HomeMy WebLinkAboutForm 11 Soil Suitablilty - Soil Testing Results - 190 GRAY STREET 6/18/2024 Commonwealth of Massachusetts
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Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal °der
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DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but th'e information must
be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form
A. Facility Information
1. Facility Information
K. Finnegan
Owner Name
190 Gray St. Map/Lot_107/137
Street Address
N.Andover MA 01845
City/Town State Zip Code
B. Site Information
1. (Check one) New Construction ❑ Upgrade ® Repair ❑
2. Published Soil Survey available? Yes ❑ No ❑ If yes:
Year Published Publication Scale Soil Map Unit
Soil Name Soil limitations
3. Surficial Geological Report available? Yes ❑ No ❑ If yes:
Year Published Publication Scale Map Unit
Geologic Material Landform
4. Flood Rate Insurance Map:
Above the 500 year flood boundary? Yes ❑ No ❑ Within the 100 year flood boundary? Yes ❑ No ❑
Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes ❑ No ❑
5. Wetland Area: National Wetland Inventory Map
Map Unit Name
Wetlands Conservancy Program Map
Map Unit Name
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 1 of 7
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
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6. Current Water Resource Conditions (USGS) Range: Above Normal ❑ Normal ❑ Below Normal ❑
MonthNear
7. Other references reviewed:
C. On-Site Review (minimum of two holes required at every proposed disposal area)
Deep Observation Hole Number: _3_ 5i21/02
Date Time Weather
1. Location
Ground Elevation at Surface of Hole 200.6
Location (Identify on Plan ) TP-3
2. Land Use: lawn area
(e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%)
mowed grass outwash plain middle
Vegetation Landform Position on landscape(attach sheet)
3. Distances from: Open Water Body_>100 Drainage Way Possible Wet Area _100
feet feet feet
Property Line_>10 Drinking Water Well _>100 Other
feet feet
4. Parent Material: loamy sand Unsuitable Materials Present: Yes ❑ No
If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑
5. Groundwater Observed: Yes ® No ❑
If Yes: Depth Weeping from Pit Depth Standing Water in Hole_60"
Estimated Depth to High Groundwater: 36" 197.60'
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 2 of 7
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Deep Observation Hole Number: TP-3
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil
Depth Horizon/ Color-Moist (mottles) Texture %by Volume Consistence Other
Layer (Munsell) (USDA) (Moist)
(In.) Depth Color Percent Gravel Cobbles
&Stones
0-9 Ap 10YR3/2 FSL
9-12 Bw 10YR4/8 FSL
7.5YR5/8
12-75 C1 2.5Y5/4 36" 5Y/7/2 S,LS 5%
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 7
Commonwealth of Massachusetts
MRNM City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (Cont.)
Deep Observation Hole Number: _4 _5/21/02
Date Time Weather
1. Location
Ground Elevation at Surface of Hole 202.6'
Location (Identify on Plan ) TP-4
2. Land Use: lawn area
(e.g.woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%)
mowed grass outwash plain middle
Vegetation Landform Position on landscape(attach sheet)
3. Distances from: Open Water Body_>100 Drainage Way Possible Wet Area _>100
feet feet feet
Property Line_>10 Drinking Water Well _>100_ Other
feet feet
4. Parent Material: Loamy Sand Unsuitable Materials Present: Yes ❑ No
If Yes: Disturbed Soil❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑
5. Groundwater Observed: Yes ® No ❑
If Yes: Depth Weeping from Pit Depth Standing Water in Hole 72"
Estimated Depth to High Groundwater: 40 199.27'
inches elevation
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 7
Commonwealth of Massachusetts
City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
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Deep Observation Hole Number: TP-4
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Soil
Depth Horizon/ Color-Moist (mottles) Texture %by Volume Structure Consistence Other
Layer (Munsell) (USDA) (Moist)
(In.) Depth Color Percent Gravel Cobbles
&Stones
0-6 Ap 10YR3/2 FSL
6-14 Bw 10YR4/8 FSL
7.5YR5/8
14-84 C1 2.5Y5/4 40" 5Y7/2 GRAY. 10%
S,LS
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 5 of 7
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Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
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D. Determination of High Groundwater Elevation
1. Method used: ❑ Depth observed standing water in observation hole A. B.
inches inches
❑ Depth weeping from side of observation hole A. B.
inches inches
® Depth to soil redoximorphic features (mottles) A._36_ B._40
inches inches
❑ Groundwater adjustment(USGS methodology) A. B.
inches inches
2. Index Well Number Reading Date Index Well Level
Adjustment Factor Adjusted Groundwater Level
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? Upper boundary: 14" Lower boundary: 84"
inches inches
F. Certification
I certify that I have passed the soil evaluator examination* approved by the Department of Environmental Protection and that the above
analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017.
Signature of Soil Evaluator Date
Typed or Printed Name of Soil Evaluator *Date of Soil Evaluator Exam
Name of Board of Health Witness Board of Health
Note: This form must be submitted to the approving authority with Percolation Test Form 12
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 6 of 7
Commonwealth of Massachusetts
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Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
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Use this sheet for field diagrams:
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 7 of 7