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HomeMy WebLinkAboutSoil Testing Results - 1 GRAY STREET 4/30/2018 TOWN 01j'NOR'n] ANDOVER Corratxtttrtr r en<n t ic Developinent HEALI 11 1-1 DEPARTMENT 121) Mainnnn Street � � NORTH ANDOVER, MASSACllIRS1. "1-I'S 01845 100 978.68 ,1540 _phone 978.688.9, 42_.-FAX healtlydept@noi�thandoverrna.gov www.northandovenna,gov APPLICATION FOR SOIL TESTS DATE: December 5, 2017 MAP&PARCEL: map 107B Lot 50 LOCATION OF SOIL TESTS: Off of back left corner of existing house OWNER:Ake Rullo Contact#: 603-401-2888 APPLICANT: (Same as Owner) Contact#: ADDRESS: 1 Gray Street North Andover, MA 01845 ENGINEER: Jack Sullivan Contact#: 781-854-8644 CERTIFIED SOIL EVALUATOR: (Same as Engineer)....email:_�acksulf53@comcast.net Intended Use of Land: Residential Subdivision Sianglc Family home Commercial Is This: Repair Testing: X Undeveloped.Lot Testing: Upgrade for Addition; 1n the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM > Proof of land ownership(Tax bill,or letter fi•om owner permitting test) > 8.5".v 11"Plot plan&Locatlon of T"estlyg.(please irrtlrcate test pit sites ori the plait) > tee 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. �t`E 40.00 per lot for repairs or upgrades, GENERAL INFORMATION 1 Only Certified Soil Evaluators may perform deep hole inspections, > Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 1� 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 B01-1 representative. > Full payment will be required for all additional tests within two weeks of testing, > Within 45 clays 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 1 N.A. Conservation Commission Approval:Date Signature of Conservation Agent: Date back to Health Department: (stamp in): Town of North Andover, MA December 8, 2017 107.0-0079 s 1 r.. 107,E3•0049 d� f! f f` t P� �I� C;17 umwmuuoi� 107.0-0049 � 1 / 107.9-0050All ! (' 107.9-00il " 107.9.0154 a fy P. 107 9ao5z 107 Go, ge /�� p Property Information Property ID 107.E-0050.0000.0 Location 1 GRAY STREET Owner RULLO,MICHAEL MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover,MA makes no claims and no warranties,expressed or Implied,concerning the validity or accuracy of the GIS data presented on this map. December, 5,2017 f Town of North Andover North Andover, MA 01845 To whom it may concern: I, Mike R.Llllo, owner of 1 Gray Street, North Andover grant permission for soil testing on my property for a future septic system. Thank you, Michael Rullo 1 Gray Street North Andover, MA 01845 I i i i r l i i i 1 w_ i ,a w arc, IAll �f w _.. s ;ti Commonwealth of Massachusetts City/Town of rV66 A'46W\�- 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: A. Site Information When filling out forms on the computer,use Mike Rullo only the tab key Owner Name to move your 1 Gray treet cursor-do not use the return Street Address or Lot# key. North Andover MA 01845 _G71t_Y/_rown -__­__' _­____­­--- -__ State Cade Same as Owner) 603401-2888 Contact Person(if different from Owner) Telephone Number B. Test Results 12/21/17 10:00 a.m. Date Time Date Time Observation Hole# Depth of Perc 3511-53" Start Pre-Soak 9:40 End Pre-Soak -9:55 Time at 12" 9:57 Time at 9" 10:02 Time at 6" 10: 11 Time(9"-6") 9 min Rate (MinAnch) 3 MPI ...... Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: El John D. Sullivan 111, P.E. Test Performed By: Issac Rowe, Consultant for Town of North Andover BOH .......... Witnessed By: Comments: t5form 1 2.doc-06/03 Perc Test-Page 1 of 1 Commonwealth of Ma�sachuse City/Town of 1,,10gjH /QN tT Form I I - Soil Suitability Assessment for On-Site Sewage Disposal 31 DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. 409% A. Facility Information 000yr-ow 1. Facility Information Michael Rullo 30 ;-leoOwner Name Of Map/Lot: Map 107B Lot 50 1 Gray Street wo' vv Street Address �Wo North Andover MA 01845 City[Town State Zip Code B. Site Information 1. (Check one) New Construction E] Upgrade Z Repair R 2. Published Soil Survey available? Yes E] No 7 If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil limitations 3. Surficial Geological Report available? Yes R No Z If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes No ❑ Within the 100 year flood boundary? Yes ❑ No Z Within the 500 year flood boundary? Yes E] No Z Within a Velocity Zone? Yes ❑ No 5. Wetland Area., National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 1 of 7 Commonwealth of Massachusetts City/Town of NORTH ANDOVER Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information Michael Rullo Owner Name 1 Gray Street Map/Lot: Map 107B Lot 50 Street Address North Andover MA 01845 City/Town State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ® Repair ❑ 2. Published Soil Survey available? Yes ❑ No ® If yes: Year Published Publication Seale Soil Map Unit Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes © No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 91 Soil Suitability Assessment for On-Site Sewage Disposal•Page 1 of 7 Commonwealth of Massachusetts City/Town of NORTH ANDOVER Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions(USGS) Range: Above Normal 0 Normal El Below Normal F-1 MonthNear 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 1 12/21117 9:00 a.m. 40 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 94.5 Location (identify on Plan) See Sheet 7 of 7 2. Land Use: Residential property_ None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope —Grass— Ground Moraine Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body>200– Drainage Way>200 Possible Wet Area >150 feet feet feet Property Line 30 Drinking Water Well >200 Other feet feet 4. Parent material: Coarse Loamy over Sandy Meltout Unsuitable Materials Present: YesZ No[] If Yes: Disturbed SoilE] Fill material® Impervious Layer(s)❑ Weathered/Fractured RockF] Bedrock[j 5. Groundwater Observed: Yes ❑ No 0 If Yes: Depth Weeping from Pit_ n/a Depth Standing Water in Hole—n/a Estimated Depth to High Groundwaer–: 64" (Mottles) DEP Form I 1 Soil Suitability Assessment for On-Site Sewage Disposal-Page 2 of 7 &\ Commonwealth of Massachusetts City[Town of NORTH ANDOVER Form I I - it Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Horizon/ Color-Moist {mottles) 'texture %by Volume Consistence Other Depth Layer (Munsell) (USDA) (Moist) (in.) Depth Color Percent Gravel Cobbles &Stones 0-30 FILL 30-39 A 10 YR 3/3 n/a LS 39-48 B 10 YR 618 n/a LS 48-98 C 2.5 Y 6/4 64" 5 YR 5/6 50 LS Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 3 of 7 � ' Commonwealth of Massachusetts Rim Cof NORTH ANDOVER Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: _2___ 12/21/17 9:00 AM 40 degrees/clear Date Time Weather i. Location Ground Elevation otSurface ofHole S3.8_____ Location (identify onPlan) SeeSheet 7of 2, Land Use: Residential none 1 (o.g.woodland,agricultural field,vacant lot,etc) Surface Stones ~~p~`., Grassed- Ground Moraine Position nnlandscape(attach sheet) vegetation Landform 3. Distances from: Open Water 8ody >200Drainage Way__>20U____ Possible VVetArea ___>15O___ �� feet feet Property Line 35____ Drinking Water VVe|| __>2OUOther �� �� 4. Parent Material: Coarse Loamy over Sandy K8ehou Unsuitable Materials Present: YesNo F-1 If Yes: Disturbed Soil[] FiUyNoteha|M Impervious Layer(u) F­1 VVeathanad/FnyctunadRonk[] BmdrockFl 5. Groundwater Observed: Yea Fl No Z If Yes: Depth Weeping from Pit_____n/aDepth Standing Water inHole___n/a______ Estimated Depth boHigh Groundwater: 56^(mod|ea) 2 o |noxmu elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal^Page 4of7 Commonwealth of Massachusetts City/Town of NORTH ANDOVER Form I I - it Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 2 1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other Depth Layer (Munsell) (USDA) (Moist) (in.) Depth Color Percent Gravel j Cobbles &Stones 0-12 Fili/A 10 YR 3/3 n/a LS 12-24 B 10 YR 6/8 n1a LS 24-74 C 2.5 Y 6/4 55" 5 YR 5/6 50 LS Refusal @ 74" Additional Notes DEP Form 1 I Soil Suitability Assessment for On-Site Sewage Disposal-Page 5 of 7 Commonwealth ofMcIssachu.$etts Af. City/Town of pa�'A' Tv Form 11 LL - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1, Method used: 7 Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches Depth to soil redoximorphic features (mottles) A.r-64" 8. 55" inches inches ❑ Groundwater adjustment(USGS methodology) A. S. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level 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 E No E] b. If yes, at what depth was it observed? Upper boundary:.24_ Lower boundary: _74_ inches inches F. Certification A I certify that I have sled the sgk6valuator examination*approved by the Department of Environmental Protection and that the above analysis was pelonfied Jby 'ed with the required training, expertise and experience described in 310 CMR 15.017, Signature of Soil Mvval�brn Date V V. n D. Sullivan III, P.E.— October 1995 Typed or Printed Name of Soil Evaluator *Date of Soil Evaluator Exam Issac Rowe— Consultant for the Town of North Andover Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form I! Soil Suitability Assessment for on-Site Sewage Disposal-Page 6 of 7 ................ ------------ Commonwealth of Massachusetts Cityfrown of ru� 1rj1 7 Form I I - Soil Suitability Assessment for On-Site Sewage Disposal Use this sheet#o,, GOINC. ppjto EX. SHED QC) VC. 1r4GRO'J�D pOOL 22" 22" TH-20 DDC. Fp,-no BENCHMARK. PT—I NAIL IN TREE ELEV= 95.0' 28" (ASSUMED DATUM) 1.7'± Above Ground Ex. D—Box TH—I rl CY 11ON -TOP OF 0.07 EI.E\j,:A SSTRUCVJPIF- �NOOD FR k F,OOVAS) E)c STOP (6 SSSSSOR RECORDS ZD 3 BEOPOO, ER DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 7 of 7 Commonwealth of Massachusetts - ` City/Town of North Andover W 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 1 the local Board of Health to determine the form they use. Important: j � Information filling out A.forms on the computer,use Mike Rullo only the tab key Owner Name to move your 1 GraStreet --- cursor-donot y_-._..____ use the return Street Address or Lot#f key. North Andover ...... MA 01845 _ _ State Zip Code Cityfrown _ Same as Owner _ 603-401-2888 Contact Person(if different from Owner) Telephone Number �n B. Test Results 12/21/17 10:00 a.m. Date Time __.._.— Date Time Observation Hole# PT-1___.__— Depth of Perc 35"-53" Start Pre-Soak 9:40 End Pre-Soak 9:55 Time at 12" 9:57Time at 9" 10:02 Time at 6" 10.11 Time (9"-6") 9 min-.._-,.______.'__,,_______ ..._._..------_�..__ Rate (Min./Inch) 3 MPI Test Passed: ® Test Passed: ❑ Test Failed: © Test Failed: ❑ John D. Sullivan III, P.E. Test Performed By: _._.._ — Issac Rowe, Consultant for Town of North Andover B'OH Witnessed By: Comments: Wform12.doc-06/03 Perc Test•Page 1 of 1 1 Vi _ . ........ . r l !_ o-wc ° ►, �rAd ,u _ r9v ._ (Ck pyoi y Commonwealth of Massachusetts CityfTown of Formll - Soil / Uit�.b~lity Assessment for On-Site Sewage Disposal O, Current Water Resource Conditions 8JSGSl Range: Above Normal E] Normal F-1 Below Normal El MonthNear 7. Other references reviewed: C. On-Site Review (minimum ofbmxhmAes required at every proposed disposal area) Deep Observation Hole Number: 1 12/21/17 9:00a.nn. 40da0nees/deor Date Time Weather 1. Location Ground Elevation edSurface ofHole _B4.6_______ Location (identify onPlan > SeeSheet 7of 2. Land Use: Residential Non (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones owpo(r0 -Grass LGround Moraine Vegetation Landform Position unlandscape(attach sheet) 3. Distancaa8om: Open Water Body>2O0_ Dna|na8e\A/av>200 Posaib|eWetAnao ~150 feet feet feet PropartvLine30 Drinking Water Well ~200 Other feet feet 4. ponantK8absho|: Coarse Loamy over Sandy K8e|toutUnsuitable Materials Present: YeaZ No[] If Yes: Oisturbed8oUF1 FiUW1etgda|Z Impervious Layer(m)[l VVea1hened/FnactunadRockO 8ednnnkEl 5. Groundwater Observed: Yea Fl No Z If Yes: Depth Weeping from Pit___n [)epdhStanding VVaharinHole Estimated Depth to High Groundwater: G4^ (Mottles) DEP Form 11Soil Suitability Assessment for On-Site Sewage Disposal^Page 2of7 Commonwealth fsaehuse� City/Town of � = 1 - Soili Suitability Assessment for On-Sites Disposal Deep Observation Hole Number: 1 Soil 1 Soil matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure ' Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other Dent} Layer (Munsell) (USDA) (moist) Depth Color Percent Gravel Cobbles &Stones 0-30 FILL 30-39 j A 10 YR 313 n/a j FSL t s 39-48 Bw 10 YR 6/8 n/a SL I � 48-98 C 2.5 Y 6/4 64" 5 YR 5/6 50 j LS r i � I t I j r i Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7 Commonwealth of use City/Town of IVYLI� A r,0-0 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: -2-- 12/21/17 9:00 AM 40 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 93.8 Location (identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential none 1-3 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope Grassed Ground Moraine Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body_>200 Drainage Way_>200 Possible Wet Area >150 feet feet feet Property Line 35 Drinking Water Well >200 Other feet feet 4. Parent Material: Coarse Loamy over Sandy Meltout Unsuitable Materials Present: Yes No❑ If Yes: Disturbed Soiln Fill Material® Impervious Layer(s)F] Weathered/Fractured RockEl BedrockEl 5. Groundwater Observed: Yes 0 No E If Yes: Depth Weeping from Pit_n/a Depth Standing Water in Hole_n/a Estimated Depth to High Groundwater: 55" (mottles) 89.2 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 4 of 7 Commonwealth of Massachuseys City[Town of rVo�* Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-moist (mottles) Texture %by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (in.) Depth 1 Color Percent Gravel Cobbles &Stones 0-12 Fill/A 10 YR 313 n/a FLS 12-24 B 10 YR 618 n/a SL 24-74 C 2,5 Y 614 55- 5 YR,516 50 LS Refusal @ 74' Additional Notes DEP Form I I Soil Suitability Assessment for On-Site Sewage Disposal Page 5 of 7 Commonwealth of assachuse City/Town of vi - Soil Suitabilityssess e t for On-Site Sewage Disposal _ s D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. 64" B 55" inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level 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: _24 Lower boundary:_74 inches inches F. Certification I certify that I have passed the soil evaluator examination*approved by the Department of Environmental Protection and that the above analysis was performd by me cSDsistent with the required training, expertise and77�eOence described in 310 CMR 15.017. Signature of Soil Eva ar Date ohn . Sullivan III, P.E._ October 1995 Typed or Printed Na of Soil Evaluator *Date of Soil Evaluator Exam ]ssac Rowe Consultant for the Town of North Andover Name of Board of Health Witness Board of Health Note.This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal.Page 6 of 7 Commonwealth of Masselchusetts 11 City/Town of � orm I I it Suitability Assessment for On-Site Sewage Disposal Use this sheet fo- GONG. Pp,-no Ex_ SHED QE%. 1NGROUV40 pooL 22" 22" TH-20 9PT-1 CONC- PAIIO BENCHMAHK. NAIL r/N TREE ELEV= 95.0' 28" (ASSUAGED DA TUM) 11 ± Above 0� .7'± Above Cro=d Ex. D—Box TH-10 Fit (7r ly Top Of 0.00, E)(. GARP FRAMEELE � SI-RUcj-0PF- q000 Ex STORY BEDROOMSE�ASOS'JoSj'Z RF-CofZ[)S 4D ZD pf:R AS DEP Form 91 Soil Suitability Assessment for On-Site Sewage Disposal-Page 7 of 7 Commonwealth of Massachusetts City/Town of NORTH ANDOVER Form 11 - Soil SuitabilityAssessment f On-Site is osa DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information Michael Rullo Owner Name 1 Gray Street MaplLot: Map 107E Trot 50 Street Address North Andover MA 01845 City/Town State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade E Repair ❑ 2. Published Soil Survey available? Yes ❑ No ® If yes: Year Published Publication Scale Soil Map Unit Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 1 of 7 Commonwealth of Massachusetts City/Town of NORTH ANDOVER it Suitability Assessment for On-Site Sewage Disposal Form 11 6. Current Water Resource Conditions (USGS) Range: Above Normal ❑ Normal F-1 Below Normal ❑ Month/Year 7. Other references reviewed: Co On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 1 12/21117 9:00 a,m. 40 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 94.5 Location (identify on Plan) See Sheet 7 of 7 2. Land Use: Residential property_ None —2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope —Grass— Ground Moraine Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body>200_ Drainage Way>200 Possible Wet Area >150 feet feet feet Property Line 30 Drinking Water Well >200 Other feet feet 4. Parent Material: Coarse Loamy over Sandy Meltout Unsuitable Materials Present: YesE NoEl If Yes: Disturbed SoilE] Fill Materia[® Impervious Layer(s)❑ Weathered/Fractured RockE] Bedrock[] 5. Groundwater Observed: Yes [] No 2 If Yes: Depth Weeping from Pit—–n/a Depth Standing Water in Hole—nla Estimated Depth to High Groundwater. 64" (Mottles) DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 2 of 7 Commonwealth of Massachusetts City/Town of NORTH ANDOVER Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other (in.) Layer (Munsell) Depth Color Percent (U (Moist) SDA) Gravel Cobbles F&Stones 0-30 FILL 30-39 A 10 YR 3/3 n/a LS 39-48 B 10 YR 6/8 n1a LS 48-98 C 2.5 Y 6/4 64" 5 YR 5/6 50 LS Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 3 of 7 Commonwealth of Massachusetts City/Town of NORTH ANDOVER Form 11 - it Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (Cont.) Deep Observation Hole Number: _2__ 12/21/17 9:00 AM 40 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 93.8 Location (identify on Plan) See Sheet 7 of 7 2. Land Use: Residential none 1-3 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope Grassed Ground Moraine Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body_>200 Drainage Way_>200 Possible Wet Area >150 feet feet feet Property Line 35 Drinking Water Well >200 Other Te—et — fie�t_ 4. Parent Material: Coarse Loamy over Sandy Meltout Unsuitable Materials Present: Yes ® No E] If Yes: Disturbed Soi[E] Fill Material® Impervious Layer(s)[I Weathered/Fractured Rocl<❑ BedrockF_1 5. Groundwater Observed: Yes F-1 No Z If Yes: Depth Weeping from Pit_n/a Depth Standing Water in Hole_n/a Estimated Depth to High Groundwater: 55" (mottles) —89.2 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 4 of 7 Commonwealth of Massachusetts CityfTown of NORTH ANDOVER Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other (in.) Layer (Munsell) (Moist) Depth Color Percent (USDA) Gravel Cobbles &Stones 0-12 Fill/A 10 YR 3/3 n/a LS 12-24 B 10 YR 6/8 n/a LS 24-74 C j 2.5 Y 6/4 55" 1 5 YR 5/6 50 LS Refusal @ 74" Additional Notes DEP Form I 9 Soil Suitability Assessment for On-Site Sewage Disposal-Page 5 of 7 Commonwealth of McIssachusetts City/Town of 1fJ Form I I - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: [I Depth observed standing water in observation hole A. B. inches inches El Depth weeping from side of observation hole A. B. inches inches 2 Depth to soil redoximorphic features (mottles) A.T-64" B. 55" inches inches Groundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level 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 Z No F1 b. If yes, at what depth was it observed? Upper boundary: 24 Lower boundary:_74 inches inches F. Certification I certify that I haveAassed the sq'Ovaluator examination*approved by the Department of Environmental Protection and that the above analysis was pelrred y nsistent with the required training, expertise and experience described in 310 CMR 15-017. /Z Signature of Soilgal or' Date ! n D. Sullivan III, P.E. October 1995 Typed or Printed Name of Soil Evaluator *Date of Soil Evaluator Exam Issac Rowe Consultant for the Town of North Andover Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 6 of 7 Commonwealth of Massachusetts Ci /Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Use this sheet fog ONC. ?p,-no EX. St4ED QE)(. 114GROUt4o POOL 22" TH-2Q5 — 22" QPT—I CONC- PA-TIO PaENCHWAA�RK: NAIL IN TREE E L 9 _0 LEV= 95.0' 28" M 0 (A ssumEo DA-�njm) I.7± Above Ground Ground Ex. D—Box TH—1 J 0 Top OF ().0' E)(. GARP Et.F-\J_-1 S AME To YW000 FF, OUog REGARDS PE 'OOMS) D 3 OfOR0R p5 OM ssss14 COFDS PE Z DEP Form 1 I Soil Suitability Assessment for On-Site Sewage Disposal-Page 7 of 7 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: A. Site Information --- - When filling out forms on the computer,use Mike Rullo only the tab key Owner Name to move your 1 Gra Street cursor-do not ---- ..___._._. ._ _,_._ ...--- __ .__._, _ _.__._----_- use the return Street Address or Lot* key. North Andover MA01645 City/Town State Zip Code (Same as Owner)_ 603-401-2686 Contact Person(if different from Owner) Telephone Number B. fest Results 12/21/17 10:00 a.m. Date Time Date Time Observation Hole# PT-1 _..... Depth of Perc 35"-53" Start Pre-Soak 9:40 End Pre-Soak 9:55 Time at 12" 9:57 Time at 9" 10:02 Time at 6" 10:11 Time(9"-6") 9 min Rate(Min./Inch) 3 MPI Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ John D. Sullivan III, P.E. Test Performed By: _-..-_-- Issac Rowe, Consultant for Town of North Andover BOH Witnessed t3y: Comments: r t5form12.doc*06/03 Pere Test•Page 1 of 1 i I�