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Home My WebLink About- Soil Testing Results - 9 HAWKINS LANE 6/25/2024 Commonwealth of Massachusetts • City/Town of = Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Owner me as � 7 !7' ��-i�1��►. Tl�l � Street Address Map/Lot# �lo�-T� A�►r,�vE� City State Zip Code B. Site Inform7New n 1. (Check one) Constru tion ❑ Upgrade ❑ Repair 2. Soil Survey Available? Yes ❑ No If yes: Source Soil Map Unit Tm t� `0�,� ZDGL� 6l�f�G�Of? oil ae Soil Limitations n L1 CV VU'k Soil Parent material Landform 3. Surficial Geological Report Available? ❑ Yes U No If yes: Year Published/Source Map Unit Description of Geologic Map Unit: 4. Flood Rate Insurance Map Within a re ulatory floodway? El Yes �o 5. Within a velocity zone? El Yes No 6. Within a Mapped Wetland Area? ❑ Yes U No If yes, MassGIS Wetland Data Layer: Wetland Type 7. Current Water Resource Conditions (USGS): J aLy Z ym Range: ❑ Above Normal ❑ Normal Below Normal Month/Day/Year 8. Other references reviewed: Soil Evaluation Forms.doc•rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 5 Commonwealth of Massachusetts City/Town of wz 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: -T'-)_ J?,-M-�5g 71-4=!O I Hole# Date Time Weather Latitude Longitude: �n 0 IUhC ' e�FS ,QI.YI'G9W-4 �'SY, 1. Land Use (e.g.,woodland,agri ultural field,vacant lot,etc.) Vegetation Surface Stones(e. .,cobbles,stones,boulders,etc.) Slope(%) Description of Location: 2. Soil Parent Material: NW,*kx !N Landform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body 7100 feet Drainage Way ?I,D feet Wetlands :? 0O feet Property Line r795 feet Drinking Water Well ��feet Other feet 4. Unsuitable Materials Present: [ Yes ❑ No If Yes: ❑ Disturbed Soil ❑ Fill Material [Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed:❑ Yes [kIGo 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- /o by Volume Depth(in) /Layer (USDA Moist(Munsell) Cobbles& Soil Structure Consistence Other Depth Color Percent Gravel Stones (Moist) 0-1p A F 17.E l orthn I0-7't Additional Notes: Soil Evaluation Forms.doc-rev.3/15/18 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. On-Site Review(minimum of two holes required at every proposed primary and reserve disposal area) Deep Observation Hole Number: T 2 G.2p--A?/ I I ki-I %ok" 4Z-"-,!r IJ 7) +4&keJ Hole# Date Time Weather Latitude Longitude: / 1. Land Use: (e.g.,woodland,agricultural field,vacant lot,etc.) Vegetation Surface Stones(e.g.,cobbles,itones,boulders,etc.) Slope(%) Description of Location: !�?frr' TLA. c�wg 2. SOII Parent Material: andform Position on Landscape(SU,SH,BS,FS,TS) 3. Distances from: Open Water Body yl� feet Drainage Way 7 feet Wetlands >!I feet i Property Line (Q� feet Drinking Water Well feet Other feet 4. Unsuitable Materials Present: [3(�es ❑ No If Yes: ❑ Disturbed Soil ❑ Fill Material [;?�eathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed:❑ Yes NO If yes: Depth Weeping from Pit - Depth Standing Water in Hole Soil Log Coarse Fragments Soil Horizon Soil Texture Soil Matrix: Redoximorphic Features °/o Soil Depth(in) by Volume Soil Structure Consistence Other /Layer (USDA) Color-Moist Cobbles& (Munsell) Depth Color Percent Gravel Stones (Moist) 0-t 04 1 ID--v hV 4,Irs Additional Notes: Soil Evaluation Forms.doc•rev.3115/18 Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 5 Commonwealth of Massachusetts City/Town of Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Y 9 p D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole# T-II Obs. Hole# ❑ Depth observed standing water in observation hole inches inches ❑ Depth weeping from side of observation hole inches inches �epth to soil redoximorphic features (mottles) inches 1,6 inches ❑ Depth to adjusted seasonal high groundwater(Sh) inches inches (USGS methodology) Index Well Number Reading Date Sh = S�-[Sr X (OW,-OWmax)/OWr] 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 WoeNo b. If yes, at what depth was it observed (exclude A and O Upper boundary: Lower boundary: Horizons)? inches inches N c. If no, at what depth was impervious material observed? Upper boundary: _ Lower boundary: 26" inches inches Soil Evaluation Forms.doc•rev.3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 5 Commonwealth of Massachusetts ,p City/Town of 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. l)-j AN A "'.10 JA Signature o Sal valuator Date 11II L 4AkV% bU�� 6�d �4-30-� Typed or Printed Name of Soil Evaluator/License# Expiration Date of License DABotrwH .1 Hai; K IA . 0. 1PA , Name of Approving Authority Witness Appr vo ing 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: Soil Evaluation Forms.doc•rev. 3/15/18 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 5