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Home My WebLink About- Miscellaneous - 521 SALEM STREET 2 10/22/2018 TOWN OF NORTH ANDOVVER , Community & Economic Development HEALTH DEPARTMENT 120 Main Street NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone 978.6W9542 FAX E-MAIL: Wt BSII'F_ht�Nwwcv.nor(hatidovei-iii ,.gcry SEPTIC. PLAN SUBMITTAL t FORM RECEIVED Date of Submission:July 11, 2018-- — ----- JUL 1 µ" ?01 8 It O OF " plq 0'VE Site Location:521 salem Street iGL 9NUfi0 "l Engineer;John M. Morin, PE, The Morin-Cameron Group, Inc. New Plans? Yes X $27.5/Plan Check #2298 _(includes I" submission and one re- review only) _. Revised Plans?Yes $125/Plan Check Site Evaluation norms Included? Yes X No Local IJpgradc Form Included? Yes No—.X__ Telephone #:978-777-8586 Fax#:978-774-3488 E-mail:John@morincameron.com Homeowner Name: Laura A. Deinlein (Unit 1) & Mark Stein (Unit 2) OFFICE USE ONLY When the subssion is complete (including check): _Date stamp plans and letter > Complete and attach.Receipt j ➢ Copy File; Forward to Consultant i I ➢ Enter on Log Sheet and Database Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Laura Deinlein (Unit 1) & Mark Stein (Unit 2) Owner Name — — --- — 521 & 521 R Salem Street Map 38, Block 8, Lots 521.1 & 521.2 Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ❑ Upgrade D� Repair 2. Soil Survey Available? ® Yes ❑ No If yes: NRCS 421 B Source Soil Map Unit Canton Fine Sandy Loam Depth to restrictive features Soil Name Soil Limitations Coarse-loamy over sandy melt-W till derived from gneiss,granite,and/or schist Morralne Sol Parent material Landform 3. Surficial Geological Report Available? ❑ Yes❑ No If yes: 20061 stone,stone,iaiciacomo-Cohen Thin_ Till Year PublishediSource Map llnit Nonsorted, nonstratified matrix of sand, some silt and little clay containing scattered gravel clast and few large boulders Description of Geologic Map Unit: 4. Flood Rate Insurance Map Within a regulatory floodway? ❑ Yes ® No 5. Within a velocity zone? ❑ Yes ® No MassGIS Wetland Data Layer: 6. Within a Mapped Wetland Area? ❑ Yes ® No if yes, Wetland Type 7. Current Water Resource Conditions (USGS): 5/18 Range: ❑ Above Normal ® Normal ❑ Below Normal Month/Day/Year 8. Other references reviewed: 3629 Form11(Soil Suitability).doc•rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 6 Commonwealth of Massachusetts City/Town of North Andover Farm 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: 18-1 5-18-18 561 'F, P. Cloudy Hole# Date Time Weather Latitude Longitude: Lawn Grass 0-5% 1. Land Use (e.g.,woodland,agricultural field,vacant lot,etc.) Vegetation Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope{ala} Description of Location: Rear yard off driveway 2. Soil Parent Material: Coarse-loamy over sandy melt-out till derived from gneiss,granite, Morralne SH and/or schist �.-_T Landform Position on Landscape(SU,SH, BS,FS.TS) 3. Distances from: Open Water Body >100 feet Drainage Way >10 feet Wetlands >100 feet Property Line >10 feet Drinking Water Well >100 feet Other feet 4. Unsuitable Materials Present: Z Yes ❑ No If Yes: ❑ Disturbed Sol ® Fill Material ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed:® Yes [] No If yes: 100" Depth Weeping from Pit 100" Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil l Depth(in) Soil Horizon Soil Texture Soil Matrix:Color- %by Volume Soil Structure Consistence Other /Layer (USDA Moist(Munsell) Depth Color Percent Gravel Cobbles (Moist) Stones 0-18 Fill 18-23 Ab SL 10YR 3/2 MASS FRI I 23-30 Bw LS i 10YR 5/8 5 MASS FRI 30-106 C1 GrLS 2.5Y 6/8 74 7.5YR 5/8 5Y 612 5 5 MASS FRI I I l Additional Notes: 3629 Forml 1(Soil Sukability).doc•rev.3/15118 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 6 Commonwealth of Massachusetts City/Town of North Andover Form 1 - 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: 18-2 5-18-18 560F, P. Cloudy Hole# Date Time Weather Latitude Lonqitude: Lawn Grass 0-5% 1. Land Use (e.g.,woodland,agricultural field,vacant lot,etc.) Vegetation Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope Description of Location: Rear yard off driveway 2. Soil Parent Material:. coarse-loamyover sandy melt-out fill derived from gneiss,granite, Morralne .SH and/or schist Landform Position on Landscape(SU,SH,13S,FS,TS) 3. Distances from: Open Water Body >100 feet Drainage Way >10 feet Wetlands >100 feet Property Line >10 feet Drinking Water Well >100 feet Other feet 4. Unsuitable Materials Present: ® Yes ❑ No If Yes: ❑ Disturbed Soil ® Fill Material ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed:® Yes ❑ No If yes: 100" Depth Weeping from Pit 100" Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil Depth(in} Soil Horizon Soil Texture Soil Matrix:Color- °lo b Volume Soil Structure Consistence Other /Layer (USDA Moist( unseli) Depth Color Percent Gravel Cobbles& (Moist) Stones 0-50" Fill — -- -- 50-58 Ab SL 10YR 3/2 MASS FRI I 58-66 Bw LS 10YR 5/8 5 MASS FRI 66-106 C1 GrLS 2.5Y 6/8 76 7.5YR 5/8 5 5 MASS FRI 5Y 6/2 Additional Notes: 3629 Form11(Soil Suitability).doc-rev.3/15118 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 6 _ Commonwealth of Massachusetts i v City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole#18-1 Obs. Hole#18-2 ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches ® Depth to soil redoximorphic features (mottles) 74 inches 76 inches ❑ Depth to adjusted seasonal high groundwater(Sh) inches inches (USGS methodology) Index Well Number Reading Date — ---� -- Sh = SC-[Sr x (OW1_-OWmax)/OWr] Obs. HoleNVell# Sc Sr OWc OWmax OWr Sh 2. Estimated Depth to High Groundwater: inches 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 (exclude A and O Upper boundary: 23,58_ Lower boundary: 106,106 Horizons)? inches inches c. If no, at what depth was impervious material observed? Upper boundary: ___ Lower boundary: inches inches 3629 Form11(Soil Sustability).doc•rev. 3115/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 6 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Sail Suitability Assessment for On-Site Sewage Disposal F. 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 15.10`7 Signature of Soil Evaluator Date Will Schkuta, SE#14030 11/1/19 Typed or Printed Name of Soil Evaluator/License# Expiration Date of License Issac Rowe BOH Representative Name of Approving Authority Witness Approving Authority 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. Field Diagrams: Use this area for field diagrams: 3629 Form11(Soil Suitability).doc•rev.3/15/18 Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 6 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal I �l .1sNr,24 s a? r � i N LOT A ASSESSOR'S MAP 38,BLOCK 8, LOTS 521.1 k 521.2 Y Z1. 4 Y 3629 Form11(Soil Suitability).doe•rev.3/15118 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 6 Commonwealth of Massachusetts City/Town of North Andover Percolation Test Farm 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 A. Site Information filling out farms on the Laura Deinlein Unit 1 & Mark Stein Unit 2 use onlyly the the tab ---.------ __.� .) f —_--- - ------- key — to move your Owner Name cursor-do not 521 & 521 R Salem Street use the return Street Address or Lot# _...._...r,,._.a.__.........__------.---.__-_.- __.._.._._......__.__ key. North Andover MA 01845 VQ 6tyfrown State Zip Code 978-590-8975 _.._._ ..A.....___ _. ._-- SO Contact Person(if different from Owner) Telephone Number B. Test Results 5-18-18 9:48 Date Time Date Time Observation Hale# 18-1 Depth of Perc 34+18 = 52 Start Pre-Soak 9:48 End Pre-Soak 10:03 Time at 12" 10:03 Time at 9" 10.08 Time at 6" 10:16 Time (9"'-6") 8 min Rate (Min./inch) 3 min/in Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: [� Will Schkuta, SE#14030 Test Performed By: Issac Rowe, BOH Representative Board of Health Witness Comments: t5form12.doc•08115 Perc Test•Page 1 of 1 ORTH 2 fyam. Town of North Andover HEALTH DEPARTMENT 2 CHECK#: DATE: LOCATION: '1�� H/O NAME: CONTRACTOR NAME: Ty pe of Permit or License- (Check box) 0 Animal • Body Art-Est-ablishinent • Body Art Practitioner 0 Dunipster 0 Food Service-Type:_--__.,.-_-- 13 Funeral Directors 13 Massage Establishment • Massage Practice • Offal(Septic)Haider • Recreational Camp • Sun tanning • Swimming Pool 0 Tobacco 0 Trash/Solid Waste Hauler 0 Well Construction SEPTIC Systems: 0 Septic-Soil Testing Septic-]Design Approval • Septic Disposal Works Construction(DWQ • Septic Disposal Works Installers(DWI) 0 Title 5 Inspector 1:1 Title 5 Report 0 Other:(Indicate)—.--- $ Hea tX A"g'ent Initialsi White-Applicant Xellow--Health Pink-Treasurer