244 Soil Suitability 2010 __ �sali'i',�,iiwt or massacnusetts
s City/Town of
�'la:� Form 11 - Soil Suitability
,, Assessment for On-Site Sewage Disposal
Wetlands Conservancy Program Map
Map Unit Name
6. Current Water Resource Conditions (USGS) Range: Above Normal
Month/Year ❑ Normal ❑ Below Normal ❑
7. Other references reviewed:
C. On-Site Review (minimum of two holes required at every proposed disposal area)
Deep Observation Hole Number: 1 4-23-2010
— 9:00 A.M. Clear
1. Location Date Time Weather
Ground Elevation at Surface of Hole 0
Location (Identify on Plan )
2. Land Use: Residential
(e.g.woodland, agricultural field,vacant lot,etc.) Surface Stones
Slope(%)
Lawn Terrace
Vegetation Landform
Position on landscape(attach sheet)
3. Distances from: Open Water Body 500+ Drainage Way None Possible Wet Area 50"
Property Line 10' Drinking Water Well City Other
4. Parent Material: Outwash Unsuitable Materials Present Yes X No ❑
If Yes: Disturbed Soil❑ Fill Material X Impervious Layer(s) ❑ Weathered/Fractured Rock❑ Bedrock❑
5. Groundwater Observed: Yes ❑ No X
If Yes: Depth Weeping from Pit Depth Standing Water in Hole
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal ' Page 2 of 7
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Estimated Depth to High Groundwater: 78" ?
inches elevation
Deep Observation Hole Number: One
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soil Structure Soil
Depth Horizon/ Color-Moist (mottles) Texture %by Volume
(In.) Layer (Munsell) (USDA) Consistence Other
Depth Color Percent Gravel Cobbles (Moist)
0 to 24 Fill Stones
24 to A/B 10 Yr. 3/4 NO M/S 0
36 0 Single Grain Loose
36 to Bw 10 Yr. 5/8 NO M/S
42 0 0 Single Grain Loose
42 to Cl 10 Yr. 5/6 48" 7.5 Yr.5/8 5 M/S
78 0 0 Single Grain Firm Friable
78 to C2 2.5Y 5/3 78" 7.5 Yr. 5/8 10 F/S 0 0
120 Single Grain Firm Friable
Additional Notes At 101"well defined oxidation layer 7.5 Yr. 5/8 High croma in Cl layer appears to be relic mottles.
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 7
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Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
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C. On-Site Review (Cont.)
Deep Observation Hole Number: Two
4-23-2010 9:00 A.M. Clear
Date Time Weather
1. Location
Ground Elevation at Surface of Hole 0
Location (Identify on Plan )
2. Land Use: Residential
(e.g.woodland,agricultural field,vacant lot,etc.)
Surface Stones Slope(%)
Lawn Terrace
Vegetation Landform
Position on landscape(attach sheet)
3. Distances from: Open Water Body 500+ Drainage Way None Possible Wet Area 50
feet feet
Property Line 40 Drinking Water Well CITY Other feet
feet feet
4. Parent Material: Out wash Unsuitable Materials Present: Yes X No❑
If Yes: Disturbed Soil ❑ Fill Material X Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock ❑
5. Groundwater Observed: Yes ❑ No X
If Yes: Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater:
Inches elevation
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 4 of 7
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Deep Observation Hole Number: TWO
Soil Soil Matrix: Redoximorphic Features Soil Coarse Fragments Soli
De th Horizon/ Color-Moist (mottles) Texture % Soilt
p Layer (Munsell) by Volume Structure Consistence Other
(In.) (USDA) (Moist)
Depth Color Percent Gravel Cobbles
0 to 32 Fill ___ &Stones
32 to NB 10 Yr. ' None L/S 0
39 0 Single Firm Friable
Grain
39 to Bw 10 Yr. 5/8 None S 0 ' 0
48 Single Firm Friable
Grain
48 to Cl 2.5 Y 7/3 78+" 7.5 Yr. 5/8 5 F/S 0 0
93 Single Firm Friable
Grain
Additional Notes Root Penetration to 39"
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal• Page 5 of 7
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Form 11 - Soil SuitabilityAssessment for On-Site Sewage
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D. Determination of High Groundwater Elevation
1. Method used: ❑ Depth observed standing water in observation hole A.
B.
❑ Depth weeping from side of observation hole inches inches
A. B.
X Depth to soil redoximorphic features (mottles) inches inches
A. 78" B. 78
❑ Groundwater adjustment(USGS methodology) A inches inches
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 X No❑
b. If yes, at what depth was it observed? Upper boundary: 24
inches Lower boundary: 32
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
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Use this sheet for field diagrams:
Owner must confirm property lines prior to plan approval.
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 7 of 7