HomeMy WebLinkAboutSoil Testing Results - 1312 SALEM STREET 8/17/2005 FOR II.- SOIL EVALUATOR FORM
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No. �I Ii-1��. � ,
Date:
Commonwealth of Massachusetts
Massachusetts
Soil Suitability Assessment for On-site Sewage oosal
Performed By: ....t. Via....
........��... ..... ,......,�' -�°`.....�'.............. .. Date:
Witnessed By: e. .... . ",.. .. .. ..... ,�.��..... ��. . r....... .ta..l° .i..
............
.. ......................
........w_.
l.xation Address or I °• "�'r ` ' .Owner's s Na", .,/ 1 l
/ Address,and / 1
AJo r AvAl>ver Tekphone/
ew Construction ❑ Repair PKr 9.7 8 (13 6'_ 9p
Office Review
Published Soil Survey Available: No ❑ Yes
Year Published I. . .1...... Publication scale i 15'$.040 Soil Map Unit
Drainage Class :l(....... Soil Limi ions ....... ... ► ..... .C'.V ......................................_..........................
Surficial Geologic Report Available: No Yes ❑
Year Published Publication Scale M.
GeologicMaterial (Map Unit) ................................•...................,................•,.•,.,...••......,.:,...................... ................... _.....,._...;
Landform. ................................................................
4
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes
Within 500 year flood boundary No ❑Yes ❑
Within 100 year flood boundary No ❑Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit) ...:.. ..........................................................
........:,.,.__......_.,_.,
Wetlands Conservancy Program Map (map unit) ,, ...! ........................•.......,..........,.:............_......__._.,
Current Water Resource Conditions (USGS): Month
Range :Above Normal Normal ❑Bek-w Normal ❑
Other References Reviewed:
DEP APPROVED FORM-12/07195
FOWM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot No. 131a St? over
On-site Review
Deep Hole Nu
mber 'P1 Date:-... Time:.: c ®., Weather
Location (identify on site plan) eAr—:..::::::1: ". . .:. .............:.::..:.:....::..:::::«.:.......::::......:..:.,:..::...::.:,...:: _
Land Use :.: ,Sb. .l� l . Slope {/o) ...:..:�.:. ®
P .. Surface Stones
.....:.... .
Vegetation :,....:.:.0 _::::.::::::.:....:::..:.. . ... .::..:.:.:.:::........:..::..:.::::::::::..:...:::...,.:.:.:..:.:.:.:....::.......:....:..... .:..... ...... ..
LandformpC' �f� ..:.::.::...:::.:::.:.:.. ...::.....:::::..:::...:......
Position on landscape (sketch on the back) � :,: .� � ..:...:...
Distances from:
Open Water Body : .® .:... feet y.3.
Drainage way, dO
9 ..:.... .;:. feet
Possible'.Wet Area,. .4® ....:.: feet Property Line ...:. ::.::.::. feet -
'Drinking Water Well 2-9 feet Ot her
DEEP OBSERVATION HOLE LOG`
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency,
Gravel)
0-47 7 P1
5-0
joyR
® 7SYR bra
C*b
-MINIMUM OF 2 H011TRSM
Parent Material(geologic) I. ®v. Depthto8edrock: �fa
Depth to Groundwater: 'Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground und Water: - '
DEP APPROVED FORM-12/07195
;FORM 11 e SOIL EVALUATOR hORRZ
Page 2 of 3
Location Address or Lot No. 131
0n-site Review
® � t ®®Dee P Hole Number Date::.
Weather ,.�trt .. ......
Location (identify on site plan)
Land Use ::. -Q ..(.....:ft1 "1. �.. Slope (%) ..: .:I®.. Surface Stones
Vegetation -&'r . ..5-::::.:....::.;:.::::.:.::.:.....:
LandformCt.f .:..,. .....:...:::.....,. .. : .. .....:.. .:.::....:..:.::...:::...::.:..:.:...:.:..::.::.::.::....:.:::::.::._:.:::::.. .... ...:.:... ..:::. ..:.
Position on landscape (sketch on the back) _.:-OotO
Distances from:
Open Water Body :: :,-, feet Drainage way..3 ...:. feet
Possible;Wer~Area feet Property Line .:.v. :,....:., feet
Drinking Water Well }1 feet Other ....�..v. .. N,..:
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Solt(_nlni -Soil •,•�-
Surface.priches) (USDA) (MunselQ Mottlin
g (Structure,Stones,Boulders,Consistency, /o
Gravel)
Q )oyK Griow.
N j 3 % &Tav
A -5 0 75YR
MINIMUM OF 2 HOLES REQUIRED AT-EV
A
1t
Parent Material(geologic) I ,. DepthtoBedrock:
Depth to Groundwater. -'Standing Water in the Hole: ' Weeping from Pit Face:
Estimated Seasonal High Ground Water-_
DEP APPROVED FORNI-12/07/95
TO SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot i1o. �P A4er
On-site Review
Deep Hole Number ..(.P,.j�...
Date:.:. ...
Time:...:.��®®� Weather � ..�
Location (identify on site plan) ..^ A ...:. .. ..
:r:::.:::....: :::.::...::..:::::..:...::...
Land Use :..� .�.�.. :.:�.�:::...:...... �:.:.. ... .. .
. .,::.:... ...:
Slope (%) : .: .? .. Surface Stones
Vegetation ::�..J.:....:ae�s ..::.::.:.:..:...:.:...�:....:.:.:..:::.::.:.:::::...::.. .:.: .::...::: ...::.::.....::..:.....:::.....,:.....: :..:.::::. ..:.: . ..:.:.. ::..:. .... ...
Landform
Position on landscape (sketch on the back)
Distances from: � .....:. ..::.. ..:..:
Open Water Body :. .... feet
Drainage way-300-1.. feet
. . Possible'Wel Areal',,,( feet Property Pro P ert y
Line ...::.�.....::. feet
` -Drinking Water Well >13�®
:::::.:...:..:. feet Other
DEEP OBSERVATION HOLE LOG'
Depth from Soil Horizon Soil Texture Soil Col
Surface(Inches) oi(USDA) SO1I Other
(Munsell) Mottling (Structure,Stones,Boulders,Consistency, %
Gravel)
ort
do !d
MINIMUM OF 2 LUUIKLU AT EVE
Parent Material(geologic)
DepthtoBedrock:
Depth to Groundwater: "Standing Water in the Hole:
-°�p t) Weeping from Pit Face:
Estimated Seasonal High Ground Water._ / ./
DEP APPROVED FORM-12/07/95
:FORM - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot into. JU2 Sallem
On-site Review
Deep Hole Number Date:A�:: :1®r Time:.:.,1®-+..®® Weather �if..
Location lidentif n site Ian
Land Use :.: 4 :. 1 <�..:-,:.. Slope M ""-: ::W. Surface Stones ,_,J,®L"f ;-.:....: ....:.:..... ,..:..
Position on landscape (sketch on the back) 9P.
Distances from:
Open Water Body f Drainage way... ,:. feet '
PossibleMet"Area :`....:.: feet Property Line .:. :�,..;,,..» feet
Drinking Water Well>►5 feet Other
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture S4i!roloi ottling Soil
Surf a.ce.hnches) (USDA) - (MunseU) M (Structure,Stones,Boulders,Consistency,
- Gravel)
/
JX` Ins ®
MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAC A
Parent Material(geologic) ® 7{
_ G
Depth to Groundwater: -'Standing Water in the Hole: Weeping from Pit Face:
1�
Estimated Seasonal High Ground Water: 5`9
DEP APPROVED FORM-12/07/95
;FORM 11 e SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot into. 13 Salem- r f kyl-J'An ver
On.-site Review
Deep Hole Number Weather
:.:::. :: Date:..,: ® Time
Location (identify,o site plan) ..... .:.::::,s�.`. .::.. !®::....::: :..v... .. ...:...... .......
Land Use :::. f. ` 1a, ..:..._..:._ Slope Surface Stones :..... ....... .. .
Vegetation
: ... .........
............
Landform
Position on landscape (sketch on the back)
Distances from:
Open Water Body : ..;,., feet Drainage way.. ..:::..;.:,., feet
Possible:Wet Area .,YOP..:: feet Property Line .:...> ..:..::. feet '
Drinking Water Well AW®,,: feet Other
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Soil refer -So;! M r I
Surface.06ches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, %
Gravel)
MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAC A
Parent Material(geologic) -)Ak"AoIZPA DepthtoBedrock: '
Depth to Groundwater: 'Standing Water in the Hole: Weeping from Pit Face:
l It
Estimated Seasonal High Ground Water:
DEP APPROVED FORM-12107/95
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. 1eim 54kA AIA /`'ysAc
Detennination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole................... inches
❑ Depth weeping from side of observation hole ........... ...... inches
Dep.th.to soil mottles ,::,.:::::.::.: inches
❑ Ground -water adjustment ................... feet
Index Well Number .................. Reading Date ................... Index well level ...................
.Adjustment factor ................... Adjusted ground water level ........................................................
Depth of Naturally Occurring Pervious Material
Does at least four- feet of naturally occurring pervious material exist in I areas
observed throughout the area proposed for the soil absorption system? AZo If not, what is the depth of naturally occurring pervious material? p
Certification
I certify that on d (date) 1 have. passed the soil evaluator examination
approved by the De a ment 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 Date 8/J`7 ®Y
DEP APPROVED FORM-12107/95
Commonwealth of Massachusetts
City/Town of or+h
Y [
Percolation Test
i.4f, '2, � dGb".°
U
Form 12
K
n
nnr spa �i�
Percolation test results must be submitted with the Soil Suitability Asse sn-ieh1'f6r'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: A. Site Information
When filling out
forms on the
computer, use Gay-Neilson
only the tab key Owner Name
to move your 1312 Salem Street
cursor-do not
use the return
Street Address or Lot# - --- -
key. North Andover MA 01845
00 City/Town State Zip Code
978 685-9415
Contact Person(if different from Owner) Telephone Number
rerwn
B. Test Results
6/8/05 10:00 7/12/05 8:00
Date Time Date Time
Observation Hole# PT1 PT1 B
Depth of Perc 81"/17" 57"/18"
Start Pre-Soak x.56 8:07
End Pre-Soak 10:11 8:25
Time at 12" 10:11 _ 8:25
Time at 9° 10:41 time at 10.5" 8:54
Time at 6" - 9:27
Time (9"-6") - 33 MIN.
Rate (Min./Inch) - 11 MIN. PER INCH
Test Passed: ❑ Test Passed:
Test Failed: ® Test Failed: ❑
Thomas K. Hector
Test Performed By:
Andrew McBrearty, Mill River
Witnessed By:
Comments:
t5form12.doc•06/03 Perc Test-Page 1 of 1
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PRESSURE DISTRIBUTION DESIGN SPREADSHEET
Property Location: 1312 SALEM STREET NORTH ANDOVER,MA
DESIGN FLOW(in gallons/day)? 440
Elevation of the PUMP OFF SWITCH,in feet? 93.45 --
Elevation of the upper LATERAL,in feel? 97.55
DELIVERY PIPE distance,from pump to manifold,in feet? 39
DELIVERY PIPE diameter,in inches(if not 2"--use 2"min)? 3
Design DISTAL PRESSURE,in feet(if not 2.5)?(lid) 4.5
IS MANIFOLD CENTER-FED&SYMETRICAL(yes or no)? yes YES , 3 � !
How many orifices in the MANIFOLD? 0 d! '�
i
MANIFOLD ORIFICE diameter,in inches(If not 5/16") 0 03125
MANIFOLD DIAMETER(if not 2"--use 2"min)? 4 4 (,0h,!,A j,
TOTAL LENGTH OF MANIFOLD 11
Does±dANIFOLD drain to FIELD after dose(yes or no)? no �.-
How many LATERALS? 4
Pumping chamber weep hole size(usually.25") 0.25 USE 0 IF FORCE MAIN DOES NOT DRAIN
PROGRAM WILL CALCULATE UP TO 26 LATERALS AND UP TO 50 ORIFICES PER LATERAL
Your HIGHEST elevation lateral MUST be LATERAL 1:
(first orifice from lateral 1/2 of orifice spacing) Lateral 1: Lateral 2: Lateral 3: Lateral 4:
Length of each LATERAL,in feet? 53.13 53.13 5313 53.13
Diameter of each LATERAL,in inches(1.5 min)? 1.5 1.5 1.5 1.5
Elevation of each LATERAL,in feet? 97.55 97.55 97.55 97.55
Number of ORIFICES per lateral 12 12 12 12
Distance from Manifold to closest Orifice,in feet 1.94 1.94 1.94 1.94
ORIFICE SPACING,in feet 4.5 4.5 4.5 4.5
Diameter of ORIFICES,in inches?(D) 0.25 0.25 0.25 0.25
Square feet of leachfield per laterals(can ignore)
Maximurn number of orifices in any one lateral 14
Minimum lateral diameter 1.5
RESULTS
FRICTION CALCULATIONS(using Hazen Williams friction ft=Ld((3.55Qm/Ch(Dc1A2.63)))A1.85)
PRESSURE CALCULATIONS(using orifice dischage equation Q=11.79 D A 2 hdA.5
Lateral 1: Lateral 2: Lateral 3: Lateral 4:
LATERAL DISCHAGE(first approximation) 18.76 1836 18.76 18.76
MANIFOLD ORIFICE DISCHARGE 0.00
TOTAL SYSTEM DISCHAGE(first approximation) 75.03
TOTAL DISCHARGE PER LATERAL 18.85 18,85 18.85 18.85
DISCHARGE PER SQUARE FOOT OF LEACHFIELD #DIV/0! #DIV/0! #DIV/0! #DIV/0!
ORIFICE MAXIMUM DISCHARGE BY LATERAL 1.58 1.5B 1.58 1.58
ORIFICE MINIMUM DISCHARGE BY LATERAL 1.56 1.56 1.56 1.56
ORIFICE%DIFFERENCE DISCHARGE within LATERAL 13% 1 3°% 1,3% 1.3% 0.0%
MAXIMUM DISCHARGE LATERAL 18.85
MINIMUM DISCHARGE LATERAL 18.85
MAXIMUM DISCHARGE PER SQUARE FOOT #DIV/0!
MINIMUM DISCHARGE PER SQUARE FOOT #DIV/0!
•DIFFERENCE DISCHARGE for SYSTEM by orifice #REFI as percent of maximum orifice in system
•DIFFERENCE DISCHARGE for SYSTEM by laterals 0.0%as percent of maximum lateral in system
•DIFFERENCE DISCHARGE for SYSTEM by square feet as percent of maximum square foot in system
WEEP HOLE DISCHARGE(usually a 1/4"weep hole) 2.03 weep hole= 0.25 inch
VOID VOLUME IN DELIVERY PIPE 14.32
VOID VOLUME IN MANIFOLD 7.18
VOID VOLUME IN EACH LATERAL 4.88 4.88 4.88 4.88 o.00
TOTAL LATERAL VOID VOLUME 19.51
MINIMUM DOSE VOLUME(based on void volume) 97.54 to 195.08 MIN
ACTUAL MINIMUM IS BASED ON DAILY DESIGN FLOW
(weep hole,usually 1/4",riot counted for close,effluent is repumped during process and not counted for friction,except as fitting headloss)
TOTAL HEAD LOSS IN EACH LATERAL 0,72 0.72 0.72 0.72
MAXIMUM TOTAL LATERAL HEADLOSS IN SYSTEM 0.72
MANIFOLD HEADLOSS(center-fed unless manifold design) 0.04
DELIVERY PIPE HEADLOSS 0.54 w/delivery 3 inch diameter
FITTING LOSS(headloss`.15) 0.68 add extra head if fittings are more than absolute minimum
DISTAL PRESSURE HEAD 4.50
STATIC HEAD(OFF-SWITCH TO HIGH LATERAL/MANIFOLD) 4.10
HEADLOSS PUMP TO WEEPHOLE(assume T run) 0.04
PUMP MUST BE ABLE TO PASS SOLIDS AT 77.42 G.P M 10.62 FEET OF HEAD
or
After OTIS(network lasses=1.3`distal heard) 77.42 G.P.M. 15.08 FEET OF HEAD
60 BE(." h(WOOD DRIVE- NORTH ANDOVER, MA U1!'45 (978)686-1768-(888)359-7134 5-. FAX(978)685-1099
.�o,...�... ._.. .m........ ... ..,...�.�. .......W . ...,
NEW.. .. .. ._ ..... _....o�..- I N C . ...
August 22, 2005
Susan Sawyer "
North Andover Board of Health
400 Osgood Street
North Andover, MA 01845
Re: 1312 Salem Street, North Andover, MA
Local Upgrade Approval Request
Dear Ms. Sawyer,
The purpose of this letter is to request that the above referenced property be included on the
October 2005 Board ofl-lealth meeting agenda to discuss the following local upgrade approval
requests;
Local Upgrade Approval Required
1. Allow reduction in offset distance between the leach bed and a foundation wall from 20
feet required by "Title 5, section 15.211(1) to I3 feet.
2. Allow a 25% reduction in leach area from 785.71 square feet required 589.29 square feet.
If you have any questions or comments, please do not hesitate to contact this office.
Sincerely,
-I h�4—
l
Thomas E lector
Project Engineer
60 BEECHWOOD DRIVE-NORTH ANI)OV R, MA 01845-(97B)686-1768-(888)359-7645- F-AX(978)685-1099
BOARD OF HEALTI3
NORTH ANDOVE R� MASS. 01845 iii" IVED
978688-9540
APPLICATION FOR SOIL TESTS MAY 1 8 2005
TtJI�IG A( I t-I D E (AI I;ANDOVER
DATE: MAP&PARCEL: ffd '
rhAE N
LOCATION OF SOIL TESTS:
OWNER, I r V4 c�"=t �� E )L—S014 '3 TEL.NO.: 79-C
ADDRESS: t (Z jfi L r l `,j -Cjr
ENGINEER: h\ A� f �tX�Clr1Jrt, IN� II�(r.- TEL.NO.;
CERTIFIED SOIL EVALUATOR: ( >CeA 4M l�/ C_ 09 -t�U� �i2 Z i2t�vt,i�ic' K Gfit�G7���
Intended use of land: Residential Subdivision mgle Family Home Commercial
Is This:
Repair testing Undeveloped lot testing Upgrade for addition
In the Lake Cochichewick Watershed? Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests)
2. Plot plan
3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests
required for each disposal area. Fee of$360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass.Registered Sanitarian and Professional Engineers can design septic plans.
3. At least two deep holes and two percolation tests are required for each septic system disposal area.
4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative,
5. Full payment will be required for all additional tests within two weeks of testing,
6. Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the
location of all tests(including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This
N.A.Conservation Conunission Approval:
Date Received: Check Amount: Check Date:
C
CER T!RED FOUNDA WN PLAN
LOCATED IN .
SCAL .% 6nL DATE. U l
3L.GILES RL.,S
LAWRENCEa NORrHANDOVER
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(57.271 — I�1,92 �� 96,
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CERTIFY THAT rH OFFSETS` SHOWN .414E FOR THE USE OF-
OFFSETS �y,
SHOWN THE BUIL D/NO INSPECTOR ONLY, 8 SUCH
.I
CONFORM TO THE USE IS FOR DETERMINATION OFZONING
ZONING S Y L A W OF CONFORMITY OR NON CONFORMITY
r,jary g A-j� WHEN TAKEN
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Commonwealth of Massachusetts 1 t
-- - +
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City Town of AJOrh
=ta -A>1doJe,-
i
r Application r Local Upqrad,6A00tbvaJ
DEP has provided this form for use by local Boards of Health. Other farms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use.
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
5.404(1), is not feasible.
310 CMR 15.403(4) requires the system owner to provide a copy of the local upgrade approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.417.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information
Important:
When filling out 1. Facility Name and Address:
forms on the
Ga Neilson
computer, use y--------- ------- - - ---
only the tab key Name
to move your 1312 Salem Street
cursor-do not Street Address
use the return
key. North Andover MA 01845
City/Town State Zip Code
tab
2. Owner Name and Address (if different from above):
same as above
Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
Installation of new residential subsurface sewage disposal system_-_
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
Current residential sewage disposal system is in failure.
Form 9A-1312 Salem Street North Andover- rev. 5/02 Application for Local Upgrade Approval* Page 1 of 4
Commonwealth of Massachusetts
City/Town of Nor+k Av\ !over
Form 9A - Application for Local Upgrade Approval
iG^M
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 your
local Board of Health to determine the form they use.
A. Facility Information (continued)
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Leach field
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: Unknown
gpd
Design flow of proposed upgraded system 440
gpd
Design flow of facility: 440
gpd
B. Proposed Upgrade of System
1. Proposed upgrade is (check one):
® Voluntary ❑ Required by order, letter, etc. (attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection
2. Describe the proposed upgrade to the system:
Replacement of leaching facility and components.
3. Local Upgrade Approval is requested for(check all that apply):
® Reduction in setback(s) —describe reductions:
1. Request for reduction in offset distance between the leach bed and a foundation wall from 20 feet
required by Title 5, Section 15.211(1) to 13 feet.
® Reduction in SAS area of up to 25%: 589.29 25%SAS size,sq.ft. %reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft.
Form 9A-1312 Salem Street North Andover•rev.5/02 Application for Local Upgrade Approval* Page 2 of 4
Commonwealt of Massachusetts
City/Town of /Va °vt suer
Form 9A - Application for Local Upgrade Approval
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 your
local Board of Health to determine the form they use.
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(i)(1). The soil evaluator must be a member
or agent of the local approving authority.
High groundwater evaluation determined by:
Andrew McBrearty 6/8/05
Evaluator's Name(type or print) Signature Date of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
No other location available on the lot for the system size required. _
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
A1500 gallon Micro Fast Semitic tank is included in the design.
Form 9A-1312 Salem Street North Andover•rev.5/02 Application for Local Upgrade Approval* Page 3 of 4
CommonweaVr-l-k f Massachusetts
City/Town of A'gotler
Form 9A ® Application for Local Upgrade Approval
iG^M
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 your
local Board of Health to determine the form they use.
C. Explanation (continued)
3. A shared system is not feasible:
No available system in the vacinity.
4. Connection to a public sewer is not feasible:
Town sewer is not in the area of the property.
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
❑ Application for Disposal System Construction Permit
❑ Complete plans and specifications
❑ Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
D. Certification
"I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
8/22/05
—faciWy Owner's Signature Date
Benjamin C. Osgood, r., P.E.
(Agent for owner)
New England Engineering Services 8/22/05
Name of Preparer Date
60 Beechwood Drive North Andover
Preparer's address City/Town
MA 978-686-1768
State/ZIP Code Telephone
Form 9A-1312 Salem Street North Andover•rev.5/02 Application for Local Upgrade Approval* Page 4 of 4