HomeMy WebLinkAboutForm 11- Soil Suitability - Soil Testing Results - 82 LIBERTY STREET 12/18/2023 Commonwealth of Massachusetts
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Form 11 - Soil Suitability Assessment for Can-Site Sewage Disposal �,�
A. Facility Information
Dirk Landgra#
Owner Nance
82 Liberty Street 90-B/54
Street Address Map/Lot#
North Andover MA 81845
— — --—
city State Zip Code
B. Site Information
1. (Check cane) ❑ New Construction Upgrade
2. Soil Surrey MRCS Web Soil Survey 42D Canton fine sandy loam
Sources Soil Map Una Soil Series
Moraines, gills, ridges Shallow to refusal
Landform Soil Limitations i -
Coarse-loamy over sandy melt-out till
Soil Parent material
3. Surflcial Geological Report Mass Mapper Till or bedrock
Year Publlshed{Sources Map Unit
Description of Geologic Map Unit:
4, Flood Rate Insurance Map Within a regulatory floodway? ❑ Yes ® No
5. Within a velocity zone? ❑ Yes 0 No
6. Within a dapped Wetland Area? ❑ Yes No If yes; MassGI Wetland Data Layer.
Wetland Type
7. Current Water Resource Conditions(USGS): 12/11/2023 Range: Above Normal ❑ Normal ❑ Below Normal
Month/Day/Year
8. Other references reviewed. None
(Zone 1t,IWPA,Zone A,EEA Data Portal,etc-}
I
t§forml 1 revised 1-23-20.d -rev. 1/15# OW Form 11—Sail Suitability Assessment for On-Site Sewage Disposal •Page 1 of 5
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
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C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number:
Hole# Date Time Weather Latitude Longitude
�_i, - �- C�
(e.g-,woodland,agriculturarfield,vacant tot,etc.) Vegetation Surface-Stones(e-g.,6obtiles-,stones,boulders,etc.)
Description of Location,-
GA"
2. Soil Parent Material:
Landform Position on Landscape(SU,SH,BS,FS,TS,Plain)
3. Distances from,- Open Water Body 1:1C _-"1 " feet Wetlands feet01 _>
feet Drainage Way
Property Line feet Drinking Water Well feet Other feet
4. Unsuitable Materials Present: n Yes n No If Yes: 0 Disturbed Soil/Fill Material 0 Weathered/Fracturbed Rock ❑ Bedrock
5, Groundwater Observed:IdYes ❑ No If yes: ( Depth to weeping in Hole (0 Depth to Standing Water in Hole
Soil Log Coarse Fragments
Soil Horizon Horizon Soil Texture Soil Matrix: by Volume Soil
[Depth(in) Redoximorphic Features % Soil
/Layer (USDA Moist(Munsell) & Structure Consistence Other
Depth Color Cobbles Percent Gravel Storms re (Moist)
'nc
A
ka
:)Pl:
C >c
iv :)Pl:
1CnC
a C i IDPI:
Dpl.
,nc
ICnc
pl:
Additional Notes,
t5form1 I revised 1-23-20.doe-rev. 1/15/2020 Form 11-Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 5
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. an-Site Review(minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: 3C
Hole# Date Time Weather Latitude Longitude
1. Land Use:
/' l 6A(t-)i
--
(e.g.,woodland,agricultural fie Wvacant lot,etc.) Vegetation Surface Stones(e.g_cobbles,stones,boulders,—etc) -Slope
Description of Location: J.-I CA
2. Soil Parent Material:
Landform Position on Landscape(SU,SH,BS,FS,TS,Plain)
3. Distances from-, Open Water Body 4Z feet Drainage Way ---'10v feet Wetlands r feet
Property Line IU feet Drinking Water Well _-710o— feet Other feet
4, Unsuitable Materials Present: E] Yes a No If Yes: E] Disturbed Soil/Fill Material n Weathered/Fractured Rock E] Bedrock
5. Groundwater Observed:a Yes F1 No If yes: Depth to Weeping in Hole TDepth Standing Water in Hole
Soil Loq
Coarse Fragments
Redoximorphic Features Soil
Soil Horizon Soil Texture Soil Matrix:Color- %by Volume Soil
Depth(in) /Layer (USDA) Moist(Munsell) I v Cobbles& lure Consistence Other
Depth Color Percent gavel tones (Moist)
51
Dpl:
tric A
L5 IDp
nc :1,
Zi :)Pl:
--no
C -5 5
:)pl:
'no
:)Pt
,no .
:)Pl:
Additional Notes:
t5forml 1 revised 1-23-20.doc-rev.1115/2020 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal Page 3 of 5
Commonwealth of Massachusetts
City/Town of
Percolation Test
Form 12
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
Important:When the local Board of Health to determine the form they use.
filling out forms A. Site Information
on the computer,
use only the tab Dirk Landgraf
key to move your Owner Name
cursor-do not 82 Liberty Street
use the return
key. Street Adtlresa or Lot#
North Andover MA 01845
-S—ta-t-e----------- Zip—Code
617-504-4244
Z;Wta�t_P�ii�W(Tfd_4;r"en_t from'0"w n e—r) --,- . ..... 'Tele-ph
B. Test Results
S
one hturnber
i
Cate Time Date Time
Observation Hole# If 1'__�.._
�7()
Depth of Perc
Start Pre-Soak
/q
End Pre-Soak
Time at 12"
61 3
Time at 9"'
Time at 6" .............
Time (9"-6")
Rate (Min./inch) . ........
Test Passed: Test Passed: Fl
Test Failed-, Test Failed:
Stamski and Mo Nary Test Performed By:
----U'4,
Board of Heath�V nW�i ..........................---------
Comments:
t5form 12 doc-08/15 Perc Test-Page 1 of 1
Commonwealth of Massachusetts
Cityffown of
Form I I - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1, Method Used (Choose one): Obs. Hole# Obs. Hole#
f-1 Depth to soil redoximorphic features inches inches
E] Depth to observed standing water in observation hole inches inches
El Depth to adjusted seasonal high groundwater(St,) inches inches ,55
(USGS methodology)
Index Well Number Reading Date
Sh= Sc—[SrX(OWC—0WnVx)/0Wr]
Obs, HoIeNVeII# SC Sr owc OW, ax 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?
0 Yes [:) No
b, If yes, at what depth was it observed (exclude O.A,and E Horizons)? Upper boundary: Lower boundary'.
inches inches ___
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
in—&-4s— inches
t5form 11 revised 1-23-20.doc-rev, 1/15/2020 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 4 of 5
Commonwealth of Massachusetts
City/Town of
Ap 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
15107.
Signature of Soil Evaluator Date
Nathanial Cataldo SE 14601 511/2025
Typed7
or Printed Name of Soil Evaluator/License# Expiration Date of License
M. Board of Health
Name cifApproving Authority Vilitness 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-,
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t5forml 1 revised 1-23-20.doc-rev- 1/16/2020 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 5