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HomeMy WebLinkAboutApplication and Results - Soil Testing Results - 27 BRADFORD STREET 8/13/2019 Town of North Andover, Massachusetts Form No. 1 pORTH BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION �9SSACHU �S Applicant �Er� T' �l y � 17 NAME ADDRESS TELEPHONE Site Location r76raJ-�u rj S4 nglcEnd�'ilyj4eeriny /� �j Engineer. �'ery�e� s, tv1.e . l��0 &e ,q�i(,� coc[Dri V'a 97?-&?6-17 NAME ADDRESS VV-r TELEPHONE Test/Inspection Date and Time t CHAIRMAN,BOARD OF HEALTH Fee 4� d, Test No. 1Lc� S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 ,� — - APPLICATION FOR SOIL TESTS 2 2001 DATE: t MAP & PARCEL: U LOCATION OF SOIL TESTS: 2 R rs�, s re v t OWNER: TEL. NO.: _r- ADDRESS: �z 7 a40�4-0 �TaC-6 .V r.rH F�,�:�► ^,2 ENGINEER: W C, TEL. NO.: ! W, 7 CERTIFIED SOIL EVALUATOR: �r.. Fisc.c:oo , Ric►-cd41-0 C Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: ( Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No ?F THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 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 one percolation test, at the discretion of the BOH 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 1"-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 Do Not Write Below This Line N.A. Conservation Commission Approval: Rfl�" r:►''� Date Received: Check Amount: �?G'G�, Check Date: /o a I � I—C vey) FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. 1.?-4 2- Date: Commonwealth of Massachusetts Massachusetts Soil SuitabilioL Assessment for On-site Sewage Disposal Performed By: �_ __ _ _ _ /����� Date: 1/ m Witnessed By: ... o, .Y � Lm400n Addrus or Address,and /u Telephone/ 3 39 New Construction ❑ Repair ® N/ _Office Review Published Soil Survey Available: No ❑ Yes Year Published �9��.. .-- -- Publication Scale l R�Jri -P�J. Soil Map Unit err C Drainage Class Soil Limitations Surficial Geologic Report Available: No ® Yes ❑ Year Published I I I Publication Scale Geologic Material (?Flap Unit) ... ._._.......__...........___... . _.... _ Landform ......................... .. ..............I_.................. _ Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes 91 Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) - Current Water Resource Conditions (USGS): Month Range :Above Normal El Normal ❑13elc,-/ Normal Other References Reviewed: — ki DEP APPROVED FO}LM- 12/07/95 FORM 11 - SOIL EVALUATOR F0101 Page 2 of 3 Location Address or Lot Ao. On-site Review Deep Hole Number Dater//��/�� Time: 9 �S Weather,��—-! 57 Location (ides if on site plan) - Land Use SiZ�6��7.9� Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: d Open Water Body ��m feet Drainage way feet Possible Wet Area 7�OQ feet Property Line 3� feet Drinking Water Well ��� feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, :--':��IMMUM OF 2 HOLES REQUIRED AT EVERTMPM��ISPOSAL AREA �.�-�Z � �� •.may 4 o��,m� Parent Material (geologic) dlze�E%��y�'�-� DepthtoBedrock: — Depth to Groundwater: Standing Water in the Hole: — Weeping from Pit Face: — t0' i/ Estimated Seasonal High Ground Water: _- -- -- -- DEP APPROVED FORM- 12/07/95 FORUM 11 SOIL EVALUATOP, FOpNI Page ? of 3 Location Address or Lot i�o. - On-site Review 0 Deep Hole Number Date: /� F/_1 Time: Weather��� Location (identify on site plan) Land Use Z2t;<147 Slope (%) Surface Stones '— Vegetation Land for Position on landscape (sketch on the back) ��1 � ?��✓�� Distances from: Open Water Body�� feet Drainage way� feet Possible Wet Area :>/mom feet Property Line boa feet Drinking Water Well,, feet Other _ DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency. Gravel) Z�y YR MINIMUM O"-14OLES REQUIRED-A=ERY PROPOSED DISPOSAL AREA m,¢rts� �� Q� � ��5 r,?"2 �srvcr ��3i✓� ,���G� � 2 Parent Material (geologic) P,00< YeHC �'_" _ DepthtoBedrock: _ Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: /O y Estimated Seasonal High Ground Water: DU APPROVED FORM - 12/07/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. -7 COMMONWEALTH OF MASSACHUSETTS N o �'fNDOv�-/Z , Massachusetts I Percolation Test` Date: i>/� s ® � Time:, Observation Hnle # / Depth of Perc Start Pre-soak lv . oy End Pre-soak Time at 12" Time at 9" ) 0 Time at 6" Time (9"-6") Rate Min./Inch z . I iviinimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ❑ Site Failed ❑ ...................................................... __. Performed By: Witnessed By: ✓ L ^ A.10 a I—V Comments: DEP APPROVED FORM-12/07/95 FORM II - SOIL EVALUATOR FOR%I Page 2 of 3 -7o/05 Location Address or Lot vlo_ Z 7 13�t�9-OForep ST, i Ov Mtn o IJCn_- On-site Review _ Deep Hole Number _ Date: �'. .. �' Time: /O 0�i"l Weather G`� - 3� Location (identify on site plan) f Land Use Slope M 7 Surface Stones Vegetation o�r-QQI Landform p Position on landscape (sketch on the back) 1 Distances from: P-01 Open Water Body feet Drainage way feet A1Z 51v- Possible Wet Area feet Property Line feet Drinking Water Well feet Other "t env i Rl 5 C DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Sol Texture Sol Color Soil Other Surface(Inches) 4USDA) (Munsell) Mottling fStructure,Stones,Boulders,Consistency, % Graven /61 5 S 1 v c/ryz,rol 74 I5 -7 i Z.1Y / 75YX �r�rr` c• AVG Z l© d . �� vf. j 5�''S/� GCS - 7` PGA sue" D�L�-7�a L�1 Y t.-at i Parent Material(geologic) papthtoga&oa: Depth to Groundwater; Standing Water in the Hole: Weeping from Pit face: Estimated Seasonal High Ground Water: DEP APPRON'M FORM-IZM7195 I FORM 11 - SOIL EVALUATOR FOR.Nj I'age 2 of 3 7C/1 —7 Location Address or Lot I4o. Z- —7 Mc-,Wi /'vim ✓4 N Q O v On-site Review _ Deep Hole Number Date:_.' Time: Weather `>5 Location (identify on site plan) Land Use - Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG' Depth from Soil Horizon Sol Texture Sol Color Sod Other Surface(Inches) (USDA) (Munrelq Mottling (Structure.Stones.Boulders, Consistency, % Graven AWO - ZQ - 3 SF1c Z_(rf ✓���s 3 7 foy2 z/Z - yy/hs S�✓ 3 7 - y a �w D F S r0vo�,'t ` M Ir�v� 1f'!*�d �vc J ¢Q f,o O $7 G GO�YC S:~`4 l �sT�8V l=S ��Z- ea ��-mot. U Parent Material(geologic) 0vPd aBa�nrlc: Depth to Groundwater; Standing Water in the Hole: Weeping from Pit face: iV Estimated Seasonal High Ground Water: —3y O v'�''`r S G • 7- v 5 FORM 11 - SOIL EVALUATOR FOR'N1 Page 3 of 3 Location Address or Lot No. Determination ,for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole - inches ❑ Depth weeping from side of observation hole inches ❑ Depth to soil mottles ...._ ' inches ❑ Ground water adjustment .... .. ......... feetz Index Well Number . __. Reading Date ...... _ Index well level Adjustment factor . _ . _ Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in a1J areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) I have passed the soil evaluator examination approved by the p rtment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signa 24e��ateture �� DEP APPROVED FORM- 12/07/95