Loading...
HomeMy WebLinkAboutSoil Testing Results - 130 WINDKIST FARM ROAD 6/20/2018 TOWN OF NORTH ANDOVER Conaaatunity & Economic Development RECEIVED HEALTH (DEPARTMENT 120 Mahin Street NORTH ANDOVER, MASSACHUSETTS 01.845 NOW kf % 978.688.9540 Phone 978.6$8.9542—FAX 1 healtlidept@tiortliatidoveri-na.gov northatrdoverma.gov www.iiorthaiidovernia.gov APPLICATION FOR SOIL TESTS DATE: 5/5117 MAP&PARCEL: 109.0-0054 LOCATION OF SOIL TESTS: Lot 9 Windkist Farm Road OWNER: Robert Rivard Contact#: APPLICANT:Steven Knight Contact Y: ADDRESS: 334 Maple Street Danvers, MA 01923 ENGINEER: Christiansen & Sergi, Inc. Contact il: 978 373 0310 CERTIFIED SOIL EVALUATOR: Phil Christiansen, SE 378 Intended Use of Land: Residential Subdivision Single FamilyLomo Commercial Is This: Repair Testing: Undeveloped Lot Testing:Y Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of laird ownership(Tax hill,or letter frorn owner permitting test) t> 8.5'x ll"Plot plana&Locations of Testing(please ia(licate test pit sates on the plant) Fee of$585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of. 4$...40..00 per lot for repairs or upgrades. GENERAL INFORMATION Y 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. Conservations ConnnIssionn Approval Date. _ Signnattire of Conservation Agent: Date hack to Health Department: (stamp In): 'Town of North Andover, MA May 8, 2017 109.0-0058 1 109,0-0035 109.0-0057 r'1<2 } rS.. 109.0-0056 109.0.0055 APPROX. FEST LOCATION 09,0-0054 r" d� e� 1� V k 109.0-0034 l f " —1 158,ft i Ll moi.! Property information Property 1.09.0-0051-0000.0 ID Location 0 WINDKIST FARM ROAD Owner RNARD, ROBERT MAP FOR REFERENCE ONLY j 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. i � k 0. 'AORY J ' U .. Cjy O m ' i Town of North Andover «n ;a HEALTH DEPARTMENT CHECK #: _ u, DATE: L.00ATIC7N Hf C)NAME: ,,-_.A -�c1 CCJNTRACTO NAME: A �� � a TypeofPermit or License: (Check box) ® Animal © Rory Art Establishment $ 0 Body Art Practitioner $ �_ ® Dumpster • Food Service T"ype: $ • Funeral Directors $ © Massage Establishment © Massage Practice $� • Offal(Septic)hauler • Recreational Camp ® Sun tanning $_ L SzvinaningPool ® Tobacco • Trash/Solid Waste.Hauler $ • Well Construction SEPTIC It,gtems: Septic-Soil Testing $ 0 Septic-Design Approval $ 0 Septic Disposal Warks Construction(DWC) $ 0 Septic Disposal Works Installers(DWI) $ _ 0 Title 5 Inspector © Title 5 Report $ 1 ® Other.(Indicate) $ H lth'Agent Initials White-applicant Yellow-health Pink-Treasurer � ri � l illi i i � ; l � t � f 11ll, li � rril + lll � l , ir { , II Commonwealth of Massachusetts City/Town of 15 -Site Sewage Disposal Soil Suitability Assessment for On Form I I A. Facility Information A R' Owner Name Street Address MapiLot# city State Zip Code B. Site Information 1. (Check one) ❑ New Construction Fj Upgrade F-1 Repair 2. Soil Survey Available? ff—yes D No If yes-- !Nr R C_ Source Soil Map Unit P,4x :71'�N Soil Name Soil LimitaRtions � Geologic/Parent Material Landform, -77 LL 3. Surficial Geological Report Available? Yes ❑ No If yes: _a<'17 Year Published/Source Publication Scale Map Unit 4. Flood Rate Insurance Map f Above the 500-year flood boundary? Yes El No Within the 100-year flood boundary? E] Yes No If Yes,continue to#5- 5. Within a velocity zone? ❑ Yes ❑ No MassGIS Wetland Data Layer: 6. Within a Mapped Wetland Area? El Yes No Wetland Type 7. Current Water Resource Conditions (USGS): -7 Range: F-1 Above Normal TNormal E] Below Normal Month/Year 8. Other references reviewed: t5form 11 doc-rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 1 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. Ort-Site Review (minimum of two holes required/at every proposed primary and reserve disposal area) Deep Observation Hole Number: 7"i C,/ " :let -7 `C0 �u P'r NJ's Date Time Weather 1. Location Ground Elevation at Surface of Hole: Latitude/Longitude: / feet Description of Location: A I o oi�-I' cr 4 2_ Land Use �f rte'- { ( � (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) Vege ation Lam, Landform Position on Landscape(Su,SH,BS,FS,TS) 3. Distances from: Open Water Body Drainage Way Wetlands feet feet feet Property Line 0 Drinking Water Well Other feet feet feet-, 4. Parent Material: .- nQS-3 Y► 1ot)s.rA Cz.�-; x?L;r Unsuitable Materials Present: ❑ Yes V No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: VYes ❑ No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: t - inches elevation t5forml 1 Am•rev.8/15 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 8 Commonwealth of Massachusetts City/Town of Farm 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: -- Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- Soil Texture %by Volume Soil Depth{in.} Layer Moist{Munsell} {USDA} Cobbles Soil Structure Consistence Other Depth Color Percent Gravel (Moist) 8.Stones ' YON F S Additional Notes: t5forml l.doc•rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 3 of 8 Commonwealth of Massachusetts City/Town of {i Form 11 - Soil Suitability Assessment for ©n-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole# t7 —/ Obs. Hole# ❑ Depth observed standing water in observation hole inches inches Depth weeping from side of observation hole � I inches inches Depth to soil redoximorphic features (mottles) L-1 inches inches ❑ Depth to adjusted seasonal high groundwater(Sh) (USES methodology) inches inches Index well Number Reading Date Sh= SC s[Sr X(OW,—OWrnax)IOWrl Obs. Hole# Sr Sr OWC OWM. 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 t5forml 1.doc-rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 6 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Board of Health Witness -T5PDC RC�i= i ck-TH �NVt PN t)C 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. .A 3 Al - Si ture of Soil Evaluator Date t. Typed or Printed Name of Soil Evaluator/License# Expiratiorf 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. t5forml 1.doc-rev.8,15 Form 11—Soil Suitability Assessment for do-Site Sewage Disposal -Page 7 of 8 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: t5form1 l.doc•rev.8115 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 OF HEALTH H ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS -51 tAT'E: MAP&PARCEL; loci.._ LOCATION OF SOIL TESTS: /d - j OWNER: �l LQ_4�7 _ TEL.N ! ADDRFSS:_JL. !t!ENGINEER:-T, I �/NI�"k TEL. NO.: CERTIFIED SOIL EVALUATOR: Intended use of land; Residential Subdivision �Singl'Family Horne'` Commercial Is This: G' Repair testing __ Undeveloped lot testing NO In the Lake Cochichewick Watershed'? Yes — -- THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1 . Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2, Plot pllan . Fee o 425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for cacti disposal area. Fee of 5200.00 per lot for repairs or upgrades. GENERAL INFOItMATION 1 . Only Certified Soil Evaluators may perform deep hole inspections. 2, Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least ane percolation test, at the discretion of the BOI1 representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than I -100')shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing; soil evaluation forms shall be submitted. Please Da Not Write B aw This Line N.A. Conservation Cam issian Approval: Date Received:''-1 Chock Amaunl: � _ .heck Date: _ Ax2c�, F . , Sk �.. ( -- `.. --- -- 3 F s —lc�4' s �a 1 ----- — 3