Commonwealth ;of
Massachusetts
EM City/Town of
Form 11 - Soil Suitability Assessment for ®n-Site Sewage Disposal
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Field Diagramsl
Use this sheet for field diagrams:
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P
e
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t5form11.doc•rev.8,15 Form 11—Soil Suitability Assessment for On-Site Sewage disposal Page 8 of 8
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