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Home My WebLink AboutSeptic Plan Submittal Form - 6.1.2016 - lot 1 - Miscellaneous - 500 BOXFORD STREET 1/30/2020 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; SUITE 2035 NORTH ANDOVER, MASSAMUSETTS 01845 978.688.9540— Phone 978.688.8476—FAX E-MAIL: healthdeptCnorthandovenna.-ov WEBSrm: htW://www.northandovenna.gov SEPTIC PLAN SUBMITTAL FORM Date of Submission: bil 11(a Site Location: Engineer: �il,� •C1 ECG �� New Plans? Yes ✓$275/Plan Check#(includes IS` submission "WED review only) JUN 0 1 2016 �I Revised Plans?Yes $125/Plan Check# TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Site Evaluation Forms Included? Yes �� No Local Upgrade Form Included? Yes No 1,1114 ,t31«, 'g- .^c lf-pz Telephone #: 9' 7 d- b B 7 -3 g 2�? Fax #: E-mail: !I AZ/ 2PA J, W e7- Homeowner / A Name: OFFICE USE ONLY When the submission is complete (including check): > Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File; Forward to Consultant > Enter on Log Sheet and Database Commonwealth of Massachusetts City/Town of North Andover Percolation Test -- Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposat 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: goutfor When A. Site Information riling out frrrs on the computes. Michael Donovan Thomas&Catherine Donovan use only the tab — ---- key to move your Owner Name cursor-do not 500 Boxford Street-Map 105C Lots 41 &42 s L/ Lo 7— use the return ----— key, Street Address or Lot 0 North Andover MA 01846 I�Sf C4'rrown --- --- State Zip Code Contact Person(if diffeteM from Owner) Telephone Number B. Test Results 12/2/15 11:00 a.m. 12015 11:00 a.m. Date Time Date Time Observation Hole# Perc 1 Perc 2 Depth of Perc 58" 52" Start Pre-Soak 11:19 _ 11:21 ___— End Pre-Soak 11:34 11:36 Time at 12` 11:34 _ 11:36 Time at 9" 11:36 11:38_ Time at T 11:40 — _--- 11:41 4 Mins 3 Mins Time(9 -6 Rate(Min./Inch) <2 Min./inch <2 Min./Inch Test Passed: Test Passed: (� Test Failed: ❑ Test Failed-. ❑ Steve Eriksen Test Performed By: Issac Rowe-North Andover Board of Health Board of Health Witneu Comments: t5form12.doc-08/15 Perc Test-Page 1 of t _ Commonwealth of Massachusetla Cityrrown of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Michael Donovan, Thomas&Catherine Donovan Owner Name 500 Boxford Street Map 105C Lots 41 &42 Saeet address Map/Lot North Andover MA 01845 city State - — Zip Gads B. Site Information 1. (Check one) ® New Construction ❑ Upgrade ❑ Repair 2. Soil Survey Available? ® Yes ❑ No If yes: Web Sal Survey 253E SoarOa 604 fop Unit Hinckley Loamy Sand Slope&Droughtiness Soil Name Soil Lamrtatiom Glacial OuNvash Outwash Plain Cw9logicRillent M-Wial Landform 3. Surficial Geological Report Available? ❑ Yes ® No If yes: Yedr PuplishCdlSourra Pwa4capon Seaib Map Unit 4, Flood Rate Insurance Map Above the 500-year flood 0our4ary? ® Yes ❑ No Within the 100-year flood bcuu4ary? [] Yes No If Yes,continue to ir&. 5. Within a velocity zone? ❑ Yes ® No 6. Within a Mapped Wet ❑ MassGIS Wetland Data Wetland Area? Yes ® No Layer 7. Current Water Resource Conditions(USGS): 12/15 Range: ❑ Above Normal ❑ Normal ® Bslow Normal htoNtYYear 8. Other references reviewed: t5fcrml 1 test 1 and 2-rev.all Form 11—SW Suitability Assescmant for oo-Site Sewape Qicp W •Pagv t or a Commonwealth of Massachusetts 7` City/Town of North Andover Ilk 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: DH-1 12 2/1-5______,__. 11:00 a.m. _Rain Date Time -- WwAhor 1. Location Ground Elevation at Surface of Hole: See Plan Latituder'Longitude: 42 40 04N 1 71 03.0.68W feet Description of Location: Existing single family lot -shown on the plan as Lot 1 Test 1 2. Land Use Cleared backyard area None 0-3%_ (e.g.,woodland,agrlGUlWral field,vacant tot„etc.) Surface Stones(e.g.,cobbles,,.tone#,bQukltus,etc,) Grass, rubes and muitiflora rose Outwash plain Toesbpe vegetation Landform Positian on LaN,.capa(SU,SH,SS,FS,TS) 3. Distances from: Open Water Body >50 ft Drainage Way >50 ft. Wetlands >50 ft feet feat tit _ Property Line >10 ft Drinking Water Well >100 ft. Other feet feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present_. ❑ Yes Z No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ WeathereWFractured RocJt ❑ Bedrock 5. Groundwater Observed: Yes ❑ No If yes: 76' 75" Estimated Depth to High Groundwater. 60" Depth Weeping from Pit Depth Staftrig Water in Hole inches elevation ---- t5tormi 1 test 1 and 2•rev,di15 Form 11—Sal Suital)ky Assessrnent for An-Site Sewa9e Dispoeal •Pa-cm 2 of 8 Commonwealth of Massachusetts Cityrrown of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site review (continued) Deep 04:5eryation Hale Number: OH-1 Redoximorphic Featured Coarse Frawrants Depth(in.) Soil Morixory Soil mautx:Color- Soil Texture %by V'�e soil t.ayer Moist(Munsoll) (,USDA) CobblesSoil structure Condisternce 0UW Depth Color Parcent Gravel &Stan" 1 tI 0-10" Ap 10 yr2/2 FSL Granular Friable 10-16, 8W 10 yr 4/4 FSL Weak Blocky Friable 18-fie" C1 2,5y 5/4 60' 7.5yr file 10% Mad-Coarse 400,6 Single Grain Loose 66-80" C2 2.5y 314 7.5 yr 2/2 15% LUG 301k 15% Massive Firm i i Additional Notes. t5fom,t 1 test 1 and 2 rev.8115 Form 11-Soil$►ulagili►yy A*se$sment for on Sits s4wage assposal •Page 3 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep observation Hole Number: DH-2 112115 11:00 a.m. Rain Date Time weather 1. Location Ground Elevation at Surface of Hole: See Plan Latitude/Longitude: 42'40'04"N / 71'02'0.68%W feet 2. Land Use Cleared backyard area None 0-3% (e.g.,woodland,agricuitutal field,vacant lot,etc.) Surface Stones(e.g.,wbbiea,stones,boulders,etc.) Slope(96) Grass, rubus and multiflora rose Outwash plain Toeslope vegetation Landform Pos"n on Lar4sgapo($lf,$N.BS,FS, _ 3. Distances from: Open Water Body >50 ft. Drainage Way > 50 ft. Wetlands. >50 ft feet feet foot Property Line > loft. Drinking Water Well > 100 ft. Other feet tact feet 4. Parent Material. Glacial Outwash Unsuitable Materials Present: ❑ Yes ® No If Yrss: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layers) ❑ WeatheredlFracturad Rock ❑ Bedrock 5. Groundwater Observed, ® Yes ❑ No If yes: 74" _ 74" Depth Weeping from Pit Depth Standing 1 V4W in hole Estimated Depth to High.Groundwater: 54" inches — elevation t5form1l test 1 and 2 rev.8115 Form 11-Soil Suitability Assessment for On-Site Sewage Disppyat •Pago 4 of 8 .:` Commonwealth of Massachusetts Ckyfrown of North Andover _ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (c¢nlnued) Deep Observation Hale Number. DH-2 Redcaimorphic Features coarse Fragments Depth(tn.) Soil Horizoo Soil Matrix:Color- Soil Texture %pll Volume Soil layer Moist{Muruell} (USDA) _ .Soil Structure Coosistenca other Depth Color ercent Gravel Stgneslam) __. 0-9" Ap 10 yr 2t2 FSL Granular Friable 9-20" Bw 10 yr 4/4 FSL j Weak Blocky Friable 20-88" C 1 2.5y 5/4 54" 7.5yr 6/6 15% CS&G 30°,b 15% Single grain Loose Additional Notes: t5form t 1 test 1 and 2•rev.8l15 Form 11—Soil Suitapility Assessment fqr On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts Cityffown of North Andover owr", Form 11 - Saul Suitability Assessment for On-Site Sewage Disposal D. Determination of Heigh Groundwater Elevation 1. Method Used; Obs. Hole*DH-1 Obs. Hole DH-2 ® Depth observed standing water in observation hole 75' 74" inches inches Depth weeping from side of observation hole 75" 74" inct= In J*4 T ® Depth to soil redoximorphic features (mottles) 60• 54" -- inches ❑ Depth to adjusted seasonal high groundwater(Si) (USGS methodology) inches — ink -- Index Wali Number Reading Date Sh=Sc—(Sr X(OWc—Owmax)/OWrI Obs. Hole# SC Sr QWc 4WD OWE Sh Obs. Hole# So Sr OWC OWE 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? E Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: 20" Lower boundary: aWl inehos ino ws c. If no,at what depth was impervious material observed? Upper boundary: 4 Lower boundary: inc hos inches t5forml1 test 1 and 2-rev-6115 Fam 11—Soil SuitabdityAceaccmont for pn_Siw, -sawage o4oWi •Page 6 of S Commonwealth of Massachusetts kCity/Town of North Andover a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal "'4wp ` F. Board of Health Witness Issac Rowe North Andover Name of Board of Health Witness Board of Heam 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, experfi§e and experience described in 310 CMR 15.017. I 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. .y s' i~ L 12/8115 Signature of Sod Eval.ualor gate Steven Enksen 6/30/16_ Typed or Printed Name of Soil Evaluator/License# Expiration Dace of License Note: In accordance with 310 CMR 15-018(2)this form myst be submitted to the approving authority within 60 days of the date of field testing,and to the designer and the property owner with Percoistion Tt t tbform 11 test 1 and 2•rev:8/15 Form 11—Soil Suitability Assessment for On-site SQwage Disposal •Page 7 of 8 '�. Commonwealth of Massachusetts u« City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: t5forml t test 1 and 2 rev.W15 Form 11—Soil$u4oil4 Assessment for On- ►4eSawaee pisposal Plea of 8 Commonwealth of Massachusetts T ` City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Michael Donovan, Thomas&Catherine Donovan Owner Name 500 Boxford Street __ Map 1= Lots 41 &42 Street Address Map/Lot 0 '- 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 Soil Survey 253E Source Soil Map Unit Hinckley Loamy Sand _ Slope&Droughtiness Sal Name Soil Limitations Glacial Outwash Outwash Plain GeologiclParent Material - -- Landform 3. Surficial Geological Report Available? ❑ Yes No If yes: Rear Pu6liihodlSource Publication ScaMi M.p 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 Qj No 6. Within a Mapped Wetland Area? ❑ MassGIS Wetland Data Layer: Yes ® No ----- ------ wetland Type 7. Current Water Resource Conditions(USGS): 12/15 Range: ❑ Above Normal ❑ Normal 0 Below Normal Month/Year 8. Other references reviewed: t5iorm 11 test 5 and 6•rev.11115 Form 11 -Soi Suitability A4soornant for On-Site Sewage Disposal -Page 1 of a Commonwealth of Massachusetts C4/Town of North Andover w 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: DH-5 12015 11:00 a.m. Rain Date Time Weather 1. Location Ground Elevation at Surface of Hole: See Plan _ Latitude/Longitude: 42 40 04N / 7103 0.68W feat Description of Location: Existing single family lot-deep hole performed between Test 1 and Test 2 2_ Land Use Cleared backyard area None% 0-3% (e_g.,w000land,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cabbies,stones,boulders,etc) slope(%) Grass, rubus and multifiora rose Outwash plain Toeslopa Vegetation Landforrn Posibon on Lardwape(SU,SH,BS.FS,TS) 3. Distances from: Open Water Body >50 ft. Drainage Way >50 ft. Wetlands > 50 ft ft3et toot teed Property Line > 10 ft Drinking Water Well > 100 ft. Other feet feet feet 4. Parent Material: Glacial Outwash i_ Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ VNeathweWFractured mock ❑ Bedrock 5. Groundwater Observed: Yes ❑ No If yes: 80" 801, Estimated Depth to High Groundwater: 54" Depth Weeping from Pit Depth Standing Water in Hole incnes elevation t5fonnl i test 5 and 6-rev.W15 Forth 11—Scil Suitability Assessment for On-Stile Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts .• = City/Town of North Andover Form I I - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number. DH-5 Redoximorphir Features Coarse F'agfi1ents Soil horizory Soil Matrix:Color- Soil Texture %by Voluttw Soil Depth(in.) Layer Moist(1lunseli) U$DAI UdStructure Consistence ottrer Depth Color Percent Gravel Cobbles (Moot) _ 4 Stories 0-8" Ap 10 yr 2/2 FSL Granular Friable 8-18" Bw 10 yr 4/4 FSL Weak Blocky Friable 18-87" C1 2.5y 514 54" 7.5yr 6/6 10% m-C s&g 40% Single grain Loose 87-90" C2 2.5 y 314 7.5 yr 2/2 15% L$ ,&G 30% � 150� Massive Firm -- Additional Notes: t5form1l test 5 and 6•rev.8115 Form 11:-Soil Suitaoility Assessment for Ori-Site Sewage Diapesel •Page 3 of 6 L Commonwealth of Massachusetts _ City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site $OWage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole#DH-5 00s. Hole#DH-6 ❑ Depth observed standing water in observation hole inches �� ® Depth weeping from side of observation hole 801, inches inches (g Depth to soil redoximorphic features (mottles) 54" 90.!1 inches inchvc _ El Depth to adjusted seasonal high groundwater(St,) (USES methodology) inches inches Index Well Number Reading Date Sh= Sc—(Sr X(OWc—OWrrai yowr] Obs. Hole# Sc Sr owe OWM" OK Sn Obs. Hole# Sc Sr owl own= Owr Sn 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 bouncary: 18" Lower boundary: 105"_ c. If no,at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5form11 test 5 and 6•rev.8115 Form 11—Soil Suit, 14 Assessment for On-Site Sewage Disposal •Pare 6 of a Commonwealth of Massachusetts City[Fown of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Board of Health Witness Issac Rowe _ North Andover Board of Health Name of board of Hoalth 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 hat;been performed by me consistent with the rtrquired kraining,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 accor ance.with 310 CMR 15.100 through 15.107. Signature of Sat Evaluator Date Steven Enksen 6/30i16 _ Typed or Printed Flame of Sol Evaluator/License it Expiration Date of Liken" Note: In accordance with 310 CMR 15.018(2)this form must be submitted fa the approving authority within 60 days cif the date of field testing,and to the designer and the property owner with Per;elgtjcg Jed F,rtr -,12, t5form1 l test 3 and 4•rev.8/15 Form 11 Soil Suimpility Assessment for On-$tta$awage Disposal •Page 7 of 8