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Home My WebLink About- Soil Testing Results - 61 FOREST STREET 6/4/2020 A TOWN OF NORTH ANDOVER ' RECEIVED Community & Economic Development HEALTH DEPARTMENT DEC 14 2018 120 Mainn Street TOWN OF NORTH ANDOVERNORTH ANDOVER, MASSACHUSETTS 01845 HEp,LTH DEPARTMENT 978.688.9540—Phone 978.688.9542—FAX healthdept@northandoverma.gov www.northandoverma.gov APPLICATION FOR SOIL TESTS DATE: Dec. 13, 2018 MAP&PARCEL: Map 106A Parcel 168 LOCATION OF SOIL TESTS: Rear Yard -See attached plan OWNER: Scott Cooke Contact#: 781-710-6880 _ APPLICANT: Same as Owner Contact#: ADDRESS: 61 Forest Street _. ENGINEER: Jack Sullivan Contact#: 781-854-8644 CERTIFIED SOIL EVALUATOR: Jack Sullivan Intended Use of Land: Residential Subdivision Single Family 1 lome Commercial Is This: Repair Testing:X Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill, or letter from owner permitting test) ➢ 8 S"L 11"Plot plan&Location of Testinc(please indicate test pit sites oil the plan) ➢ 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$440.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ 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. Corrservatiorr Conrinissiorr A roval Date: i Signalrrre of Conservation Agent Dat back to Health Department. (s amp in): "J_ /1 �60 Town of North Andover, MA December 12, 2018 106.A 04fi5 106.A-0066 a 106.A-0064 fV .� N 106!�0114 � y \ 1 10113 nd f "f o, poi 106%A O 94 106.A-0069 „ eft. qa 106.A-0070 306 Ca'df Rd- 146®71 b� lo�� f 106.A-04168 i 106.A-0110 %IA-0006 1 10& 9 Wo lob-A-0116 106.A-01 352 lO6.A--001116 r g '06.A-0174" .-y 6.A-013 lO6.A-0-02 1"=183ft Go gle 1 Property Information Property ID 106.A-0168-0000.0 Location 61 FOREST STREET Owner COOKE,SCOTT P. MAP FOR REFERENCE ONLY 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. Geometry updated 10/31/2018 Data updated 10/31/2018 December 12, 2018 Scott Cooke 61 Forest Street North Andover,MA 01845 Re: 61 Forest Street, North Andover Permission for soil testing Health Department; I, Scott Cooke,owner of 61 Forest Street,will permit soil testing on my property for an uggraded septic system. Sincerely, Scott Cooke Of"OFT" V 5 L. O IO- p • . Town of North Andover HEALTH DEPARTMENT ,SSACNU5ft CHECK#: S/A DATE: LOCATION: �,- r'yt H/O NAME: -onl[ e CONTRACTOR NAME: �c�.c Sv /� ✓a./� Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: Septic-Soil Testing $ `%° r' ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ He &Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts RECEIVED City/Town of t,w 'i 2011. System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT DEP has provided this form for use-by Kcal 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 your local Board of Health to determine the form they use.The,System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/Right front of house a tg rear of hou , Left/right side of house, Left/ Right side of building, Left/Right front of bul dieft/R gh rear of buildm , Under deck g Address City/Town State Zip Code 2. System Owner. Name Address(if different from location) Cityffown State � � ` �Zip Telephone Number .B. Pumping JR ?cord V_C� r� ( �. 1. Date of Pumping bate 2. Quantity Pumped: Gallons "—I 1 3. Type-of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes D—Iqo--- If yes, was it cleaned? ❑ Yes ❑ Na 5. Condition of System: 6: System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locafi a contents were disposed: Lowell Waste Water Signitu re Haule Date t5form4.doc•06103 System Pumping Record•Page 9 of 1 Commonwealth of Massachusetts u City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal LAM DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information MAR 0 ��9 Scott Cooke Owner Name niri Z 61 Forest Street Map/Lot: Map 106A Lot 168 Street Address North Andover MA 01845 City(rown State Zip Code B. Site Information 1. (Check one) New Construction ❑ Upgrade ® Repair ❑ 2. Published Soil Survey available? Yes ® No ❑ If yes: NRCS Soil Map 421C Soil Map Unit Canton Fine Sandy Loam Soil Name Soil limitations 3. Surficial Geological Report available? Yes ❑ No ® If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ® No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ® Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 1 of 7 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 6. Current Water Resource Conditions (USGS) Range: Above Normal ❑ Normal ❑ Below Normal ❑ Month/Year 7. Other references reviewed: C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole Number: 1 1/4/2019 9:00 a.m. 40 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 98.3 Location (identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential property None 2-5 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grass Ground Moraine Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body >200_ Drainage Way >200 Possible Wet Area >150 feet feet feet Property Line 55 Drinking Water Well n/a Other feet feet 4. Parent Material: Coarse Loamy over Sandy Meltout Unsuitable Materials Present: Yes ® No❑ If Yes: Disturbed Soil❑ Fill Material® Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit__n/a Depth Standing Water in Hole_n/a Estimated Depth to High Groundwater: 116" (Mottling) Elevation: 89.4' DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal - Page 2 of 7 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Deep Observation Hole Number: 1 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Consistence Other Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones 0-48 FILL 48-52 A 10 YR 3/3 n/a FSL 52-60 Bw 10 YR 6/8 n/a LS 60-108 C 2.5 Y 6/8 106" SL Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal- Page 3 of 7 Commonwealth of Massachusetts �1 City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 'G M C. On-Site Review (Cont.) Deep Observation Hole Number: 2__ 1/4/2019 9:00 AM 40 degrees/clear Date Time Weather 1. Location Ground Elevation at Surface of Hole 89.9' Location (Identify on Plan ) See Sheet 7 of 7 2. Land Use: Residential none 1-3 (e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grassed_ Ground Moraine Vegetation Landform Position on landscape(attach sheet) 3. Distances from: Open Water Body > 200 Drainage Way >200 Possible Wet Area >150 feet feet feet Property Line 40 Drinking Water Well N/A Other feet feet 4. Parent Material: Coarse Loamy over Sandy Meltout Unsuitable Materials Present: Yes ❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑ 5. Groundwater Observed: Yes ❑ No If Yes: Depth Weeping from Pit n/a Depth Standing Water in Hole_n/a Estimated Depth to High Groundwater: 60" (Bottom Excavation) 84.9 inches elevation DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal r M Deep Observation Hole Number: 2 Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil Depth Horizon/ Color-Moist (mottles) Texture % by Volume Structure Consistence Other Layer (Munsell) (USDA) (Moist) (In') Depth Color Percent Gravel Cobbles &Stones 0-10 A 10 YR 3/3 n/a FSL 10-26 B 10 YR 6/8 n/a LS 26-60 C 2.5 Y 6/8 n/a SL Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 5 of 7 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. inches inches ElDepth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. 106 B. inches inches ElGroundwater adjustment(USGS methodology) A. B. inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level 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: _52 Lower boundary: _ 108 inches inches F. Certification I certify that I have passed soil evalu r examination*approved by the Department of Environmental Protection and that the above analysis was performed b m consi t with the required training, expertise and experience described in 310 CMR 15.017. 2-21-2019 Signature of Soil EvaluatfhD. Date Jo an tll, P.E._ October 1995 Typed or Printed Name o aluator 'Date of Soil Evaluator Exam Erin Kirchner Consultant for the Town of North Andover Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 6 of 7 Commonwealth of Massachusetts City/Town of North Andover For 11 _ Sail Rijitahility Assessment for On_Cito nlicnr%sal M 18" SNfO Ek 161, 14"� TH-2 Use this sheet 1s" 012" 12'• 6„ G"'�'2„ s 24„ PT-1 Q TH-1 20., 12" 3 EX. DECK �,..,✓ 1 N D CONC T N rn RI VEWA Y EX 2 r\ N Wp) STORY W20 cry STRU FRAME VW. 9 CT(/RE r, c BEDROOM HOUSE Assessment for On-Site Sewage Disposal- Page 7 of 7 Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 �M 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 filling out A. Site Information forms on the computer,use Scott Cooke only the tab key Owner Name to move your 61 Forest Street cursor-do not Street Address or Lot# use the return key. North Andover MA 01845 City/Town State Zip Code r� (Same as Owner) 781-710-6880 Contact Person(if different from Owner) Telephone Number B. Test Results 1/4/19 9:30 a.m. Date Time Date Time Observation Hole# PT-1 Depth of Perc 70"-88" Start Pre-Soak 9:31 End Pre-Soak 9:46 Time at 12" 9:46 Time at 9" 11:04 Time at 6" 12:38 Time (9"-6") 94 min Rate(Min./Inch) 32 MPI Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ John D. Sullivan III, P.E. Test Performed By: Erin Kirchner, Consultant for Town of North Andover BOH Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1 i of„ORT„,� 8565 f • P Town of North Andover ',,•-�,,,,p.: ,' HEALTH DEPARTMENT �SS�cHus°� CHECK#: .y/ DATE: LOCATION: Cb l A O i Q-5 1 4 H/O NAME: J c-c, t 4 Coo k-R- CONTRACTOR NAME: 7j-;�.C./C Sy��✓�-/� Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ Septic-Design Approval $ a� S - ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ Hea'fthAgent Initials White-Applicant Yellow-Health Pink- Treasurer