HomeMy WebLinkAboutSoil Testing Results - 101 CROSSBOW LANE 9/11/2002 Town of North Andover, Massachusetts Form No. 1
NORTH qti BOARD OF HEALTH
APPLICATION FOR SITE TESTING/INSPECTION
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Applicant
NAME ADDRESS TELEPHONE
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Site Location
-� Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
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OCT. 3.2002 5:57FM P 1
FROM R.O. TA!aGARD F'HOHE NO. , 781 334 01115
FORM I I - S01I. EVAIXIATOR FORNI
Page 2 of 3
Location Address or Lot No.
(/?�)n-site Review
Deep Hale Number Date:../ `..)/� Tima,.. Weather�6�
Location (identify on site plan) ..... :.:... ..
Land Use Slope (°!a) Surface Stones
L andform
Position on landscape (sketch on the back)
Distances frorn:
Open Water Body feet Drainage way feet
Possible Wet Area feet Property Line .. feet
Drinking Water Well feet Other . :..::..:. ..:...:...::.,..::..
DEEP OBSERVATION HOLE LOG* i
Depth from Soil Horizon ' Soil Texture Soil Color Soil Other
Surface(Inch&s) i (USDA) (Mansell) Mottling (Structure,Stones,Boulders,Consistency, %
! Gravtll
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of
� t &I
MnSALAREA
J NEQUIRED AT EVERY
Parent Materia:(geologic) _ Depthto6adrock:
D¢t}th to Droundvvatef: Standing Water in the Hole; _ Weeping from Pit Fate: Y
N
Estimated Seasonal Hqh vround Water; _ — Q
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DSP APPRO✓Eb FORD(• 12107/95
FROM R..C. TANGAFD PHONE NO. 731G3714J0115 ' G
FORM 11 - SOIL ENAX.,t ATOR FORM
Page 2of3
Location Address or [,ot too,A'�C
av
On-sits Re�vam
Deep Hole Number ., Date;. f:-.. r Time:. .� Weather
Location (identify on site plan) . ..:• --
. . .........................
Land Use Slope (°k} 1. Surface Stones 77
Vegetation `2.OL
Landform
Position on landscape {sketch on the back} .... .....:...:.....��..I`.�'�
Distances from: '
� I
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 Soil Texture soil Color Soil Other
Surface(Inches) (USDA) (Munsell) Mottling {Structure, Stones,Boulders, Consistency, 0A
Gravel) _
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Ul"Z DISPOSAL AREA
Parent Material!geologic) _ DapthtvUedrock;—_ --
Deoth to Groundwater: Standing Water in the Hole:_ Weeping from Fit Face: _._---_-
Esjimat9d Seasonal High (.,round Water:
VEI'API'KOVED FOPUNI• 12.49195
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BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978688-9540
APPLICATION FOR SOIL TESTS
DATE: c MAP &PARCEL: /Z-1'4-/3
LOCATION OF SOIL TESTS: C go e-
OWNER: K4(2)24 TEL. NO.:
ADDRESS: c, P- rs
ENGINEER: N e c,,rte- 9 TEL. NO.: z 7C 10
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision -Siffg-re-Family-Hon� Commercial
Is This:
Repair Testing: Undeveloped lot testing:
In the Lake Cochichewick Watershed? Yes No
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
upyrades. (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:
Date Received: Check Amount: //Check Date:
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