HomeMy WebLinkAboutMiscellaneous - 257 BOXFORD STREET 6/13/2018 Community & Economic Development
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HEALTH DEPARTMENT
PmAC tl t l V 120 tl ain Strme et
„w ttIIW OR'11-8 ANDOVER, MASSA C:'tflt.DSETTS 01845
I&68&9510- t"bone
978.68&9542 FAX
E-MAIL, ILL: h a thdept@noilhandovemia,gov
WEBSITE lioL //N w w iio� than ido,��werni� t;t,y
SEPTIC PLAN SUBMITTAL
.
FOR
Date of Submission:-June 12, 2018
Site Location: 257 Boxford St.
Engineer: Doug Smith-Soilsmith Designs w�
New flans? "Yes X $275/Plan Check#t (includes 1St submission and one re-
review only)
Devised Plans?Yes $125/Plan Check##
Site Evaluation Dorms Included? Yes X No
Local Upgrade Form Included? Yes__--_ No X
l"elephone##: 603-487-2298 DougSmith ______....._._I'a
E-mail;Soilsmith@aol.com
Homeowner
Name:Sharon Holland c/o Terry Holland 133 Green St. Borth Andover, MA 01845 978-360-1791
CDT'FICE USE ONLY
When th subm'ssion is complete (including che&):
WDate stamp flans and letter
tComplete and attach Receipt
Copy File, Forward to Consultant
Enter on Log Sheet and Database
Commonwealth of Massachusetts
f City/Town of (North Andover
it Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Sharon Holland
Owner Name
257 Boxford Stree 106-A lot 3
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
Source Soil Map Unit
Hinkley poor filter
Soil Name Soil Limitations
outwash
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 ® 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): Range: ❑ Above Normal ® Normal ❑ Below Normal
Month/Year
8. Other references reviewed:
t5form11 north andover BOXFORD m 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
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: 1 4-17-2018 8:30 sunny
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 100.96 Latitude/Longitude:
feet
Description of Location: front yard
2. Land Use house lot few 7%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope
Vegetation Landform Position on Landscape(SU,SH,13S,FS,TS)
3. Distances from: Open Water Body none Drainage Way none Wetlands 125"
feet feet feet
Property Line 5' Drinking Water Well 127" Other
feet feet feet
4. Parent Material: outwash Unsuitable Materials Present: ❑ Yes M 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: none
inches elevation
t5forml 1 north andover BOXFORD•rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
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: 1
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture by Volume Soil
%
Depth(in.) Soil Structure Consistence Other
Layer Moist(Munsell) Depth Color Percent (USDA) Gravel Cobbles (Moist)
&Stones
0-8" A 1 OYR3/3 sandy loam gran friable
8"-28" B 1 OYR4/4 sandy loam granular friable
28"-68" C1 2,5Y4/3 Loamy sand 15%
68"-113" C2 2.5Y6/4 loamy sand
Additional Notes:
t5forml 1 north andover BOXFORD-rev.8115 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 3 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - it Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 2 4-17-18 9:15 sunny
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 100.18 Latitude/Longitude:
feet
2. Land Use house lot few 7%
(e.g,,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope
Vegetation Landform Position on Landscape(SU,SH,13S,FS,
3. Distances from: Open Water Body none Drainage Way none Wetlands 106'
feet feet feet
Property Line 4' Drinking Water Well 105' Other
feet feet feet
4. Parent Material: outwash Unsuitable Materials 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:
inches elevation
t5form1I north andover BOXFORD•rev.8115 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 4 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Form 11 - it Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 2
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Soil
Depth(in.) Layer Moist( Soil Structure Consistence Other
Munsell) (USDA)Depth Color Percent Gravel Cobbles (Moist)
&Stones
0-84" Fill
84'f-871#- A 1 OYR3/3 sandy loam granular friable
87"-104" B 7.5YR5/6 sandy loam granular friable
104"-134° C 2.5Y6/4 loamy sand
Additional Notes:
t5form1I north andover BOXFORD-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
Form 11 - it 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: 3 4-17-2018 8:30 sunny
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 101.12 Latitude/Longitude:
feet
Description of Location: front yard
2. Land Use house lot few 7%
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g,,cobbles,stones,boulders,etc.) Slope
Vegetation Landform Position on Landscape(SLI,SH,BS,FS,TS)
3. Distances from: Open Water Body none Drainage Way none Wetlands 102'
feet feet feet
Property Line 27' Drinking Water Well 135" Other
feet feet feet
4. Parent Material: outwash Unsuitable Materials Present: ❑ Yes 0 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: none
inches elevation
#3 holland north a-rev. 8115 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8
Commonwealth of Massachusetts
rr City/Town of North Andover
Form 11 - it Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: 3
Redoximorphic Features Coarse Fragments
Soil Horizon/Soil Matrix:Color- Soil Texture to by Volume Soil
Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other
Depth Color Percent Gravel I&Cobbi s (Moist)
Stones
0-7" A I OYR3/3 sandy loam gran friable
7"-36" B I OYR5/6 sandy loam granular friable
36"-133" C 2.5Y5/4 Loamy sand
Additional Notes:
#3 holland north a-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
" it Suitability Assessment for On-Site Sewage Disposal
j
D.
Determination of i roue aer Elevation
1. Method Used: obs. Hole#1 obs. Hole#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)
(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: Lower boundary:
inches inches
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
inches inches
t5formi 1 north andover BOXFORD-rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal .Page 6 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Fo
Soil Suitability Assessment for On-Site Sewage Disposal rm 11
F. Board of Health Witness
Isaac Rowe North Andover
Name of Board of Health Witness Board of Health
G.
it 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.
June 12, 2018
Signa of Soilvaluator - Date
Douglas J Smith ma se 2267 2019
Typed or Printed Name of Soil Evaluator t 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 For: 12.
t5form11 north andover BOXFORD-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
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Field Diagrams
Use this sheet for field diagrams:
t5forml 1 north andover BOXFORD-rev.8115 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal Page 8 of 8
Commonwealth of Massachusetts
City/Town of North Andover
Percolation Test
For 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 Sharon Holland -------------- ----------
key to move your Owner Name
cursor-do not 257 Boxford Street
use the return
key. Street Address or Lot#
North Andover Ma
...............
raa
City/Town State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
4-17-2018 10:40:
Date Time Date Time-
Observation Hole# A —
Depth of Perc 48" —-----------
Start Pre-Soak 10:40
End Pre-Soak 10:55
Time at 12" 10:56
Time at 9" 11:00 -------
Time at 6" 11:04_------ --—------------------------------------
Time (9"-6") 4/3 =1.3
Rate(Min./inch) faster than 2
Test Passed: z Test Passed: z
Test Failed: ❑ Test Failed: El
Doug Smith
Test Performed By:
Issac Rowe
Board 6f_Health_Wit�ess-------
Comments:
t5form12.doc-08/15 Perc Test-Page 1 of 1
Residential Property Record Card
Parcel ID: 210/106.A-0003-0000.0 MAP: 106.A BLOCK: 0003 LOT: 0000.0 Parcel Address: 257 BOXFORD STREET FY: 2017
PARCEL INFORMATION Use-Code: 101 Sale Price: I Book: 14042 Road Type: T Inspect Date: 0612112011
Owner: Tax Class: T Sale Date: 11/17/2014 Page: 0330 Rd Condition: P Meas Date: 0612112011
HOLLAND,SHARON,L. Tot Fin Area: 1836 Sale Type: P Cert/Doc: Traffic: M Entrance: C
Address: Tot Land Area: 2.170 Sale Valid: A Water: Collect Id: RRC
257 BOXFORD STREET Sewer: Grantor: HOLLAND Sewer: Inspect Reas: C
NORTH ANDOVER MA 01845 Exempt-B/L% .010 Resid-B/L% 100/100 Comm-B/L% 010 Indust-B/L% 0/0 Open Sp-B/L% 010
RESIDENCE INFORMATION LAND INFORMATION
Style: CL Tot Rooms: 7 Main Fn Area: 900 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: 111
I Story Height: 2.00 Bedrooms: 4 Up Fn Area: 936 Bsmt Area: goo Sag Type Code Method Sq-Ft Acres lnflu-Y/N Value Class
Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1.000 N 206,910
Ext Wall: FB Half Baths: I Unfln Area: Bsmt Grade: 2 R 101 A 1.170 N 8,892
Masonry Trim: Ext Bath Fix: Tot Fin Area: Foundation: CN DETACHED STRUCTURE INFORMATION
Bath Qual: M RCNLD: 204493 Kitch QuaL M Eff Yr Built: 1984 Str Unit Msr-1 Msr-2 E-YR-Bft Grade Cond %Good PIREIR Cost Class
Mkt Adj: Heat Type: HW Ext Kitch: Year Built: 1991 SE S 96 2002 A A ///92 1,600 1
Sound Value: Fuel Type: 0 Grade: AG Cost Bldg: 204,500 VALUATION INFORMATION
Fireplace: i Bsmt Gar Cap: 2 Condition: A Att Str Vall: Current Total: 421,900 Bldg: 206,100 Land: 215,800 MktLnd: 215,800
Central AC: Y Bsmt Gar SF: Pet Complete: 100 Aft Str Val2: Prior Total: 400,600 Bldg: 188,700 Land: 211,900 MktLnd: 211,900
Att Gar SF: %Good P/F/E/R: /1180
Porch Type Porch Area Porch Grade Factor
W 360
Sketch Photo
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Major Road Valera Data g Comm:The data far this map was produced by Towna f
qgOR'P&g Uagey Planning Commission(PAUPC)using data Iunv#ded try the Town of
Roads 4 v aQ , North Andover.Additional data provided by dm Executive Often of
Easements �tirp'°a EmAronmanmi AffairsfhlassGIS.The information deplctod on this map is
parcels 4 for planning purposes only,it may not be adequate for legal boundary
—•- definition or regulatory interpret lion.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
a¢ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
•yA,dggopy4 THIS INFORMATION
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Property 1D 105.A-0003-0000.0
Location 257 BOXFORD STREET Natural Resource Protection Wetlands
Owner HOLLAND,SHARON,L.
NHESP Certified Vernal Pools /Shoreline
i N "Hydrologic Connection
Mean L
N( NHESP Potential vernal Pools Limit-"'Wetland
Water Line
LLimit
Town of North F !c ,,'Closure Line
warranties, e
accuracy of the NHESP Priority Habitats of Rare '. Reservoir(with PWSID)
Species W�6, Marsh/Bog
Wooded Marsh
NHESP Estimated Habitats of Cranberry Bog
Rare V,11diif'e Salt Marsh
Tidal Flats
1
Beach/Dune
Areas of Critical Environmental
Concern Massachusetts DER
IN
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6 a.
« Town o�`Nort Andover�� ;.
`�;„•�,�a: 41HEALTH DEPARTMENT
04
CHECK. 4: .__. __�” DATE
a
H/O NAME: � a
CO�7TRAC
'TOR , A ME
g
r
Type of Perk or License: (Check box)
❑ Animal $ �
❑ Body Art Establishment $ �
❑ Body Art Practitioner $
❑ Durrepster $
❑ Food SerTice-
❑ Funeral Directors $�
❑ Massage Establishment $
❑ Massage Practice $
l
❑ Offal(Septic) Hauler $
❑ Recreational Camp $,._..,,
❑ Sun tanning $
❑ Swimming Pool $
❑ Tobacco $
❑ Trash,/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems. {
❑ Septic--Soil Testing $
® Septic-Design Approval $
I
❑ Septic Disposal Works Construction(DWQ $
❑ Septic Disposal'Works Installers(DW) $
❑ Title 5nspector $
�(
❑ Title 5 Report $
3
i
i
❑ Other.(medicate)._,_,._,,, $
� HeallhAgit,Initials
White-Applicant Yellow--.,Health Pink.-Treasurer j
t