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Home My WebLink AboutForm 11 Soil Suitability Assessment - Soil Testing Results - 1499 SALEM STREET 5/17/2021 9 (3� R�CEtVED - Commonwealth of Massachusetts f p 21+ / 20 �1 City/Town of North Andover MAY Im h� Y 9DisposalpPNpEPAR MEND R Form 11 - Soil Suitability Assessment for On-Site Sewage A. Facility Information Ashish Shah Owner Name 1499 Salem Street 106.A-30 Street Address Map/Lot# 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: USDA NRCS 306D Source Soil Map Unit Paxton None Soil Name Soil Limitations Coarse-loamy lodgment till Drumlin Soil Parent material Landform 3. Surficial Geological Report Available? ® Yes❑ No If yes: MassGIS Oliver Till or Bedrock Year Published/Source Map Unit Till 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): 5/4/2021 Range: ® Above Normal ❑ Normal ❑ Below Normal Month/Day/Year 8. Other references reviewed: t5form11 (32)•rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 5 Commonwealth of Massachusetts �1 =_, City/Town of North Andover \ y 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 5/4/2021 1:OOPM Overcast, 50 42.651500 -71.064640 Hole# Date Time Weather Latitude Lonqitude: Single family home Lawn None 5-8% 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: Coarse-loamy lodgment till Drumlin SH Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body 100+ feet Drainage Way 100+ feet Wetlands 100+ feet Property Line 10+ 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: Depth Weeping from Pit Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil Soil Horizon Soil Texture Soil Matrix:Color- %b Volume Depth(in) /Layer (USDA Moist(Munsell) Cobbles& Soil Structure Consistence Other Depth Color Percent Gravel Stones (Moist) 0-58 Fill 58-68 Bw FSL 1 OYR 4/6 68-102 C SL 5Y 6/3 Additional Notes: t5form11 (32)•rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 2 of 5 Commonwealth of Massachusetts al City/Town of North Andover 'v 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 5/4/2021 1:OOPM Overcast, 50 42.651500 -71.064640 Hole# Date Time Weather Latitude Longitude: Single family home Lawn None 5-8% 1. Land Use: (e.g.,woodland,agricultural field,vacant lot,etc.) Vegetation Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) Lawn in rear of single faimly home Description of Location: 2. Soil Parent Material: Coarse-loamy lodgment till Drumlin SH Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body 100+ feet Drainage Way 100+ feet Wetlands 100+ feet Property Line 10+ 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: Depth Weeping from Pit Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil Soil Horizon Soil Texture Soil Matrix: %by Volume Depth(in) Color-Moist Soil Structure Consistence Other /Layer (USDA) Cobbles& (Munsell) Depth Color Percent Gravel Stones (Moist) 0-50 Fill 50-70 Ab FSL 10YR 3/2 70-89 Bw FSL 10YR 4/6 89-118 C SL 5Y 6/3 Additional Notes: t5form11 (32)-rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 5 Commonwealth of Massachusetts �l P City/Town of North Andover h *` Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole#TP-1 Obs. Hole#TP-2 ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches ® Depth to soil redoximorphic features (mottles) None inches None inches ❑ Depth to adjusted seasonal high groundwater(Sh) inches inches (USGS methodology) Index Well Number Reading Date Sh = Sc—[Sr X (OWc—OWmax)/OWr] Obs. HoleMell# 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: 68 Lower boundary: 118 Horizons)? inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5form11 (32)•rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 4 of 5 Commonwealth of Massachusetts �1 City/Town of North Andover \ j 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-3 5/4/2021 1:OOPM Overcast, 50 42.651500 -71,064640 Hole# Date Time Weather Latitude Lonqitude: Single family home Lawn None 5-8% 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: Coarse-loamy lodgment till Drumlin SH Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body 100+ feet Drainage Way 100+ feet Wetlands 100+ feet Property Line 10+ 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: Depth Weeping from Pit Depth Standing Water in Hole Soil Log Redoximorphic Features °Coarse Fragments Soil Soil Horizon Soil Texture Soil Matrix:Color- /°by Volume Depth(in) /Layer (USDA Moist(Munsell) Cobbles& Soil Structure Consistence Other Depth Color Percent Gravel Stones (Moist) 0-36 Fill/Ab 36-44 Bw FSL 1 OYR 4/6 44-115 C SL 5Y 6/3 Additional Notes: Form 11 (2 of 2)•rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 5 Commonwealth of Massachusetts 1 City/Town of North Andover I j 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-4 5/4/2021 1:OOPM Overcast, 50 42.651500 -71.064640 Hole# Date Time Weather Latitude Longitude: Single family home Lawn None 5-8% 1. Land Use: (e.g.,woodland,agricultural field,vacant lot,etc.) Vegetation Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) Lawn in rear of single faimly home Description of Location: 2. Soil Parent Material: Coarse-loamy lodgment till Drumlin SH Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body 100+ feet Drainage Way 100+ feet Wetlands 100+ feet Property Line 10+ 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: Depth Weeping from Pit Depth Standing Water in Hole Soil Log Redoximorphic Features Coarse Fragments Soil Soil Horizon Soil Texture Soil Matrix: %by Volume Depth(in) Soil Structure Consistence Other /Layer (USDA) Color-Moist Cobbles& (Munsell) Depth Color Percent Gravel Stones (Moist) 0-40 Fill/Ab 40-59 Bw FSL 10YR 4/6 59-120 C SL 5Y 6/3 Additional Notes: Form 11 (2 of 2)•rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal -Page 3 of 5 Commonwealth of Massachusetts �1 City/Town of North Andover IT Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole#TP-3 Obs. Hole#TP-4 ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches ® Depth to soil redoximorphic features (mottles) None inches None inches ❑ Depth to adjusted seasonal high groundwater(Sh) inches inches (USGS methodology) Index Well Number Reading Date Sh = Sc—[Sr X(OWc—OWmax)/OWrl 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: 36 Lower boundary: 120 Horizons)? inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches Form 11 (2 of 2)•rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 5 Commonwealth of Massachusetts �1 City/Town of North Andover i= 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. 1 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. /iGB2�Q.j1i 5/13/2021 Signature of Soil Evaluator Date Thorsen Akerley/#14016 6/30/22 Typed or Printed Name of Soil Evaluator/License# Expiration Date of License Dan Ottenheimer, R.S. North Andover Health Department 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 (32)•rev.3/15/18 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 5 Commonwealth of Massachusetts City/Town of North Andover N Percolation Test Form 12 11M 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 A. Site Information filling out forms on the computer, use only the tab Ashish Shah key to move your Owner Name cursor-do not 1499 Salem Street use the return Street Address or Lot# key. North Andover MA Zip01845 Co ,y City/Town State Zip Code Williams&Sparages LLC 978-539-8088 Contact Person(if different from Owner) Telephone Number B. Test Results 5/4/2021 1:15 PM Date Time Date Time Observation Hole# P-1 @ TP-3 Depth of Perc 54"+18"=72" Start Pre-Soak 1:14 End Pre-Soak 1.29 Time at 12" 129 Time at 9" 1.38 Time at 6" 1:47 Time (9"-6") 9 minutes Rate (Min./Inch) 3 MPI Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Thorsen Akerley Test Performed By: Dan Ottenheimer Board of Health Witness Comments: t5form12.doc•08/15 Perc Test•Page 1 of 1