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Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
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APPLICATION FOR SITE TESTING/INSPECTION
A pl ca'
Si L ci
Engineer
F_lul
/-Z)7- /f3
Test/Inspection Date and Time
Fee
CHAIRMAN, BOARD OF HEALTH
Test No. 1&'-3'%
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
O FORM �1-SOIL FN'ALL'ATOR FORM
Page 2 of 3
Location Address or Lot i-jo.
Jo a 'i 0. l % 7Q A"
Olt -Site Review _
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Deep Hole Number / 40:- 01. -'� �n� ! n
Date: Time: Weather �'� �"�i'.>�it. �
Location (identify on site plan)
Land Use __ !N p bye Slope M Q Surface Stones AJ C7 E—
Vegetation',A •'a
Landform
Position on landscape (sketch on the back) ..__..
Distances from:
Open Water Body _�._.� feet Drainage way feet
Posi ible Wet Area feet Property Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOGS
Depth from
Surface (Inches)
Soil Horizon
Sol Texture
Sol Color
Soil
Other
(USDA)
!Munsell)
Monfing
(Structure, Stones, Boulders, Consistency, %
Graven
47
7,r,.Zi" -5�
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Z. 4L
MINIMUM1
Parent Material (geologic) � 7
Death to Groundwater Standing Water in the Hole: Weeping from Pit Face: 79 Q
Estimated Seasonal High Ground water:
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w Pr-"ra s s 0--v 13 s! •-•%o d•-�.��
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Town of North Andover, Massachusetts Form No. 1
BOARD OF HEALTH
APPLICATION FOR SITE TESTING/INSPECTION
�. Site Locati n
1-4T 1-3
Engineer
Test/Inspection Date and Time
Fee
CHAIRMAN, BOARD OF HEALTH
Test No. .1&-f'7
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
O FORM 0 SOIL EVALUATOR FORM
Parle 2 or 3
Local ion, Address or Lot v4o. GFS v 5 �--
On-site Review
:70
Deep Hole Number 4
Date: Time: Weather
Location (identify on Site plan)
Land Use 4wOO 0 5 Slope Surface Stones Ad
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 Wateir Well - feet 'Other
DEEP OBSERVATION HOLE LOG
Depth from
Surface' (inches)
Soil Horizon
Soil Texture
{USDA)
Soil Color
tMumell)
Sod
Mottling
Other
fStructure. Stones, Boulders. Consistency. %
Graven
F-5 L
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MUM
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Al tVhfiY
PROPOSLU
DISPOSAI ARPIL
Parent Material (geologic)
DapthwBodrock:
Depth to Groundwater; Standing Water in the Hole: Weeping frwn Pit Face: Z. 07
Estimated Seasonal High Ground Water: -.4 Al
wi'rlvass'i_-v
E X e A VA 'r0 G- 'V'*Pev 4.) e r/49 ti
DEF APPROVIM FORM - DW195
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FORM JI(DOIL EVALUATOR FORNI
Paas 2 of 3
Location Address or Lot IJo. 4',-e,4 y f f,
Jv a 14'0 177 0/0 7f-
an -site Review _
Deep Hole Number - % Date: 5 2-7/0 Z- Time:_ Weather G L t''�rc io at
Location (identify on site plan)
Land Use A A20 D *5 Slope (%) - Surface Stones
Vegetation 1,41 N>r
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 Other ..._____._......-.
DEEP OBSERVATION HOLE LOGS
Depth from
Surface (Inches)
Soil Horizon
Sol Texture
(USDA)
Sod Color
!Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Graven
°vz
s
4
�OYR .7
10,VA 5-/
moi* 5 !Fiv Fes�iC i,� �3 e, e'
> -- x j-j,.e cr -err.y
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Parent MaterDept
hop (geologic) e� Depg�Mcf. ?I -
Depth to Groundwater. Standing Water in the Note: p d Weeping from Pit Face:
Estimated Seasonal High Ground water: S O N
PEP- F'Or 14.1a:P
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