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Home My WebLink AboutPermit,Testing & Results - Soil Testing Results - 288 STILES STREET 5/13/2019 5/1"'2019 Date: May 13, 2019 Soil Testing Permit #48314 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointdoud.com/#/records/49484 • '`n,.F�� COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER BOARD OF HEALTH I a benjamin Osgood 288 STILES STREET is hereby granted a Soil Testing Permit This permit is granted in conformity with the statutes and ordinances relating thereto. Soil Evaluator Contact Number. -1324 Owner Contact:Number#:978-290-65190f513 Engineer Contact Number:978-435-1324 Conditions: FRANC IS R MACMILLAN,JR.,M.D. BOARD OF HEALTH CHAIRMAN 1/2 5/9/2019 Soil Testing Permit 48314 Applicant L benjamin osgood k. 9784351324 @ bosgoodpe@gmail.com Location 288 STILES STREET NORTH ANDOVER, MA 01845 General Information Owner(if different from applicant) Owner Contact Number Gale Page 978-290-6513 Engineer Engineer Contact Number: Benjamin Osgood, Jr. 978-435-1324 Certified Soil Evaluator Soil Evaluator Contact Number: Benjamin Osgood, Jr 978-435-1324 Project Details Intended Use of Land Type of Testing: Single Family Home Repair Testing In the Lake Cochichewick watershed? Location of Soil Tests: No adjacent to goat pen Internal Conditions r r 1/1 If you have questions or require further information please do not hesitate to contact Ben Osgood Jr. at(978) 435-I324 Sincerely; Benjamin C. Osgood, Jr., P.E. This proposal is acceptable as written. I hereby grant Benjamin C. Osgood, Jr., permission to enter the aforementioned property for soil testing and related work in conjunction with creating a new septic system design. Gale Page. '� Date: 1 CLIENT INFORMATION 1. Property Owner/Billing Address: Name: &C i e TCt C Address: Telephone: (H) Q7��_�,�f� -�' �(V�7) Fax) Email: K2 f L7 Town of North Andover, MA May 5, 2019 288 Stiles Road Soil test Location 107.0-0042-0000.0 id107.13-0023-0000.0 -0044-0000.0 t>i • c�i1�69 0i �w SOIL TEST AREA 107.13-0022-0000.0 r .l 1 _ \ 1"=100ft Property Information Property ID 107.D-0022-0000.0 Location 0 STILES STREET Owner M.S HOEHN REALTY TRUST 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 an this map. Geometry updated 10/31/2018 Data updated 10/31/2018 5/9/2019 Payment Receipt � yttTLED �' Town of North Andover, MA $440 .00 Paid via Check Note: ck#880 M.S. Hoehn Realty Trust 288 Stiles Rd Thanks for using the Online Service Center benjamin osgood Soil Testing Permit#48314 May 9, 2019 Repairs or Maintenance Fee $440.00 Total Paid $440.00 Powered by the ViewPoint Cloud platform Receipt number#14943 1/1 R /h i i V V • 1 3r `...e; • 04 . Y Town of North Andover HEALTH DEPARTMENT ,SS4C M1�+t4 CHECK#: 88o DATE: LOCATION: a S 8 S i es H/O NAME:/") - d . A&k 'A, CONTRACTOR NAME: 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 $�Vo— I . ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ i ❑ Title 5 Inspector $ f ❑ Title 5 Report $ ❑ Other. (Indicate) $ HM tk,Agent Initials White-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH ANDOVER "" ' Community & Economic Development HEALTH DEPARTMENT 120 Mainn Street 4� NORTH ANDOVER, MASSACHUSETTS 01845 J i 978.688.9540--Phone pFN��eP� 978.688.9542—FAX healthdept@northandoverma.gov www.northandovertna.gov APPLICATION FOR SOIL TESTS DATE: 05-06-2019 MAP&PARCEL: 107.13-0022 LOCATION OF SOIL TESTS: 288 Stiles Road OWNER: M.S Hoehn Realty Trust Contact#: APPLICANT:Gale Page Contact#: ADDRESS: 288 Stiles Road, North Andover, MA 01845 ENGINEER: Ben Osgood, Jr. Contact#: 978-435-1324 CERTIFIED SOIL EVALUATOR: Benjamin C. Osgood,Jr. Intended Use of Land: Residential Subdivision Single Family Home 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"x 11"Plot plait&Location of Testing(please indicate test pit sites on the plait) )> 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 I"-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. Conservation Commission Approval Date: Signature of Conservation Agent: Date back to Health Department: (stamp in): Town of North Andover, MA May 5, 2019 288 Stiles Road Soil test Location 107.D-0042-0000.0 f/ `M1 r i / 107.D-0023-0000.0 a -0044-0000.0eSt "sue �h a SOIL TEST AREA i 107.D-0022-0000.0 Ill ��■�MI�� IIJJ 1"=100ft Property Information Property ID 107.D-0022-0000.0 Location 0 STILES STREET Owner M.S HOEHN REALTY TRUST ' MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT Town of North Andover,MA makes no claims and no E1VEp warranties,expressed or implied,concerning the validity or RECaccuracy of the GIS data presented on this map. MAI O �O�n Geometry updated 018 L2018 y Data updated 10/32o18 Z0�OF�pEP R�N R SN Map Theme Legends Wetlands Shoreline Hydrologic Connection Mean Low Water Line .-'Wetland Limit Closure Line Reservoir(with PWSID) N Marsh/Bog Wooded Marsh IN Cranberry Bog Salt Marsh Tidal Flats Beach/Dune Massachusetts DEP, 107.D 0022 0000.0 1 of 1 RESIDENTIAL Total Card I Total Parcel Map Lot Sub Sublot CARD North Andover APPRAISED: 289,1001 289,100 USE VALUE: 289,100/ 289,100 PROPERTY LOCATION IN PROCESS APPRAISAL SUMMARY ASSESSED: 289,1001 289,100 No Alt No Direction/Street/Cit Use Code Land Size Building Value Yard Items Land Value Total Value Legal Description User Acct 2881 ISTILES STREET,NORTH ANDOVER 101 3.900 5,000 1,600 282,500 289,100 M 232821 9319 OWNERSHIP u a#. GIS Ref Owner 1:HERBERT,WILLIAM C.JR. Owner 2:PAGE,GALE Total Card 3.900 5,000 1,600 282,500 289,100 Entered Lot Size GIS Ref Owner 3:MARY S.HOEHN LIFE ESTATE Total Parcel 3.900 5,000 1,600 282,500 289,100 Street 1:98 TUCKER ROAD Total Land:3.9 Insp Date Patnot Street 2: Source:Market Adj Cost Total Value per SQ unit/Card:308.87 /Parcel:308.87 �03/14/19 Land Unit Type:AC Propei-des Inc. Twn/Ci :ANDOVER PREVIOUS ASSESSMENT Parcel ID l07.D-0022-0000.0 195881 USER DEFINED St/Prov:MA I Cntryl I Own 0=1 Tax Yr Use Cat Bldg Value Yrd Items Land Size Land Value Total Value Asses'd Value Notes Date Assoc Part: Postal:01810 I Type:Type:1 2019 106 FV 7600 3.9 290,400 298,000 298,000 Year End Roll 9/13/2018 PRINT Prior Id#2: PREVIOUS OWNER 2018 106 FV 51400 0 3.9 126,600 132,000 132,000 CONVERSION 1/1/2018 Prior Id#3: 2017 106 FV 5,400 0 3.9 125,500 130,900 130,900 CONVERSION 1/112017 Owner 1:M.S HOEHN REALTY TRUST- Date Time Assoc Part: Owner 2: MARY S HOEHN,TRUSTEE- 2016 106 FV 5,400 0 3.9 123,500', 128,900 128,900 CONVERSION 1/1/2016 05/13/19 116:13:38 Prior Id#2: Street 1:98 TUCKER ROAD 2015 106 FV 5,400' 0 3.9 121,900', 127,300 127,300'CONVERSION 1/1/2015 LAST REV Prior Id#3: Twn/Ci :ANDOVER 2014 106 FV 5,400 0 3.9 119,700 125,100 125,100 CONVERSION 1/1/2014 Date Time Prior Id#1: SUProv:MA Cnt 2013 106 FV 5,400 0 3.9 119,700 125,100 125,100 CONVERSION 111/2013 03/25/19 I 08:29:11 Prior Id#2: Postal:01810 2012 106 FV 5,400 0 3.9 120,700 126,100 126,100,CONVERSION 111/2012 skip Prior Id#3: 7pnmanlyCON SALES INFORMATION TAX DISTRICT PAT ACCT. 9588 ASR Map: ains 3.9 ACRES of land mainly classified as Grantor Legal Ref Type Date Sale Code Sale Price V Tst Verif Notes Fact Dist: RANCH Building built about 1965,having M.S HOEHN REALT 14466-337 P 12/4/2015 FAMILY 1 No No Revel Dist: BLOCK Exterior and 936 Square Feet,with 1 11041-187 L 1/24/2008 FAMILY 1 Yes No D Year: -- 14 Bath,0 HalfBath,4 Rooms,and 2 Bdrms. HOEHN,MARY S. 11041-0187 L 1/24/2008 FAMILY 1 Yes No D LandReason: ER ASSESSMENTS BldReason: Code Descri INo Amount Com.lnt CivilDistrict: Ratio: BUILDING PERMITS ACTIVITY INFORMATION PR PERTY FACTORS Date Number Descri Amount CIO Last Visit Fed Code F.Descrip Comment Date Result B Name 3/14/2019'INT OWNER SGC SGC Item Code Description % Item Code Description Z R2 43,560 SF 100 Water: o I Sewer n_J Utilitie Census: Exmpt Flood Haz: D NORT NORT 100 To o s Street P PAVED t Traffic: M MEDIUM Snd �- LAND SECTION(First7 line n Use LUC Depth I LT Base Unit Neigh Neigh ° Infl 2 °/° Infl 3 /°° Appraised Alt ° Spec J Fact Use Value Notes Code Description Fact No of Units PriceUnits Unit Type Land Type Factor Value Price Adj Neigh Influ Mod Infl 1 /o Value Class /0 Land Code 101 ONE FAM 43560 SQ FEET PRIMARY 1.0 0 6. 1.00 5 261,360 261,400 101 ONE FAM 2.1 ACRES RESIDUAL 1.0 0 10,000. 1.005 21,000 21,000 101 ONE FAM 0.8 ACRES UNDEVELOPA 0.1 0' 10,000.' 0.015 N WETLAN -90 40' 100 Total AC/HA:13.90000 1 Total SF/SM:169884 I Parcel LUC:101 NONE FAM I Prime NB Desc 5 Total: 282,400 Spl Credit Total:1 282,500 Disclaimer:This Information is believed to be correct but is subject to change and is not warranteed. Database:AssessPro-AssessPro apro 2020 !XTERIOR INFORMATION BATH FEATURES OMMENTS SKETCH Type:19 -RANCH Full Bath 1 Rating:AVERAGE 0107D 00022 00000. USED AS A SINGLE 26 Sum Frea By Label Sty Ht:1 1 STORY A Bath: Ratin : FAMILY BY OWNER SINCE 1998.. PAT=4fi0 Liv Units: 1 Total:1 3/4 Bath: Rating: EFP= 144 Foundation:06 SLAB A 3QBth Rating: FFL=936 Frame:01 WOOD 1/2 Bath: Rating: sTG= 1170 Prime Wall:21 -CONC BLOCK A HBth: Rating:, Sec Wall: % OthrFix: Ratin RESIDENTIAL GRID s 44 t 1170� Roof Struct:01 -GABLE OTHER FEATURES 1st Res Grid I Desc:ILine 1 1#Units 1 Roof Cover.01 -ASPHALT Kits:1 atin :AVERAGE Level FY LR DR D K FR RR BR FB HB L 0 Color: A Kits: Rating: Other Jiew/Desir: F I: Rating: UPPer iENERAL INFORMATION WSFIue: Rating: Lvl 2 CONDO INFORMATION LVI 1 26 B �4466 Grade:D -FAIR Lower Year Bit 1965 Eff Yr Bit: Location: Totals RMs:4 BRs:2 Baths:1 HB 9 Alt LUC: Alt%: Total Units: Jurisdict: Fact:. Floor: REMODELING RES BREAKDOWN 36 16 Const Mod: %Own: Exterior: No Unit RMS BRS FL EF Lump Sum Ad': Name: Interior: 1 4 2 NTERIOR INFORMATION DEPRECIATION Additions: FFL Phys Cond:DL -Dela itated 95.% t Kitchen: 93a 14 Avg HVFL:7 Functional: % 26 Prim Int Wal 01 -DRYWALL ° Baths: ° Economic: /0 PI bin Sec Int Wall: /0 Special: Partition:A TYPICAL Electric: Totals Prim Floors:02 -SOFTWOOD Override: o° Heatin Sec Floors: % Total: 95% General: 1 4 2 SUB AREA SUB AREA DETAIL CALC SUMMARY Code Description Area-SQ Rate-AV UndeprValue Sub % /° ° Bsmnt Fir. Basic STORAGE 1,170 5.690 6,656 Area Usbl Basic$/SQ:85.00 COMPARABLE SALES Descrip Qu #Ten T e Subfloor: Size Ad'.:1.35000002 Rate Parcel ID Typ Date Sale Price FFL FIRST FLOOR 936 96.170 90,019 Bsmnt Gar: Const Ad'.:0.83812314 PAT PATIO 450 3.290 1,481 Electric:3 TYPICAL Ad'$/SQ:96.175 EFP ENCL PRCH 144 30.680 4,417 Insulation:01 TYPICAL Other Features:30000 Int vs Ext: Grade Factor:0.75 Heat Fuel:06 WOOD NBHD Inf:1.00000000 H Heat Sys:eat Type:08 NONE LUC Factor:1.00 Net Sketched Area:2,700 Total: 102,5731 #/°Heated:, /°AC. N C acBHD ts:99430 /s�Factor: AvRate:tBefore DeVa17213 Size Ad 936 Gross Area 2700 FinArea 936' o ° Solar HW:NO Central Vac: NO De reciation:94459 S ecial Features:0 lSu Net:1.85IMAGECom Wal %S rinkled De reciated Total:4972 Final Total:5000Su SzAd 5.34 AssessPro Patriot Properties, Inc AOBILE HOME Make: Model:I Serial#1 EYear:=Eword >PEC FEATURESNARD ITEMS PARCEL ID 107.D-0022-0000.0 Code Description A Y/S Qty Size/Dim Qual Con Year Unit Price D/S Dep LUC Fact NB Fa ApprValue JCodJFact Juds.Value )2 SHED/FR D Y 1 600 A DL 1900 6.33 T 90 101 400 400 H BARN D Y 1960 A DL 1900 12.13T 90 101 1,200 1,200 More:N Total Yard Items: 1,60011 Total Special Featues: I TotaI;j 1,600 Commonwealth of Massachusetts RECEVED City/Town of North Andover Percolation Test JUL a ?Otq Form 12 TOWN OFNORIHANDWER ,M HEALTH DEPARTMENT 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 forms A. Site Information on the computer, use only the tab Gale Page key to move your Owner Name cursor-do not 288 Stiles Street use the return Street Address or Lot# key. North Andover MA 0 „y City/Town State Zipp Code Contact Person(if different from Owner) Telephone Number B. Test Results 5-20-19 9:30 Date Time Date Time Observation Hole# PT 1 Depth of Perc 24/14 Start Pre-Soak 9:37 End Pre-Soak 9:52 Time at 12" 9:52 Time at 9° 10:36 Time at 6" 11:57 Time (9"-6") 81 min Rate (Min./Inch) 30 MPI Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Benjamin C. Osgood, Jr. Test Performed By: Erin Kirchner Board of Health Witness Comments: t5form12.doc•08/15 Perc Test•Page 1 of 1 Of NORTH,y 8669 O O w s l Town of North Andover 1 HEALTH DEPARTMENT s^C U CHECK#: 9/y DATE: 7 / l LOCATION: S 8 d/iX S� H/O NAME: AQ CONTRACTOR NAME: �S 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 $ 9 SEPTIC Systems: j ❑ Septic-Soil Testing $ Septic-Design Approval $ 27,5 ❑ Septic Disposal Works Construction(DWC) $ j ❑ Septic Disposal Works Installers(DWI) $ 1 ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ H'eXf nAgent Initials White-Applicant Yellow-Health Pink-Treasurer ck . � 5( � f 87 41 17 lb 0- fac i -- - . 9 1 Y +I I __ Q NpR ENS cj--. f a� i f Commonwealth of Massachusetts City/Town of North Andover r` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information O Gale PageriEIVE Owner Name �p�g 288 Stiles Street 107.D -22 Street Address Map/Lot# OF N�R�\A j North Andover MA 01845 �pWN H10-6 City State Zip Code ;00 B. Site Information 1. (Check one) ❑ New Construction ® Upgrade ❑ Repair 2. Soil Survey Available? ® Yes ❑ No If yes: Web Soil Survey 311 B Source Soil Map Unit Woodbridge fine sandy loam High Water Table 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. 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): 05/19 Range: ❑ Above Normal ® Normal ❑ Below Normal Month/Day/Year 8. Other references reviewed: t5form11 •rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 5 Commonwealth of Massachusetts City/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: TP 1 5-20-19 9:30 Sunny/warm 42.637943 -71.100092 Hole# Date Time Weather Latitude Longitude: lawn grass none 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 Landform Position on Landscape(SU,SH, BS,FS,TS) 3. Distances from: Open Water Body >200 feet Drainage Way 100 feet Wetlands >100 feet Property Line 100 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: 90 Depth Weeping from Pit Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil Soil Horizon Soil Texture Soil Matrix:Color- /o b Volume Depth(in) ,Layer (USDA Moist(Munsell) Cobbles& Soil Structure Consistence Other Depth Color Percent Gravel Stones (Moist) 0-10 Ap SL 10YR 3/2 10-24 bW SL 10YR 4/6 M F 24-98 C LS 2.5Y 5/4 24 10YR 5/8 >15 M F Additional Notes: t5form11 •rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 5 N Commonwealth of Massachusetts City/Town of North Andover F 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: TP 2 5-20-19 9:30 Sunny/WARM 42.637943 -71.100092 Hole# Date Time Weather Latitude Longitude: 1. Land Use: lawn grass none 5% (e.g.,woodland,agricultural field,vacant lot,etc.) Vegetation Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) Rear Left Description of Location: 2. Soil Parent Material: Ablation Till Drumlin Slope Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body >200 feet Drainage Way 100 feet Wetlands >100 feet Property Line 100 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: 96 Depth Weeping from Pit 84 Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil in Depth Soil Horizon Soil Texture Soil Matrix: /°by Volume p ( ) Soil Structure Consistence Other /Layer (USDA) Color-Moist Cobbles& (Munsell) Depth Color Percent Gravel Stones (Moist) 0-10 Ap SL 10YR 312 10-24 Bw SL 10YR 4/6 M F 24-108 C LS 2.5Y 5/4 24 10YR 5/8 >15 M F 5Y 5/3 Additional Notes: t5form11 •rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 5 Commonwealth of Massachusetts € City/Town of North Andover A r' 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) 24 inches 24 inches ❑ Depth to adjusted seasonal high groundwater(Sh) inches inches (USGS methodology) Index Well Number Reading Date Sh = Sc—[Sr x(OWc—OWmaxyowr] Obs. Hole/Well# 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: 24 Lower boundary: 108 Horizons)? inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5form11 •rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 5 Commonwealth of Massachusetts City/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 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. 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. 'f gor 5-20-19 Sigait Evalua Date Benjamin C. Osgood r. SE1818 June 2022 Typed or Printed Name of Soil Evaluator/License# Expiration Date of License ERIN KIRCHNER Boxford BOH 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: t5form11 •rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 5