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Home My WebLink About- Permits - 2051 SALEM STREET 2/8/2019 TOWN OF NORTH ANDOVER Community & Economic Development HEALTH :DEPARTMENT 120 Mama. Street NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540._.Phone � 978.688.9542—FAX E-MAIL:laealtlidept@noilhatidoverina.gov WEBSI E:W http://www.noi-tliatidovenna.ov SEPTIC PLAN SUBMITTAL FORM ', , ;` '; Date of Submission: — l c( Site Location: 0 ( Engineer: C J Y C Vm*l G 7 .� Rom. rL✓ New Plans? Yes Vl/—$275/Plan Check## (includes lst submission and one re- review only) Revised Plans?Yes $1.25/Plan Check Site Evaluation Farms Included? Yes No Local Upgrade Form.Included? Yes No Telephone##: '/ �_ 63�Fax#: ,AIM E-mail: C...) c.`;>v> e" Homeowner ,.- Name: elf - OFFICE USE ONLY When the s �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 | #10 Town of North Andover HEALTH DEPARTMENT CHECK CONTRACTOR NAME: Type of Permit or License: (Check box) 0 Animal • Body Art Establishment $ • Body Art Practitioner • Funeral Directors $- • Massage Establishment $ • Massage Practice $- • Offal(Septic)Hauler $ • Recreational Camp • Sun tanning • Swimming Pool 0 Tobacco 0 Trash/Solid Waste Hauler --------- / Well Construction $_______' Commonwealth Of Massachusetts R 'CMVE `- City/Town of North Andover Percolation Test lw l l t7�RaIgp� ,) Form 12 K, .0 i 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:WhenA. Site Information filling out forms on the computer, Ruth T Richards Revokable Trust use only the tab _..__......._ ....___ __.__.... .._.__.. .._.._ ____.__.,....._ key to move your Owner Name cursor-do not 2051 Salem Street use the return _.__..._ ..._-. key. Street Address or Lot# North Andover - _ MA 01845 rib CityrTown State Zip Code Cleon Richards 978-685-3872 Contact Person(if different from Owner) Telephone Number rsnrnB. Test Results 12-14-18 9:00 12-14-18 9:00 Date Time Date Time Observation Hole# PT#1 t TP#1 Depth of Perc 24/16 - 24/19 -- _...__.... Start Pre-Soak 8.59 _.......__ 9:02 End Pre-Soak 91_4 _..._.. _ 917..__....._ --- Timeat 12" 9:14 _..._._.....___ _ 9 1..�.......__ _.w..._.___..._ Time at 9" 9:19 _.._.. ---.. 9:15 Time at 6° 9:2 _.._.. .___ _...._.... __._..._ 10:28 .._ .._.._ Time (9"-6") 6 MIN 38 MIN Rate (Min./Inch) m ! 13 m�! .__.__._._..._ ............. Test Passed: ® Test Passed: Test Failed: ❑ Test Failed: BenJamin C. Osgood, Jr., SE ___ --- _..__. __ _.._......_ _..... ....... . __.. Test Performed By: Erin Kirchner, Town of North Andover BOH representative Board of Health Witness 1 Comments: i J t5form12.doc•08/15 Perc Test•Page 1 of 1 Commonwealth of Massachusetts - 0- City/Town of Town of North Andover E r - Soil SuitabilityAssessment iDisposal A. Facility Information Ruth T. Richards Revokable Trust Owner Name 2051 Salem Street 108.A - 0001 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: On Line 422D Source Soil Map Unit Canton none Soil Name Soil Limitations Ablation Till Drumlin slope Soil Parent material Landform 3. Surficial Geological Report Available? ❑ Yes® No If yes: Year Published/Source Map Unit Description of Geologic Map Unit: 4. Mood Rate Insurance Map Within a regulatory tloodway? ❑ Yes ® No 5. Within a velocity zone? ❑ Yes ® No 6. Within a Mapped Wetland Area? ❑ Yes ® No If yes, MassGIS Wetland Data Layer: pp Wetland Type 7. Current Water Resource Conditions(USGS): 12112018 Range: ® Above Normal ❑ Normal ❑ Below Normal Month/Day/Year 8. Other references reviewed: t5forml 1 2051 Salem street TP1 and 2•rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 5 Commonwealth of Massachusetts O' City/Town of Town of North Andover Fo r Soil Suitability Assessment for On-Site Sewage Disposal m I I C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area) Deep Observation Hole Number: TP 1 12114/18 9:00 sunny/cold Hole# Date Time Weather Latitude Lonqitude: woods trees some 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: 2. Soil Parent Material: Ablation Till Drumlin slope BS Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body >100 feet Drainage Way >100 feet Wetlands >100 feet Property Line 50 feet Drinking Water Well >100 feet Other feet 4. Unsuitable Materials Present: 0 Yes [] No If Yes: M Disturbed Soil [I Fill Material [-I Weathered/Fractured Rock F-1 Bedrock 5. Groundwater Observed:ED Yes ❑ No If yes: 64"Depth Weeping from Pit 64" Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil So il Horizon Soil Texture Soil Matrix:Color- %by olurne Depth(in) (Layer {USDA lunsell) Depth Color Percent Gravel Cobbles& Soil Structure Consistence Other Stones (Moist) 8 A SL I OYR 2/2 26 Bw SL 1 OYR 3/6 M F 96 C FS 2.5Y 5/6 42" 1 OYR 5/8 >15 M F Additional Notes: t5form1 1 2051 salern street TP1 and 2-rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal =Page 2 of 5 Commonwealth of Massachusetts -,P- City/Town of 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: TP2 12/14/18 9:00 SUNNY/COLD Hole# Date Time Weather Latitude Longitude: 1. Land Use: WOODS TREES SOME 5 (e.g.,woodland,agricultural field,vacant lot,etc.) Vegetation Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope Base of slope Description of Location: 2. Soil Parent Material: Ablation Till Drumlin BS Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body >100 feet Drainage Way >100 feet Wetlands >100 feet Property Line 90 feet Drinking Water Well >100 feet Other feet 4. Unsuitable Materials Present [:] Yes M No If Yes: El Disturbed Soil El Fill Material El Weathered/Fractured Rock Ej Bedrock 5. Groundwater Observed:Z Yes ❑ No If yes: 54"Depth Weeping from Pit 64"Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil Depth(in) Soil Horizon Soil Texture Soil Matrix: %by Volume _ Soil Structure Consistence Other /Layer (USDA) Color-Moist Cobbles& (Munsell) Depth Color Percent Gravel Stones (Moist) 8 A SL I OYR 2/2 1 i 24 Bw S L 1 OYR 416 l M F 74 C FS 2.5Y 5/6 42" 10YR5/8 >15 M F Additional Notes: t5forml 1 2051 salern street TPI and 2-rev.3115118 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 5 Commonwealth of Massachusetts 66 City/Town of Town of North Andover Form 11 - Soil SuitabilityAssessment On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole# Obs. Hole# ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches ❑ Depth to soil redoximorphic features (mottles) 42 inches 42 inches ❑ Depth to adjusted seasonal high groundwater(Sh) inches inches (USGS methodology) Index Well Number Reading Date Sh= Sc—[Sr x(OWc—OWmax)/OWr[ Obs. HoleAfVell# Sc Sr OWc OWmar OWr Sh 2. Estimated Depth to High Groundwater: inches E. Depth of Perviousaerial 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 0 Upper boundary: 8 Lower boundary: 96 Horizons)? inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5forml 1 2051 saiem street TP1 and 2•rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 5 ' . Commonwealth of Massachusetts C of Town of North Andover HRI N� � � Soil Suitability Assessment �'� �� _m�~�m� �� Disposal Form m m ~ `��0o `��=��m�� m�� ,��-�� `��&�� o�0��n F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CIVIR 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 CIVIR 15.017. | further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CIVIR 15.100 through 15.107. A "/-- It:, '2-— a| aurem Date Benjamin C. Osgood Jr., SE1818/ june 2019 Typed ur Printed Name uy Soil Evaluator/License# Expiration Date v*License Erin Kirchner North A d 8OHRepresentative Name orApproving Authority Witness Approving Authority Note: in accordance with 310 CIVIR 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 . ��~ *� Diagrams: diagrams: t5form112Os1oalem street TPI and 3^rev.38588 Form 11-Soil Suitability Assessment for On-Site Sewage Disposal ^Page 5of5 Commonwealth of Massachusetts a r. City/Town City/Town of Town of North Andover - Form 11 - Soil Suitability Assessment forOn-Site Sewage Disposal Tk A. Facility Information Ruth T. Richards Revokable Trust Owner Name 2051 Salem Street 108.A - 0001 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: On Line 422D Source Soil Map Unit Canton none Soil Name Soil Limitations Ablation Till Drumlin slope Soil Parent material Landform 3. Surfcial Geological Report Available? ❑ Yes® No If yes: Year Published/Source Map Unit Description of Geologic Map Unit: 4. Flood Rate Insurance Map Within a regulatory floodway? ❑ Yes ® No 5. Within a velocity zone? ❑ Yes ® No 6. Within a Mapped Wetland Area? ❑ Yes ® No If yes, MassGIS Wetland Data Layer. Wetland Type 7. Current Water Resource Conditions (USGS): 1212018 Range: ® Above Normal ❑ Normal ❑ Below Normal Month/Day/Year 8. Other references reviewed: t5form11 2051 salem street TP3 and 4•rev.3115118 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 1 of 5 - --- ----------- Commonwealth of Massachusetts City/Town of Town of North Andover or I I - 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: TP3 12/14118 10:00 sunny/cold — Hole# Date Time Weather Latitude Longitude: Woods trees some 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: 2. Soil Parent Material: Ablation Till Drumlin slope BS Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body >�M feet Drainage Way >1 00 feet Wetlands >100 feet Property Line 50 feet Drinking Water Well >1 00 feet Other feet 4. Unsuitable Materials Present: ❑ Yes E No If Yes: [] Disturbed Soil 1771 Fill Material El Weathered/Fractured Rock 0 Bedrock 5. Groundwater Observed:❑ Yes M No If yes: Depth Weeping from Pit Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil 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 12 A SL 1 OYR 2/2 30 Bw SL 10YR 416 M F 90 C LS 2.5Y 4/4 40" 1 OYR 5/8 >15 M i F Additional Notes: t5forml 12051 salem street TP3 and 4-rev.3115/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal =Page 2 of 5 Commonwealth of Massachusetts City/Town of Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site eyrie (minimum of two holes required at every proposed primary and reserve disposal area) Deep Observation Hole Number: TP4 12/14/13 10:00 SUNNY/COLD Hole# Date Time Weather Latitude Longitude: 1. Land Use: WOODS TREES SOME 2 (e.g.,woodland,agricultural field,vacant lot,etc.) Vegetation Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope Base of slope Description of Location: 2. Soil Parent Material: Ablation Till Drumlin BS Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body >100 feet Drainage Way >100 feet Wetlands >100 feet Property Line 90 feet Drinking Water Well >100 feet Other feet 4. Unsuitable Materials Present: F-1 Yes M No If Yes: El Disturbed Soil [:1 Fill Material El Weathered/Fractured Rock 0 Bedrock 5. Groundwater Observed:F-1 Yes M No If yes: _Depth Weeping from Pit Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil Depth(in) Soil Horizon Soil Texture Soil Matrix: %by Volume — Soil Structure Consistence Other ILayer (USDA) Color-Moist Cobbles& (Moist) (Mansell) Depth Color Percent Gravel Stones 8 A SL 1 OYR 2/2 28 Bw SL 1 OYR 4/6 M F 90 C FS 2.5Y 5/6 40" 1 OYR 5/8 >15 M F Additional Notes: t5forml 1 2051 salem street TP3 and 4-rev.3115118 Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal -Page 3 of 5 Commonwealth of Massachusetts CitylTown of 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# Obs. Hole# ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches ❑ Depth to soil redoximorphic features (mottles) 40 inches 40 inches ❑ Depth to adjusted seasonal high groundwater(Sh) inches inches (USGS methodology) Index Well Number Reading Date Sh= Sc—[Sr x(OWc—OWmax)/OWrl Obs. HoleNVell# Sc Sr Owe Owmax OWr Sh 2. Estimated Depth to High Groundwater: inches DepthE. a ioMaterial 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? E Yes ❑ No b. If yes, at what depth was it observed (exclude A and O Upper boundary: 8 Lower boundary: 90 Horizons)? inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5form1 12051 salem street TP3 and 4•rev.3/15118 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal ^Page 4 of 5 Commonwealth of Massachusetts 0 City/Town of Town of North Andover Form 11 - Soil 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 CIVIR 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 CIVIR 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 CIVIR 15.100 through 15.107. Si Lure of it Evaluator r Date Benjamin C. Osgood Jr.&1818 June 2019 Typed or Printed Name of Soil Evaluator/License# Expiration Date of License Erin Kirchner North Andover BOH Representative Name of Approving Authority witness Approving Authority Note: In accordance with 310 CIVIR 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-rcqlatior -Te:-t:-m 12. Field Diagrams: Use this area for field diagrams: t5forml 1 2051 salem street TP3 and 4-rev.3115118 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 5 of 5