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HomeMy WebLinkAboutSoil Testing Results - 1099 SALEM STREET 1/10/2018 TOWN OF NORTH ANDOVER Community & Economic Development HEALTH DEPARTMENT 120 Mainn Street NORTI-I ANDOVER,MASSACHUSETTS 01.845 RECIVED 978.688.9540--Phone E 978.688.9542-FAX 9 healthdept@tiortliandoverma.gov www.ilorthandoverma.gov 0 14Oi"`NUUg..iANDOVER �JFAUI-i I�C.G�""kl�TWiNT APPLICATION FOR SOIL TESTS DATE: - MAP&PARCEL:: I,� LOCATION OF SOIL TESTS: �4�� `"�f��"� �`►�_�'� � Contact 4: %7 e,:093 J APPLICANT; on�t#:—..._�^� t ADDRESS:� r *-_— el A/1 ENGINEER:-.11,6', / s'S�sG �! Contact#: Q/ � ✓ CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision dr'Smgl eF au l tome Commercial Is This: Repair Testing: Undeveloped Lot Testing: -' Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM Proof of land ownership(Tax bill,or letter from owner permitting test) i 8.5"x 11"Plot plan&Location of Testing;(please indicate test hit sites on the plan) Y Fee of$585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$440.00 per lot for repairs or upgrades. GENERAL INFORMA'T'ION Only Certified Soil Evaluators may perform deep hole inspections. 5� Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. Within 45 days of testing, a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health. showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: hm h (19 Signature of Conservation Agent: c11-d V Date back to Health Department: (stamp in): p now *, formerly Archie 6, Faster ^ — z .•..an... —c..-m.....-r.Fes..'4-"M'..t.. .�.... ,.z.-:r.-w_,.�-w.r:...,...... x. 2B rods 12 Iinks •.�'-*.•• ..-.d...... .. . 71� i�Ur IVI�n l t i rt+HEAL H wtaf)1'i=(� Ts=rA,1 &a nq!^mJ Us fir^.-1.yti,J 42 k g 6 p "7 Total Area 7,G4 Acres s ea% sus a. ✓'� �,�� � flier, e Dnp,.,,,„.u-..W.,,"•"^-^,.... you -' �1 i � �tg �`a°. �,r���• � � «�` ��.�ru.��^"a..ae”-`s ✓"c � lln C� � U -it wa.tnks no-11 or formerly Elmira Galknot IB rods.i'tl Fipks formerly n'�*etot 159: c- 8asfrxr '"" t8,250 ry Ihtalna m 5 Haidrond giand.,.FJawor,.Company,,..t`? TRACT 4 4 3 vI n y New England Paxer GamQawY m ea Pkn da£ed Mar ia,18 7 1,'�.- nj f- r' Plce it-.Saga }ni as r, T 4 ,y rS .w,. _...,,._....:may- .;.,syr altsat at,..�..�,...GS, �qt rn W L Ot -rw1. r now tit formerly TRACT 1 ftFzr E.fd,KrusChwlti pial eared O 4 1t a;W now or turmerly ,,y ovn%rgt;s g� Elmira Gailoni F PNA No$aC 9sao'.ra n,rnraat nnad,....w.. COl $t RACT 2 7 SALEM STREET to Na Andcvar Ganlar-,- NOTE,Being described by dvad.itecurdod in Ease% Heglslry COMPILED PLAN OF LAND of beach Book the rrre Pala 8s. TEtshowman . . NOI hereby certd}y gtaY the pmporty k6nC: ahawn an 1h+s pian ora the lines dividing No. 1799 SALEM ST". publico awnrivate ,and the kings at Birettalready and Ways sham are those l NORTH ANDOV ER MQS� Public or Private $traeYs or Ways atraady astahishad and that no now linos far div#ding of arisilho awnarshlps or tar new Ways are shown., r ^' "` `v� OurrJeR P'RRNK R t7r'sA4drAraRS bran flog.Lund Surveyor } enc -t Scale:60 feet t0 dtl inch .........— i n_.,r Y.t 1111, SEPTEMBER g�p^C �ty i� f NOTE, I hereby certify that the building shown on thio plan is located on the F�1 LMW�f-t � ' �, ground as:hymn thereon and that It conforms to the zoning and building ,,.�a,s,.%",/, F 17, 1975 of thn town of North Andover ellon Constructed and to restrictions on record. ,:, ._._x y' r<.,.,.,.a Joseph Selwyn - Civil Engineer t rt.. .._..,e_._._.,...._....._._......_.,_ IA Lindon Ave._ Belmont, Mass i i RECEEIVED l$i.l�l."k1Bl:"RCr' +I.1, . Idf TOWN OF NORTH ANDOVER Community& Economic Development HEALTH DEPARTMENT 120 Mainn Street NORTH ANDOVER,MASSACHUSETTS 01845 978.686,9540--Phone . 978.686.9542—FAX healthdept@tiorthandoverma,gov www,northandoverma,gov APPLICATION FOR SOIL TESTS DATE: November 30,2016 MAP&PARCEL: Map 106A, Parcel 49 LOCATION OF SOIL TESTS; 1099 Salem Street OWNER; Frank R Disalvatore c/o attorney Morin Contact#; 978-809-3178 APPLICANT; Kindred Homes, David KindredContact#:-97 8-265-7641 ADDRESS: PO Box 531 North Andover, MA 01845 ENGINEER: Marchionda &Assocaiates, L.P. Contact#: 781-438-6121 CERTIFIED SOIL EVALUATOR: Craig Marchionda SE 13892 Intended Use of Land: Residential Subdivision Single Family(-Tome Commercial Is This: Repair Testing: Undeveloped Lot Testing: X Upgrade for Addition:_____ In the Lake Cochichewick Watershed"? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM Y Proof of land ownership(Tax bill,or letter from owner permitting test) Y 8.5"x 11"PIRI Plan A Location o lectink(Plegse,Indicate restt slJes on the !an r Fee of Sjg5.M per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$440.00 per lot for re airs or tioggrades. GENERAL INFORMA'T'ION ;o Only Certified Soil Evaluators may perform deep hole inspections. Y Only Mass,Registered Sanitarians and Professional Engineers can design septic plans, "r At least two deep holes and two percolation tests are required for each septic system disposal area, Y Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative, S� Full payment will be required for all additional tests within two weeks of testing, Y 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). Within 60 days of testing soil evaluation forms shall be submitted, Please Do Not Write Below This Line i N.A.Conservation Commission Approval Date:- l rp Signature of Conservation Agent: , '` t .1 c y _. / (rr-c:a.r r a� `SC- Date back to Health Department:(stamp ln): 1"J` -6� �. G, Scanned by CarnScanner I now or formerly Archie 0- Foster .. i4'* �;..r.,,, «.-:•o-�ra, ;.r_.. lac R I ,., FILA V._ �ggJr"H gg,,,yyl Upk.�W4/Y ��a g(C I Y�} y p^ V'e'tuuW dld uQ.Q9 4 i R^AC ¢✓ i w ' .a. a J Z �`� M lJ a Total Area a 7,G4 Acres yt M p 4 . to ii µ. " " t 4 .w .m X ° trod -. ..............._., I, �,m.• now at formerly Elmirn Galfanf (inks fnrmar(y P Y N. 13,250 aMoine Raf f Pari d Otand_poa,ar Campary p.., TRACT It New Englnnd Power Camhar;y n i�x of " . .... ....,._._. .,...... � ptc.dO.,d stmt za,le t t� � h Nlen H..:56a ty Nii 0 0 t Is vs OW ,..,„.,.,............... 23.46 ""`36—' IOO 36 '"IIt it �... now at formerly TRACT 3 t � 'ad naw at formerly E,k ltrusahwltz rim.dated O Q ,q. of dorva i1155 X Elmira Gallant t- pYmaGyer r- i w--._ 5na"r to r:omtkeh Road:....._ r 1i7t7 "� :TRACT 2 V=12`(,`12 IesdnimMe SALE M STREET rr No Andover Canter-« u� � �a,�fr. �. NOTE:Being described by dead.Recorded in Essen Regletry COMMEO PLAN OF LAND of Reads Rook 1179, Paoa a9. QlO9J SALEM Sal. NOrEr i hereby certify chat to property lines shown On this plot, a ,re the lines dividing pts n^ existing f Private and the lines of Streetalready and Woes shoran Are thane of NORTH A VDO ER,MASS, pibilc or Prlvofq Streets or Ways girendy oatatr4shad and that no now linos v ":' (,,) for di ding at existing Ownerships or for new Ways Ora shown f ti yr dulNcR P'ROMK 1 77rS.dLtrATdRE _tag, 1A d surveyor K t: i Scale 60 feat to an inch NOTE, f hereby certify that the butid;no shown an Inds plan is located an the n r r ground as shown fhgreon and that 11 conforms to the inning and building "��s r"fje"Yrs SEPTEMBER 17y 1' 75 Iowa of the fawn of North dndavar yban constructad and la rastriallans �,t c �l,,i a,r.,i*'' Joseph Selwyn - Civil Engineer f an racnrd.,.,f; -y,:r'j5.. ..... wr�x„r rte............... 14 linden Ave - Belmont, Mass I f i Kathryn M. Morin, LLC Kathryn M.Mofin-MA,N 11,ME Bethany .Raffa—MA,NI'I December 1, 2016 Town of North Andover Community &Economic Development Health Department 120 Main Street North Andover, MA 01845 Re: 1099 Salem Street Application for Soil Tests Dear Sir/Madam: This office represents Richard F. Miller, Trustee of the Frank R. DiSalvatore, Jr. Revocable Trust, the owner of the captioned property by virtue of deed recorded with the Essex North District Registry of Deeds at Book 12641, Page 207 (see copy enclosed). On behalf of the property owner, permission is hereby granted to allow the Town of North Andover, its employees, agents, contractors, and representatives, and Kindred Homes, Inc., David Kindred, and their agents, engineers, contractors and representatives, and Marchionda &Associates, L.P. and its agents, engineers, contractors and representatives to enter onto the captioned property and conduct testing, including without limitation, soil and percolation testing. Please let me know if you require anything further in this regard. Very truly yours, Tum LAW OFFICE OF KATHRYN M. MORIN, LLC jl Ka ryn M. Morin KMM:i Enclosure 68 Main Street,Andover,MA 01810 Phone: 978.809.3178 - Fax: 978.809.3179 Bk 12641 P 207 023546 10—b5-2011 09:20a (Space Aboyc this Line FWOmd for Registmof Duds QUITCLAIM DEED Frank R. DiSalvatore,Jr.of North Andover,Massachusetts for consideration paid and in full consideration of less than One Hundred and 001100 ($100.00)Dollars, > grants to Richard F. Miller,Trustee of the Frank R.DiSalvatore,Jr. Revocable Trust u/d/t dated September 29,2011,a Certificate of Trust relative to which is recorded herewith, of 1094 Salem Street,North Andover,MA 01845 with Quitclaim Covenants That certain parcel of land with the buildings thereon situated on Salem Street,North Andover,Essex County,Massachusetts and being numbered 1099 Salem Street,North Andover,MA being shown as a parcel of land on a plan entitled"Compiled Plan of Land, No, 1099 Salem Street,North Andover, Massachusetts, September 17, 1975,Joseph Selwyn Civil Engineer"recorded with the Essex North District Registry of Deeds as Plan No, 7293,to which plan reference is hereby made for a more particular description of the parcel conveyed. The parcel hereby conveyed contains 7.64 acres of land,more or less, according to the plan. Subject to easements and restrictions or record, if any, insofar as they same are now in force and applicable and not intending to extend or recreate any such rights. No title exam has been requested or conducted in connection with the preparation of this document. Being the same premises conveyed to Frank R, DiSalvatore,Jr. and Rosalie DiSalvatore, as tenants by the entirety,by deed dated September 26, 1975,recorded at Book 1268, Page 91. Rosalie DiSalvatore died on September 24, 1993. See M-792 recorded at Book 4597,Page 61. Bk 12641 Pg208 #23546 EXECUTED as a sealed instrument this 29h day of September,2011. Frank R. DiSalvatore,Jr, COMMONWEALTH OF MASSACHUSETTS ESSEX, ss. On this 24th day of September,2011, before me,the undersigned Notary Public, personally appeared Prank R. DiSalvatore,Jr.,who proved to me through satisfactory evidence of identification,which was ['photographic identification with signature issued by a federal or state governmental agency, ❑oath or affirmation of a credible witness,[]personal knowledge of the undersigned,to be the person whose name is signed on the preceding or attached document,and acknowledged to me that he signed it voluntarily,for its stated purpose. athryn M,Morin Notary Public My Commission Expires: 6/13/2014 fA 1W „„n►NrNrrrp��, Commonwealth of Massachusetts r—7r— City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Dave Kindred Owner Name 1099 Salem Street 106.A/49 Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ® New Construction ❑ Upgrade ❑ Repair 2. Soil Survey Available? ® Yes ❑ No If yes: MRCS 307D Source Soil Map Unit Paxton fine sandy loam Possible high groundwater table Soil Name Soil Limitations Coarse loamy lodgement till derived from gneiss, granite and/or schist Landform 3. Surficial Geological Report Available? E Yes ❑ No If yes: 2006 1:50,000 C.Deposit Year Published/Source Publication Scale s/Till 4. Flood Rate Insurance Map Above the 500-year flood boundary? ED Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No If Yes,continue to#5. 5. Within a velocity zone? ❑ Yes ® No MassGIS Wetland Data Layer: MassDEP Wetlands 12K 6. Within a Mapped Wetland Area? ❑ Yes ® No wetland Type 7. Current Water Resource Conditions (USGS): 12/2016 Range: ❑ Above Normal ® Normal ❑ Below Normal Month/Year 8. Other references reviewed: t5fomm11 -TP7-8•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal {Page 2 of Commonwealth of Massachusetts City/Town of North Andover ,# Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area) Deep Observation Hole Number: TP-7 12/13/16 Date Time Weather 1. Location Ground Elevation at Surface of Hole: 157.3 Latitude/Longitude: 1 feet Description of Location: South of existing driveway, at treeline 2. Land Use Woodland 15 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope Wooded Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: open Water Body Drainage Way Wetlands 150 feet feet feet Property Line 75 Drinking Water Well Other feet feet feet 4. Parent Material: Unsuitable Maferials Present: © Yes M No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater. 36 154.3 inches elevation t5forml1 -TP7-8•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal Paae 3 of 1 Commonwealth of Massachusetts City/Town of North Andover Y Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Continued) Deep Observation Hole Number: TP-7 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- Soil Texture Jo by Volume Soil Depth(in.} Layer Moist Munsell (USDA) Soil Structure Consistence Other y (Munsell) { ) Cobbles Moist Depth Color Percent Gravel &Stones (Moist) 0-22 AP 1OYR2/1 Loam 4 Q Weak Friable 22-31 B 1OYR3/4 SL <5 <5 Weak Friable 31-96 C 1OYR4/6 36 1QYR5/8 2 F-M Sand <5 <5 Structureless Loose Additional Notes: Beyond depth of TC layer becomes very cobbly/bouldery t5form1l -TP7-8•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal Page 4 Of 14 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP-8 12//3116 Date Time Weather 1. Location Ground Elevation at Surface of Hole: 157.4 Latitude/Longitude: / feet 2. Land Use Woodland 12 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope Wooded Vegetation Landform Position on Landscape(SU,SH,BS,FS, 3. Distances from: Open Water Body Drainage Way Wetlands 125 feet feet feet Property Line 60 Drinking Water Well Other feet feet feet 4. Parent Material: Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 27 155.1 inches elevation t5form11 -TP7-8-rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal !Page OT a Commonwealth of Massachusetts 4 City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP-8 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- Soil Texture Is by Volume Soil Depth{in.} Layer Moist{Munsell} {USDA} Cobbles Soil Structure Consistence Other Depth color Percent Gravel {Moist} &Stones 0-7 Ap 1OYR2/1 Loam 0 0 Weak Friable 7-18 6 10YR3/4 SL <5 <5 Weak Friable 18-96 C 1OYR4/6 27 2 F-M Sand 5 10 Structureless Loose Additional Notes: t5formI I -TP7-8•rev.8115 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Paae 6 of Commonwealth of Massachusetts City/Town of North Andover 'M Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area) Deep Observation Hole Number: TP-16 01/05/17 Date Time Weather 1. Location Ground Elevation at Surface of Hole: 157.8 Latitude/Longitude: / feet Description of Location: South of existing driveway, beyond treeline 2. Land Use Woodland 12 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope Wooded Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body Drainage Way Wetlands 145 feet feet feet Property Line 50 Drinking Water Well Other feet feet feet 4. Parent Material: Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes E No If yes: 78 102 Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 33 155.0 inches elevation t5form11 -TP 16•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal 'Page of Commonwealth of Massachusetts w City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP-16 Redoximorphic Features Coarse Fragments Soil Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Depth(in.) Layer Moist Munsell USDA Soil Structure Consistence Other Y (Munsell) (USDA) Cobbles Moist Depth Color Percent Gravel &Stones { 0-9 Ap 10YR2/1 Loam 0 0 Structureless V. Friable 9-29 B 10YR4/4 Silt Loam 0 0 Weak V. Friable 29-47 C1 10YR6/8 33 2.5YR3/6 2 F Sand <5 <5 Structureless Loose 47-120 C2 10YR6/8 F LS <5 <5 Structureless Loose Additional Notes: Roots to—31 t5form11 -TP 16-rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage disposal i Page 8 of Commonwealth of Massachusetts h City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hale#TP-7 Obs. Hole#TP-8 ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches ® Depth to soil redoximorphic features (mottles) 36 27 inches inches ❑ Depth to adjusted seasonal high groundwater(Sh) (USGS methodology) inches inches Index Well Number Reading Date Sh =Sc—[Sr x(OWc—OWmax)10Wrl Obs. Hole# Sc Sr OWc OWmax OWr Sh Obs. }'tole# Sc Sr OWc OWmax OWr Sh E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material 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 b. If yes, at what depth was it observed? Upper boundary: 22 Lower boundary: 96 inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5form11 -TP7-8•rev.8115 Form 11 --Soil Suitability Assessment for On-Site Sewage Disposal Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole#TP-16 Obs. Hole# ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches Depth to soil redoximorphic features (mottles) 33 inches inches ❑ Depth to adjusted seasonal high groundwater(Sh) (USGS methodology) inches inches Index Well Number Reading Date Sh =Sc—[Sr X (OWc—OW maxyow] Obs. Hole# Sc Sr OWc OWmax OWr Sh Obs. Hole# Sc Sr OWc OWmax OWr Sh E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material 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? M Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: 9 Lower boundary: 120 inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5form11 -TP 16•rev.$(15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal;-Page 1 Of sem; Commonwealth of Massachusetts v City/Town of North Andover > - Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Board of Health Witness Isaac Rowe (Mill River Consulting) North Andover. Name of Board of Health Witness Board of Health G. Soil Evaluator Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 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. 05!25!17 Signature of Soil Evaluator Date Craig Marchionda/SE13892 01/09/2019 Typed or Printed Name of Soil Evaluator/License# Expiration Date of License Dote: In accordance with 310 CMR 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. t5forml1 -TP16-rev.$115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal Pogo 11 of 1 Commonwealth of Massachusetts City/Town of North Andover 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 Dave Kindred ........ key to move your Owner Name cursor-do not 1099 Salem Street�Ma 106A Lot 49) _..__...._..m,,,,,,___-____ use the return _Street'—, ""A d-d-ress or Lot# key. North Andover MA 01845 VQ City/Town State Zip Code (978) 265-7641 Contact Person if different from Owner) Telephone Number B. Test Results 12/13/16 14:58 01/05/17 13:32 UWa'- ------- Time Date Time Observation Hole# P-7 .......- _ P-16 Depth of Perc 48"top, 71 bottom 39"top, 58"" bottom Start Pre-Soak 15:04 13:40...... End Pre-Soak 15:19 13:55 Time at 12" 15:19 13:55 15:25 14:06 Time at 9" ------- ---------- Time at 6" 15:37 14:28 Time (9"-6") 12 min 22 min Rate (MinAnch) 4 8 Test Passed: Test Passed: Test Failed: El Test Failed: El Craig Marchionda, E13892 ------------- Test Performed By: Isaac Rowe, Mill River CoqsultinA__......... Board of Health Witness Comments: .................... ------------- t5form 1 2.doc-08/15 Perc Test12 of 11 E1F ___­_.____