HomeMy WebLinkAboutMiscellaneous - 1975 SALEM STREET 4/30/2018 (3) ' ia�ssa�r{ sr. urr �
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North Andover Health Department
(ommunity and Economic Development Division
August 24, 2017
Livingstone Development Corp
PO Box 50
Tewksbury, MA 01876
Re: Subsurface Sewage Disposal System Plan for 1975 Salem Street—Lot 2
(Map 106B, Parcel 16, Lot 2)
To Whom It May Concern:
The proposed wastewater system design plan for the above site dated May 5, 2017 with a final
revision date of August 14, 2017 and received on August 17, 2017 has been approved.
The design has been approved for use in the construction of a new on-site septic system for a five
(5) bedroom, eleven(11) total room residential dwelling utilizing gravity leaching trenches. This
design plan approval is valid until August 24, 2020.
During this time, a licensed septic system installer must obtain a permit and complete this work,
and a Certificate of Compliance be endorsed by the installer, designer and the Town of North
Andover.
This approval is also subject to the following conditions:
1. Prior to the issuance of the Disposal Works Construction Permit, the applicant must
submit a foundation as-built at the same scale as the approved plan.
2. Prior to the issuance of the Disposal Works Construction Permit,the applicant must
submit the floor plans of the proposed dwelling showing no greater than five (5)
bedrooms or eleven(11) total rooms.
3. Prior to construction, the designer must establish a benchmark within seventy-five
(75) feet of the proposed system. The location and elevation of the benchmark must
be submitted to the Health Department.
Page 1 of 2
North Andover Health Department
Town Hall, 120 Main Street,
North Andover, MA 01845
Phone: 978.688.9540 Fax: 978.688. 9542
1975 Salem Street—Lot 2 August 24, 2017
4. 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)).
5. 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.
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compliance with all regulations and assure protection of public health and the environment of
North Andover.
Sinc y,
rian J. LaGrasse, CEHT
Director of Public Health
Encl. Installers list
cc: Christiansen& Sergi, Inc. 160 Summer Street, Haverhill MA 01830
File
Page 2 of 2
North Andover Health Department
Town Hall, 120 Main Street,
North Andover, MA 01845
Phone: 978.688.9540 Fax: 978.688. 9542
LIVINGSTONE DEVELOPMENT CORP.
P.O. BOX 50 `' SEP 0
TEWKSBURY,MA 01876 70
(978)640-1611 NORTH ANDOVER
Fax(978) 640-1611 CONS RVATION CO S
Cell(978) 815-4847
September 1,2017
Town of North Andover
Jennifer A. Hughes
Conservation Administer
120 Main Street
North Andover,MA 01845
Re: Contact list For North Andover
Dear Jennifer:
The following is a contact list for Lot 1-3 Salem Street,North Andover, MA.
Thomas B.Hodgson President (978) 815-4847
Bob Michalczk Forman (978) 815-5226
Brett Berube BPB Co. Excavator (603) 966-7577
Leah Basbanes Environmental monitor (978) 649-3839
If you have any questions or need more information feel free to contact me.
Sincerely,
Susan Connor
Office Manager
Livingstone Development Corp.
CHRISTIANSEN & SERGI, INC.
' PROFESSIONAL ENGINEERS AND LAND SURVEYORS
CS0160 SUMMER STREET,HAVERHILL,MA 01830
tel:978-373-0310 www.csi-engr.com fax 978-372-3960
August 14, 2017
G�
Mr. Brian LaGrasse
Director of Public Health 03 11 P
North Andover Health Dept. OkNOPS� ' �
1600 Osgood Street, Suite 2035 '�'��ov
North Andover, MA 01845
Re: Septic System Design Plan for Lot 21975 Salem Street
(Map 106DB Parcel 16, Lot 2)
Dear Mr. LaGrasse:
We have received your July 6, 2017 comments on the above referenced plan, and we offer the following
response.
1. The Title Block shows the Owner/Applicant as Livingstone Development Corp. The deed
reference listed on the plans shows Livingstone Development Corp. as the record owner.
2. All of the requested soil testing information has been added to the plans.
3. The second to last page of the soil evaluations forms were signed.
4. No response needed.
5. A foundation drain and invert were added to the plan.
6. The length and slope of the building sewer have been revised to show the correct information in
the Plan view on sheet 1 of 2.
7. An inspection port has been added to the plan.
I trust that these responses fully address all of your comments.
Please contact me if you have any questions.
Very truly yours,
Christiansen &Sergi, Inc.
Philip G. Christiansen
A
I i
541TIYD4i
TOWN OF NORTH ANDOVER
Community & Economic Development
HEALTH DEPARTMENT i
120 Main Street
NORTH ANDOVER,MASSACHUSETTS 01845
978.688.9540—Phone
978.688.9542—FAX
E-MAIL:healthdept@northandoverma.gov
northandoverma.gov
WEBSITE:http://www.northandovenna.gov
SEPTIC PLAN SUBMITTAL
FORM
Date of Submission:-4- S -0� D /7
Site Location: (q;S- 5,Q_fF M 5 Z In D T a
Engineer: QtR75?2 fVS1FN 4M0 Si7a -71 11VC.
New Plans? Yes V $275/Plan Check# 16 q(o 8 (includes I"submission and one re-
review only)
Revised Plans?Yes $125/Plan Check# ��Ci0
0
Site Evaluation Forms Included? Yes_V No
OF �Q
Local Upgrade Form Included? Yes No
Telephone#: q70 3730310 Fax#:
E-mail: _TJ CJS CS — E NG K. CO M
Homeowner
i
Name: L7-V7tvC_S7ar/E by1rt.pPmetyI CORP.
OFFICE USE ONLY
When the§Ww 'ssion is complete(including check):
Date stamp plans and letter
I
➢ Complete and attach Receipt
➢ Copy File;Forward to Consultant
➢ Enter on Log Sheet and Database
i
i
i
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
f 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
filling out forms A. Site Information
on the computer,
use only the tab Lois Lachapelle
key to move your Owner Name
cursor-do not 1975 Salem Street-Map 106 Block 106.B Lot 16
use the return
key. Street Address or Lot#
North Andover T MA _ 01845 _
City/Town State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
6/1/16 12:27 p.m. 6/1/16 12:33 p•m_
Date Time Date Time
Observation Hole# Perc 1 (DH-1)_ _ Perc 2 (DH-2)
Depth of Perc 45" ---- 47"
- - ---
Start Pre-Soak 12-27 _ _ 12:33
End Pre-Soak 12:42 12:49
Time at 12" 12:42 12:49
Time at 9" 12:53 12:52
Time at 6" 1:07 12:55
Time(9"-6") 14 Min. 3 Min.
Rate(Min./Inch) 5 Min./inch 1 Min/Inch
Test Passed: ® Test Passed:
Test Failed: ❑ Test Failed: El Herald
Test Performed By:
Issac Rowe-North Andover Board of Health
Board of Health Witness
Comments:
t5form12.doc-08/15 Perc Test•Page 1 of t
'
Commonwealth of Massachusetts ' ~
CofNorth Andover- Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal '
A. Facility Information
1
Street Address Map/Lot#
North AndYNo 01848
City State Zip Code ����------
B. Site Information
1. (Check one) 0 New Construction Fl Upgrade Repair
2. Soil Survey Available? Yen No If yes: 423O
Source Soil Map Unit
Canton Soil Slope d stoniness
Soil Name Soil Limitations � � ----------'----------------
Glacial Tilll Moraine
Geologic/Parent Mmenu| Landform
3. Sur5cim| Geological Report Available? F] Yea No If yes:
Year Published/Source Publication Scale Map Unit
4. Flood Rate Insurance Map
Above the 50V-ymorflood boundary? CE Yes E] No Within the 10D'yearflood boundary? [l Yeo Z No
|fYes,continue tv#5.
5. Within avelocity zone? [] Yea 0 No
G. Within oMapped Wetland Area? Fl Yes 0 No N1amaG|GWetland Data Layer: Welland Type
7. Current Water Resource Condidono (USGS)� Range: Fl Above Normal El Normal Z Below Normal
mvmoneu,
8. Other references reviewed:
Q done T3,T4-rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page I of 8
Commonwealth of Massachusetts
City/Town of North Andover- Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
s
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: DH-1 ( 7 6/1/16 10:00 a.m. Sunny& Mild
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: See_ 4Em 1clQ,Q Latitude/Longitude: 42 38 16"N / 71 03'6'W
feet
Description of Location: See plan
2. Land Use Woodland Some Stones 0-3%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Oak& Pine Moraine SH
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body > 100 ft Drainage Way > 100 ft Wetlands > 100 ft
feet feet feet
Property Line >25 ft _ Drinking Water Well > 100 ft Other
feet feet feet
4. Parent Material: Glacial Till _ 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: None None
Depth Weeping from Pit Depth Standing Water In Hole
Estimated Depth to High Groundwater:
inches elevation
t1 done T1,T2-rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
: . Commonwealth of Massachusetts
City/Town of North Andover- Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-1 (Lot 21
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Soil
Depth(in.) layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel Cobbles (Moist)
&Stones
0-9" Ap 10 yr 2/2 FSL Granular Friable
9-20" Bw 7.5 yr 4/6 FSL Massive Friable
20-90" C1 2.5y 5/3 LS 10% 50% Single Grain Friable Firm
Additional Notes:
__.._._._..�._..
-------- —
i
t1 done T1,T2-rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
<ZI\, Commonwealth of Massachusetts
CityRown of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-2 1 a 6/1/16 10:00 a.m. _ Sunny&Mild
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: S'€€Mmr '7 Latitude/Longitude: 42 38' 16"N / 71 03'6"W
feet
2. Land Use Woodland Some Stones _ 0-3%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) _ Slope(%)
Oak& Pine _ _ Moraine SH
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body > 100 ft Drainage Way > 100 ft Wetlands > 100 ft
feet feet feet
Property Line >25 ft Drinking Water Well > 100 ft_ Other
feet feet feet
4. Parent Material: Glacial Till 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: None _ None _
Depth Weeping from Pit Depth Standing Water in Hale
j Estimated Depth to High Groundwater: _
inches elevation
t1 done T1,T2•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8
Commonwealth of Massachusetts
m T�3 Cityrrown of North Andover- Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-2 f Lot 21
Redoximorphic Features Coarse Fragments
Depth(in.) Soil Horizon/Soil Matrix:Color- _ Soil Texture %by Volume Soil
Layer Moist(Munsell) (USDA) Soil Structure Consistence other
&Stones Depth Color Percent ravel Cobblestones (Moist)
0-10" Ap 10 yr 2/2 FSL Granular Friable
10-20" BW 10 yr 4/6 FSL Massive Friable
20-87" C1 2.5y 5/3 LS 10% 50% Single Grain Friable Firm
Additional Notes:
t1 done T1,T2•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8
�. Commonwealth of Massachusetts
dry City/Town of North Andover- Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
�1._ ter•
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: DH-3 (:.O j 6/1/16 11:00 a.m. Sunny& Mild
Date Time Weather
1. Location
r
Ground Elevation at Surface of Hole: Ste-pMrr Latitude/Longitude: 42 38 16"N / 71 03'6"W
feet �—
Description of Location: See plan
2. Land Use Woodland Some stones_ 0-3%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(°�)
Oak_& Pine Moraine _SH _
Vegetation _ Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body > 100 ft _ Drainage Way > 100 ft Wetlands > 100 ft
feet feet feet
Property Line > 25 ft Drinking Water Well > 100 ft Other
feet feet feet
4. Parent Material: Glacial Till 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: None _None
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: _
inches elevation
Q done T3,T4•rev.8115 Form 11 –Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8
Commonwealth of Massachusetts
City/Town of North Andover- Lot 2
- Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-3{Lot 21
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel Cobbles (Moist)
&Stones
0-10" Ap 10 yr 2/2 FSL Granular Friable
10-20" Bw 10 yr 4/6 FSL Massive Friable
20-86" C1 2.5y 5/3 LS 20% 50% Single Grain Friable Firm
Additional Notes:
t2 done T3,T4-rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
_ Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
� a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-4 Lq7 6/1/16 11:00 a.m. Sunny& Mild
Date Time Weather -- .-
1. Location
el-
Ground Elevation at Surface of Hole:
feet �Q, Latitude/Longitude: 42 38' 16"N / 71 03'6"W
' feet —
2. Land Use Woodland Some stones 0-5%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Oak& Pine Moraine SH
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body > 100 ft Drainage Way > 100 ft Wetlands > 100 ft
feet feet feet
Property Line >25 ft Drinking Water Well > 100 ft Other
feet feet feet
4. Parent Material: Glacial Till 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: None None
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater:
inches elevation
t2 done T3,T4•rev.8/15 Form 11–Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8
Commonwealth of Massachusetts
(6 City/Town of North Andover- Lot 2
I Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-4(Lot 2)
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
8 Stones Depth Color Percent ravel Cobblestones (Moist)
0-10" Ap 10 yr 2/2 FSL Granular Friable
10-20" Bw 10 yr 4/6 FSL Massive Friable
20-99" C1 2.5y 5/3 LS 10% 50% Single Grain Friable Firm
Additional Notes:
t2 done T3,T4•rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8
Commonwealth of Massachusetts
r�3 City/Town of North Andover- Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method Used: Obs. Hole#DH-1 Obs. Hole#DH-2
❑ Depth observed standing water in observation hole
inches inches
❑ Depth weeping from side of observation hole
inches inches _
❑ Depth to soil redoximorphic features (mottles)
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh) >90" > 87" _
(USGS methodology) inches — inches T
Index Well Number Reading Date
Sh=Sc—[Sr x(OWc—OWmax)/OWrl
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?
® Yes ❑ No
b. If yes, at what depth was it observed? Upper boundary: 20" _ Lower boundary: 90"
inches inches
c. If no, at what depth was impervious material observed? Upper boundary: _ _ Lower boundary: -
inches inches
t1 done T1,T2•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of a
Commonwealth of Massachusetts
tai - City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Q�
D. Determination of High Groundwater Elevation
1. Method Used: Obs. Hole#DH-3 Obs. Hole#DH-4
❑ Depth observed standing water in observation hole
inches inches
❑ Depth weeping from side of observation hole _ _
� inches inches
❑ Depth to soil redoximorphic features (mottles)
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh) >86" >99"
(USGS methodology) inches inches
Index Well Number Reading Date
Sh=Sc—[Sr X(OWc—OWmax)/OWr]
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?
® Yes ❑ No
b. If yes, at what depth was it observed? Upper boundary: 20" Lower boundary: 99"
inches inches
c. If no, at what depth was impervious material observed? Upper boundary: _ Lower boundary: _
inches inches
i
Q done T3,T4•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
Commonwealth of Massachusetts
ri, City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
F. Board of Health Witness
Isaac Rowe North Andover Board of Health
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.
I
— —--_ .. - -- - 6/9/16
Signature of Soil Evaluator _ Date
Steven Eriksen/SE685 6/30/18
Typed or Printed Name of Soil Evaluator/License# T Expiration Date of License
I
Note: 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.
I
t2 done T3,T4•rev.8115 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
0
D.j �0
North Andover Health Department
Community and Economic Development Division
July 6, 2017
Philip Christiansen,P.E.
Christiansen and Sergi, Inc.
160 Summer Street
Haverhill, MA 01830
Re: Subsurface Sewage Disposal System Plan for Lot 2 - 1975 Salem Street(Map 106B,Lot
16)
Dear Mr. Christiansen,
The proposed wastewater system design plan for the above site dated May 5, 2017 and received
on June 8, 2017 has been reviewed. Unfortunately,the plan cannot be approved until the
following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North
Andover regulation that is not met by this design follows each item where applicable.
1. Please indicate the record owner on the design plan (NA 3.2). The Assessor's field card
has Lois Lachapelle as the current record owner.
2. The following soil testing data was not on the design plan:
a. The results of the soil and percolation logs (310 CMR 15.220(4)(h-i))
b. Date of the soil evaluation (310 CMR 15.220(4)(h))
c. The name of the approving authority representative (310 CMR 15.220(4)(h))
d. The name and approval date of the soil evaluator(310 CMR 15.220(4)0))
3. The soil evaluation forms were not signed by the soil evaluator(3 10 CMR 15.018).
4. On sheet 1 of 2,the benchmark is shown greater than 75 feet to the proposed septic
system(3 10 CMR 15.220(4)(q)). A note on the design plan indicating a benchmark shall
be set prior to construction is sufficient.
5. A foundation drain and elevation were not shown on the design plan(NA 3.2).
6. On sheet 1 of 2, the site plan view indicates the incorrect length and slope of the proposed
building sewer line.
Page 1 of 2
North Andover Health Department, Town Hall, 120 Main Street,
North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542
7. The proposed location of the inspection port(s)were not indicated on the design plan.
Please feel free to contact the office or Mill River Consulting at 978-282-0014 with any
questions you may have. We look forward to working with you to obtain a wastewater treatment
and dispersal system which will be in compliance with all regulations and assure protection of
public health and the environment of North Andover.
Sin ly,
B an J. LaGrasse, CEHT
Director of Public Health
cc: Livingstone Development Corp.
File
i
Page 2 of 2
North Andover Health Department, Town Hall, 120 Main Street,
North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688. 9542
R)WX OF NOIR R-I I I <\--N 0 MIAZ
WTice 0('COMNIUNITYDFV'L01'MFN'T AM) SFINWI(TS
1600 0,S(1001} S'1T1'1 J-J: St ITF 2035
X( )i.,TI I D( )VF P, %! " A CI i! lis (I
RECEIVED
2016
'A\l-'A 1,01 01 1 !,i,1, 111.1 Uo"
TOWN OF NORTH ANDOVER
APPLICATION FOR SOIL TESTS HEALTH DEPA MFNT
DATE: -20j (" MAP&PARCEL: 1,A6 6 — 16 C6-1
LOCATION OF SOIL TESTS: 4 C--M
OWNER: 1615 CA-CNAP &-LtE- Contact#:
APPLICANT:.LiV1M650ti)Lz:-- DEV , Contact 79 -Y15 - 4(6 q-7
ADDRESS:-tWl NoD6-,5j5)tj Po &X 62) TC-:WkS ,3/) rte/ tm
ENGINEER:-P141/-1P Cj4,qjSn1�wsten/ Contact#: 97g -,37.3 --0310
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision Single Family Home Commercial
Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No z
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
> Proof of land ownership(Tax bill,or letter from owner permitting test)
> 8.5"x11'p Plot plan &Location of Testing(please indicate test pit sites on the plan)
> 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 INFORMATION
> Only Certified Soil Evaluators may perform deep hole inspections.
> 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:
Signature of Conservation Agent: colp2s'-e-oj 4"�
VV %
Date hack to Health Department: (stamp in): cv,
C
C Jp-LJO- 1
North Andover MIMAP April 4, 2016
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MVPC Bo
Municipal Boundary Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
Rail Line Meters Data Sources:The data for this map was produced by Merrimack
Interstates MQR'T{� Valley Planning Commission(MVPC)using data provided by the Town of
-I North Andover.Additional data provided by the Executive Office of
SR ? y�< "n+s dQ Environmental Affairs/MassGIS.The information depicted on this map is
Roads 0 - for planning purposes only.It may not be adequate for legal boundary
{�;Easements �.. -" � definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
C'I Parcels ♦'. * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
,✓fl{, d'#• OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
•- Trails W a a9( ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
Hydrographic Features ]�4. :+'• y, THIS INFORMATION
Streams gs'�t1iC15E4t
'.Wetlantls j
:;Exempt Lands 1"=229 ft =y ..
g � I
�T3r.
ARF = s
Loot A S !
LOT 2
LOT 1 (FRONTAGE
(FRONTAGE EXCEPTION LOT) -
; EXCEPTION LOT) AREA= -
f
AREA= 3.47t ACRES
3.45±ACRES
k � ti
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27.0 MMUCT This'
agft m "ecuted in multiple couampa%is to be construed as a Massachusetts contract,E to take
TION OF effect as a sealed htstrument,sets fad the en*e coffimad between the parties,is binding upon andmumto>be
ACFtF.MM T b=&of the patio hence and their respective heirs,&Vneea,emntors,adminlstratas,su =ors and assigM
ad my be ,modified or amn&d omdy by a wrbw instruct exe Md by both the QEWR and ft
BUYER If two or maga prions F"=wd hada as BUYER their obligations heramder AO be joint cad
severaL The captions and mamginal notes we used only as a meter of convenience and are not to be considered a
PW of this ageernent or to be used in determining the intet of the parties to it.
MEAD PAW Not applicable.
LAW
29.SMOKE Nat applicable.
DETEMPS
AND CARBON
MONOXIDE
DETECTORS
I
30.ADDTPMON The initiated riders,if any,attached hmvto,are incorporated herain by ref
AL eremmce.
PROVISIONS See Rider A attached hereto as Exhibit A and berm incorporated by reference.
See Exhibit B(metes and bands descriptionfor Premises attached ehed hereto and in
sketch Lanlconce Incorporated e)refereaca
See Exhibit C
( P ptusl plan Showing Parcel A as excepted from this conveyance).
See Buyer's Rider B attached hereto as Exh1btt D and herein incorporated by referenec
NOTICE: This is a legal document that creates binding obligations. If not understood,consult an attmney.
SELLER BUYER
LIVINGSTONE DEVELOPMENT CORP,
I
LOIS R.LACHAPELLE By:THOMAS HODGSON
Its: President and Treasurer
t
XXHIB1T B TO PURCHASE AND SALE AGREEMENT
7.8 Acre Parcel of land located on Salem Street,North Andover,MA
Metes and Bounds Property Vescription
A parcel of land located on Salem Street,North Andover,Essex County,Massachusetts,
bounded and described as follows:
"Beginning at a point on the Southwesterly side of said Salem Street at the Soutlicastedy corner
of the First Parcel hereinbefore described,and which First Parcel was formerly owned by Minnie
Peard and thence running Southwesterly along the stone wall,partly by said Peard land and
partly by land now or formerly of George Rhea five hundred and twenty-six(526)feet to a point
in said stone wall,thence running about Southeasterly,shill by said Rhea land and along the stone
wall,eleven hundred and thirty-three and 5/10(1133.5)feet to a point in said stone wall at land
now or formerly of Charles L Kimball,thence running Northerly by said Kimball's land,six
hundred and sixty(660)feet,more or less,to a stone bound set in the ground,thence running a
little East of Nortb,still by said Kimball's land,four hundred and eighty-five(485)feet, more or
less,to a point in said Salem Street,which point is at the Northwesterly comer of said Kimball's
land,thence running in a Northwesterly direction,following the contour of the said
Southwesterly side of said Salem Street,two hundred and eighty(280)feet to the point of
beginning.
Said Second Parcel contains 7.80 acres more or less and is shown on a plan of land entitled"Plan
of Lend of Peard&Kimball,Salem St.,North Andover",dated Dec. 1928 and duly recorded
with said Registry of Deeds."
Being a portion of the premises described in Deed from Mary V. Lachapelle to Lois R
Lachapelle dated September 2, 1992 and recorded with the Essex North District Registry of
Deeds in Book 3539,Page 353. Life tenant Mary V. Lachapelle died on February 26, 2015.
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' t Commonwealth of Massachusetts
Cit /Town of North Andover - Lot of 2
Percolation Test
Form 12
kIM
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 usin f k with
the local Board of Health to determine the form they use. IRM
Important:When
HU
filling out forms A. Site Information
on the computer, JUN 14 2016
use only the tab Lois Lacha elle
key to move your Owner Name DMIER
cursor-do not 1975 Salem Street-Map 106 Block 106.13 Lot 16 HEALTH DEPARTMENT
use the return -
key. Street Address or Lot#
North Andover MA 01845
rab City/Town State
Zip Code
Contact Person(if different from Owner) Telephone Number
R� B. Test Results
6/1/16 12:27 p.m. 6/1/16 12:33 p.m.
Date Time Date Time
Observation Hole# Perc 1 (DH-1) Perc 2 (DH-2)
Depth of Perc
45" 47"
Start Pre-Soak 12:27 12:33
End Pre-Soak 12:42 12:49
Time at 12" 12:42 12:49
Time at 9" 12:53 12:52
Time at 6" 1:07 12:55
Time (9"-6") 14 Min. 3 Min.
Rate (Min./Inch) 5 Min./Inch 1 Min/Inch
Test Passed: ® Test Passed:
Maureen Herald Test Failed: ElTest Failed: ❑
Test Performed By:
Issac Rowe- North Andover Board of Health
Board of Health Witness
Comments:
t5form12.doc•08/15
Perc Test•Page 1 of.1
Commonwealth of Massachusetts
City/Town of North Andover-- Lot 3
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
the local Board of Health to determine the form they use.
Important:When
filling out forms A. Site Information
on the computer,
use only the tab Lois Lachapelle
key to move your Owner Name
cursor-do not 1975 Salem Street-Map 106 Block 1106.13 Lot 16
use the return
key. Street Address or Lot#
North Andover MA
,ab City/Town 01845
State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
6/1/16 1:18 p.m. 6/1/16 1:40 p.m.
Date Time Date Time
Observation Hole# Perc 3 (DH-6) Perc 4 (DH-8)
Depth of Perc 44" 44"
Start Pre-Soak 1:18 1:40
End Pre-Soak 1:33 1:57
Time at 12" 1:33 1:57
Time at 9" 1:53 2:08
Time at 6" 2:21 2:20
Time (9%6") 28 Min. 12 Min.
Rate(Min./Inch) 9 Min./Inch 4 Min/Inch
Test Passed: ® Test Passed:
Maureen Herald Test Failed: ElTest Failed: El
Test Performed By:
Issac Rowe- North Andover Board of Health
Board of Health Witness
Comments:
t5form12.doc•08/15
Perc Test•Page 1 of 1
Commonwealth of Massachusetts
City/Town of North Andover - Lot 1
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
filling out forms A. Site Information
on the computer,
use only the tab Lois Lachapelle
key to move your Owner Name
cursor-do not 1975 Salem Street-Map 106 Block 106.13 Lot 16
use the return
key. Street Address or Lot#
North Andover MA
City/Town 01845
State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
6/2/16 11:26 a.m. 6/2/16 11:43 a.m.
Date Time Date Time
Observation Hole# Perc 5 (DH-11) Perc 6 (DH-12)
Depth of Perc
42" 67"
Start Pre-Soak 11:26 11:43
End Pre-Soak 11:41 11:58
Time at 12" 11:41 11:58
Time at 9" 11:52 12:04
Time at 6" 12:11 12:16
Time (9"-6") 19 Min. 12 Min.
Rate (Min./Inch) 6 Min./Inch 4 Min/Inch
Test Passed: ® Test Passed:
Steven Eriksen Test Failed: ❑ Test Failed: El
Test Performed By:
Issac Rowe- North Andover Board of Health
1 Board of Health Witness
Comments:
t5form12.doc•08/15
Perc Test•Page 1 of 1
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Lois Lachapelle
Owner Name
1975 Salem Street Map 106 Block 106.13 Lot 16
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: Web Soil Survey 422D
Source Soil Map Unit
Canton Soil Slope and stoniness
Soil Name Soil Limitations
Glacial Tilll Moraine
Geologic/Parent Material Landform
3. Surficial Geological Report Available? ❑ Yes ® No If yes:
Year Published/Source Publication Scale Map Unit
4. Flood Rate Insurance Map
Above the 500-year flood boundary? Z Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No
If Yes,continue to#5.
5. Within a velocity zone? ❑ Yes ® No
6. Within a Mapped Wetland Area? ❑ Yes ® No MassGIS Wetland Data Layer:
Wetland Type
7. Current Water Resource Conditions (USGS): 6/16 Range: ❑ Above Normal ❑ Normal ® Below Normal
Month/Year
8. Other references reviewed:
Q done T3,T4•rev. 8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
kv�
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: DH-3 6/1/16 11:00 a.m. Sunny& Mild
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: See plan Latitude/Longitude: 42 38 16"N / 71 03' 6"W
feet
Description of Location: See plan
2. Land Use Woodland Some stones 0-3%
(e.g.,woodland, agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones, boulders,etc.) Slope(%)
Oak & Pine Moraine SH
Vegetation Landform Position on Landscape(SU,SH, BS,FS,TS)
3. Distances from: Open Water Body > 100 ft Drainage Way > 100 ft Wetlands > 100 ft
feet feet feet
Property Line > 25 ft Drinking Water Well > 100 ft Other
feet feet feet
4. Parent Material: Glacial Till 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: None None
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater:
inches elevation
Q done T3,T4•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
-c-IN Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
_ = Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-3(Lot 21
Redoximorphic Features Coarse Fragments
Depth(in.) Soil Horizon/Soil Matrix: Color- Soil Texture %by Volume Soil
Layer Moist(Munsell) (USDA) Cobbles Soil Structure Consistence Other
Depth Color Percent Gravel (Moist)
&Stones
0-10" Ap 10 yr 2/2 FSL Granular Friable
10-20" BW 10 yr 4/6 FSL Massive Friable
20-86" C1 2.5y 5/3 LS 20% 50% Single Grain Friable Firm
Additional Notes:
Q done T3,T4•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
_ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-4 6/1/16 11:00 a.m. Sunny& Mild
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: See plan Latitude/Longitude: 42 38' 16"N / 71 03'6"W
feet
2. Land Use Woodland Some stones0o
(e.g.,woodland, agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones, boulders,etc.) Slope
(%)
Oak & Pine Moraine SH
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body > 100 ft Drainage Way > 100 ft Wetlands > 100 ft
feet feet feet
Property Line > 25 ft Drinking Water Well > 100 ft Other
feet feet feet
4. Parent Material: Glacial Till 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: None None
Estimated Depth to High Groundwater: Depth Weeping from Pit Depth Standing Water in Hole
inches elevation
Q done T3,T4-rev. 8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
4M
C. On-Site Review (continued)
Deep Observation Hole Number: DH-4{Lot 21
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix: Color- Soil Texture %by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel obbles (Moist)
&Stones
0-10" Ap 10 yr 2/2 FSL Granular Friable
10-20" Bw 10 yr 4/6 FSL Massive Friable
20-99" C1 2.5y 5/3 LS 10% 50% Single Grain Friable Firm
Additional Notes:
Q done T3,T4•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method Used: Obs. Hole#DH-3 Obs. Hole#DH-4
❑ Depth observed standing water in observation hole
❑ Depth weeping from side of observation hole
orches inches
❑ Depth to soil redoximorphic features (mottles) inches inches
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh) > 86„ > 991,
(USGS methodology) inches inches
Index Well Number Reading Date
Sh = Sc—[Sr x (OWc—OWmax)/OWr]
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?
® Yes ❑ No
b. If yes, at what depth was it observed? Upper boundary: 20" Lower boundary: gg"
inches inches
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
inches inches
1:2 done T3,T4-rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
_ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
F. Board of Health Witness
Isaac Rowe North Andover Board of Health
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.
6/9/16
Signature of Soil Evaluator Date
Steven Eriksen /SE685 6/30/18
Typed or Printed Name of Soil Evaluator/License# Expiration Date of License
Note: 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.
Q done T3,T4•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Field Diagrams
Use this sheet for field diagrams:
t2 done T3,T4-rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8
4
` Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
/ osal g p
A. Facility Information
Lois Lacha elle
Owner Name
1975 Salem Street
Street Address Map 106 Block 106.8 Lot 16
North Andover Map/Lot#
city Ma 01845
State Zip Code
B. Site Information
1. (Check one) ® New Construction ❑ Upgrade ❑ Repair
2. Soil Survey Available? ® Yes ❑ No If yes: Web Soil Survey 422D
Source Soil Ma
Canton Soil p Unit
_Slope and stoniness
Soil Name Soil Limitations
Glacial Till Moraine
Geologic/Parent Material Landform
3. Surficial Geological Report Available? ❑ Yes ® No If yes:
Year Published/Source Publication Scale Map Unit
4. Flood Rate Insurance Map
Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes
If Yes,continue to#5. ® No
5. Within a velocity zone? ❑ Yes ® No
6. Within a Mapped Wetland Area? ❑ Yes ® No MassGIS Wetland Data Layer:
7. Current Water Resource Conditions (USGS): 6/16 Ran e: Wetland Type
g ❑ Above Normal ❑ Normal ® Below Normal
Month/Year
8. Other references reviewed:
RECEIVED
JUN 14 2016
TOWN OF NORTH ANDOVER
t1 done T1,T2•rev.8/15 HEALTH DEPARTMENT
Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8
a
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
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)
Cheep Observation Hole Number: DH-1 6/1/16 10:00 a.m. Sunny& Mild
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: See plan Latitude/Longitude: 42 38 16"N / 71 03'6"W
feet
Description of Location: See plan
2. Land Use Woodland Some Stones 0-3%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones, boulders,etc.) Slope
Oak & Pine Moraine SH
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body > 100 ft Drainage Way > 100 ft Wetlands > 100 ft
feet feet feet
Property Line > 25 ft Drinking Water Well > 100 ft Other
feet feet feet
4. Parent Material: Glacial Till 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: None None
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater:
inches elevation
t1 done T1,T2•rev: 8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal Page 2 of 8
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-1 (Lot 2)
Redoximorphic Features Coarse Fragments
Depth(in.) Soil Horizon/Soil Matrix: Color- Soil Texture %by Volume Soil
Layer Moist(Munsell) USDA bles Soil Structure Consistence Other
Depth Color Percent (USDA)
Gravel &Stones (Moist)
0-9" Ap 10 yr 2/2 FSL Granular Friable
9-20" Bw 7.5 yr 4/6 FSL Massive Friable
20-90" C1 2.5y 5/3 LS 10% 50% Single Grain Friable Firm
Additional Notes:
t1 done T1,T2•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
1
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Up- ",
C. On-Site Review (continued)
Deep Observation Hole Number: DH-2 6/1/16 10:00 a.m. Sunny& Mild
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: See plan Latitude/Longitude: 42 38' 16"N / 71 03'6"W
feet
2. Land Use Woodland Some Stones 0-3%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones, boulders,etc.) Slope(%)
Oak & Pine Moraine SH
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body > 100 ft Drainage Way > 100 ft Wetlands > 100 ft
feet feet feet
Property Line > 25 ft Drinking Water Well > 100 ft Other
feet feet feet
4. Parent Material: Glacial Till 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: None None
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater:
inches elevation
t1 done T1,T2•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8
• Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: DH-2 {Lot 21
Redoximorphic Features Coarse Fragments
Depth(in.) Soil Horizon/Soil Matrix: Color- Soil Texture %by Volume Soil
Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel Cobbles (Moist)
&Stones
0-10" Ap 10 yr 2/2 FSL Granular Friable
10-20" Bw 10 yr 4/6 FSL Massive Friable
20-87" C1 2.5y 5/3 LS 10% 50% Single Grain Friable Firm
Additional Notes:
ti done T1,T2-rev. 8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8
Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
�o
D. Determination of High Groundwater Elevation
1. Method Used: Obs. Hole#DH-1 Obs. Hole#DH-2
❑ Depth observed standing water in observation hole
inches inches
❑ Depth weeping from side of observation hole
inches inches
❑ Depth to soil redoximorphic features (mottles)
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh) > 90" > 8T
(USGS methodology) inches inches
Index Well Number Reading Date
Sh = Sc—[Sr X(OWc—OWmax)/OWr)
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?
® Yes ❑ No
b. If yes, at what depth was it observed? Upper boundary: 20" Lower boundary: 901,
inches inches
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
inches inches
t1 done T1,T2•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
• _, Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
R - Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
F. Board of Health Witness
Isaac Rowe North Andover Board of Health
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.
6/9/16
Signature of Jon Evaluator Date -
Steven Eriksen/SE685 6/30/18
Typed or Printed Name of Soil Evaluator/License#. Expiration Date of License
Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approvingauthority within 60 days of the date of field testing, and
to the designer and the property owner with Percolation Test Form 12.
t1 done T1,T2•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
• Commonwealth of Massachusetts
City/Town of North Andover - Lot 2
_- Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Field Diagrams
Use this sheet for field diagrams:
t1 done T1,T2•rev.8/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8
