HomeMy WebLinkAboutApplication - 730 WINTER STREET 2/14/2012 Lt./Y N OF NORTrl..ANDOVER �oftYH
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Ofllc('of COIVINIUNI'rY DE C,LOPME,NT ANI) SERVICES
HEALTH DEPARTMENT
1500 OSGOO D STREET; BUILDING 20- StJ"'E 2-36 ""°•
NOI7 TH ANDOVER, MASSACHUSETTS 01845 �r"sackus�`a�
975.6 88.9540—Phone
Susan Y.Sawyer,IMPS/RS 978.68$.5476—FAX
Public health DitTetor E-iNIAIL: healtlidept fiittoivn(afi)otlliandover.conx
AVEBSUE:hltn'/r' tvw.to).Nmof'nortliandatirer.conx
SEPTIC PLAN SUBMITTAL FDIC M �� IK<<,,,���
r k
Date of'Submission. February 14, 2012 ; . „� 4 Z01Z
Site Location:ton:
7301 Winter Street, Andover
� I r bt kdr;�u r �hf'6fI Itl �
Engineer:George Zambouras - Atlantic Engineering
New Plans"? YesX $225/Plan C.hecl4# (includes IS`submission and one re- �
review only)
J
Revised I'lans7Yes $75/flan Check#
Site Evaluation Forms Included? Yes_ No ,� ICI . °
Local Upgrade Form. Included? Yes
Telephone 4.
978-352-7870 Fax 11•978-352-9940
E-mail:atlantic84@cs.com
Homeowner
Name:Diamond Realty Trust,William Bonnell
OFFICE USE ONLY
When the submission is complete(including check):
_,. /' _Date stamp plans and letter
n'/`"' Complete and attach Receipt
Copy File;Forward to Consultant
Enter on Log Sheet and Database
t-d 0b66-Z9C-9Z6-t e.loldeld ueellco d6Z40 Zt bt qed
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Tuesday, February 14, 2012 1:29 PM
To: 'ATLANTIC84 @cs.com'
Cc: Sawyer, Susan
Subject: RE: Soil Application 730 Winter St
Hello,
In addition to the septic plans that William Bonnell dropped off today,I need you to submit forms 11 and 12 for the soil
testing information,as well as any lua forms as needed. You may scan and email them to me,or fax them-attention
Pamela. Thank you.
Best Regards,
Pamela DelleChiaie
Departmental Assistant I Community Development Division I Health.Department Town of North Andover-1600
Osgood Street I Bldg 20 1 Suite 2-36 1 North Andover,MA 01845 T Office-978-688-9540 11 Fax-978-688-8476
lWebsite-http://www.townofnorthandover.con-dPages/index
--Original Message-----
From: F [ANC IC m@)cs cons �!111iJto A..I I_AN I tt 8,40-bcs c o 1t�
...... .....
Sent:Thursday,December 08,201.110:50 AM
To: DelleChiaie,Pamela
Subject: Soil Application 730 Winter St
Pamela
Attached is the soils application for the repair at 730 Winter Street. I have attached the application,plot plan and deed.
It is my understanding that you already have the required check.
Let me know when we can schedule the testing.
Thank you
John.B.Paulson
President,P.L.S.
Atlantic Engineering&Survey Cons.,Inc.
978-352-7870 office
978-352-9940 fax
978-815-7297 cell
Adant.ic�84(41 c.s.com(/111"'i�fl-)
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices
and officials are public records. For more information please refer to:ht t.p.//v✓u r c c t ll cn<a lisfl>1 /I 1wc�c1,, k t.¢r1.
Please consider the environment before printing this email.
i
Commonwealth of Massachusetts
-- CiV Town of
Form 9A ® Application for Local Upgrade Approval
yy SJ,% 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.
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
15.404(1), is not feasible.
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 15.415.
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 Diamond Realty Trust, i4illiam Bonnell
computer,use
only the tab key Name
to move your 730 winter Street _
cursor-do rot SVeet Address
use the return
key. Andover AfA 01845
C Cityrrown State Zip Code
1,
2. Owner Name and Address(if different from above):
`3 Diamond Realty Trust, William Bonnell 14 Lcndor_ St. , Apt. 2
Name Street Address
Lowell MA
City/Town State
01852 978-888-7134
Zip Code Telephone Number
3. Type of Facility(check all that apply):
❑ Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
4 bedroom single family home
S. Type of Existing System:
❑ Privy ❑ Cesspool(s) F Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
pits (existing), Presby System (proposed)
15form9a.doc•rev.7106 Applicatton for Local Upgrade Approval,Page 1 of 4
Z-d 0t66-Z9`;-9L6-i, a.ioldeld ueello0 d6Z40 Z I, V6 qaj
Cam\ Commonwealth of Massachusetts
City/Town of
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.
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design Flow of existing system: 440
gpd
440
Design flow of proposed upgraded system gpd
Design flow of facility: gpd 440
B. Proposed Upgrade of System
1. Proposed upgrade is(check one):
❑ voluntary ❑ Required by order, letter,etc. (attach copy)
El Required following inspection pursuant to 310 CMR 15.301: 9!12/2011
date of inspection
2. Describe the proposed upgrade to the system:
462 square foot Presby Environmental septic field (gravity)
3. Local Upgrade Approval is requested for(check all that apply):
❑ Reduction in setback(s)—describe reductions:
❑ Reduction in SAS area of up to 25%: SAS slze,sq.ft. %reduction
P-1 Reduction in separation between the SAS and high groundwater:
1 toot
Separation reduction ft
4
Percolation rate mindinch
4 ft. down to 3 ft.
Depth to groundwater ft
t5form9a.doc•rev.7106 Application for Local Upgrade Approval•Page 2 of 4
0'd Ob66-ZW-2M-1, e.loldald ueelloD d6Z 0 z6 b6 clad
Commonwealth of Massachusetts
City/Town of
Form 9A — location for Local Upgrade— Application pJ Approval
QEP 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):
❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater
❑ Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
❑ 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)(h)(1). The soil evaluatormustbe a
member or agent of the local approving authority.
High groundwater evaluation determined by:
John Paulson (SS 1871) 12/14/2011
Evaluator's Name(type or print) Signature Date of evaluation
G. 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:
Witheout tllis variance a pump system would need to be designed and additional
f_11 and grading in a buffer zone would be required.
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
the system is an alternative system
t5form9a.doc-rev.7/06 Application for Local Upgrade Approval*Page 3 of 4
b'd Ob66-Z9C-2M-1, woldeld uaellcC d6Z40 Z1, Vl, qej
Commonwealth of Massachusetts
City/Town of
-^ 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.
C. Explanation (continued)
3. A shared system is not feasible:
n/a
4. Connection to a public sewer is not feasible:
not available
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."
2/14/2012
Facility Ovmer's Signature Date
William Donnell, Diamond Realty Trust
Print Name
George Zambouras PE, Atlantic Engineering 2/14/2012
Name of Preparer Date
97 Tenney Street Georgetown
Preparer's address Cityrrmhn
MA 01833 978-352-7870
State/ZIP Code Telephone
t5formga.doc•rev.7106 Application for Local Upgrade Approval* Page 4 of 4
9'd Ot,66-Z9E-9Z6-1, e_loldeid uealloC dOC:l,0 Zt b6 qej
Feb 14 12 12:48p Colleen Piepiora 1-978-352-9940 p.1
No. FEE
�CON 1�Ii ONTWLALTI-I OT t IASS4CITQTSETTS
Board of Health, 141y Rl/GG 11Z51t k1A.
A PPLIC�HON FOR DISPOSAL SYSTEM C NSTPUCTI0N P0- IMIT
Application fora Permit to Constructo e) Repair( ) Upgrade Abandon O - ®Complete System O Individual Components
Location 730 WW Gr/L ST Owner's Name p/�jM0y0 READ) J�AS J
,Nfap/Parcel# (J $ Address Iq [Iloa4e ST LOf,/GiC MA
Lo t# Telephonck '17 e; 71-3 '',...........
Installer's Name Desigaer's Name
,t��L./j/,/T(G
Address Address '77 TrV114Y S% TC N N
Telephone# Telephoneg y7 y, 3 f 7, 'T$7,?
Type of$uilding S F�. Lot Size q39 9 6 _ sq.ft.
Dwelling-No.of Bedrooms Garbage grinder i, )
Other-Type of Building No.of persons Showers( ),Cafeteria( )
Other Fixtures
Design Flow(mrn.r I . ed) gpd Calculated design flow Design flow provided gpd
Plan: Date / _LO/- Number of sheets Z Revision Date
Title 73a PVOVT,5�e ST
Description ofSoil(s) �,4/✓/�y A M YY
Soil Evaluator Form No. Name of Soil Evaluator✓6d// d/ Date of Evaluation (7,
st 187I
DESCRIPTION OPREPAIRS ORALTERATIONS
The undersigned agrees to install the above descaibed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
No. COMMONWEALTH OF MASSACIIUSETT'S FEE
Board of Health, ,lv24.
C£RTITICATE OF COMPUANCE
Description of work: D Individual Component(s) D Complete S)Ntem
The undersigned hereby certify that the Sewage Disposal System; Constructed O,Repaired O,Upgraded( ),Abandoned( )
by.--
at
has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved design plans/as-built plans relating to
application No._ dated Approved De6gri Flnv; (gpd)
Installer
Designer: Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that(lie system will Function as designed.
.(� q�/(�(� 3 7 �i� r� �q �p'7T r FEE
COIF MOIL-WT-ALTII t}�ll' W63S �CHUSUTS
Board offy"alth, ,'IfA.
DISPOSAL SYSTEM CONSTRUCTION P-TWIT
Permission is herebygranted to; Construct( ) Repair( ) Upgrade( ) Abandon( )an individual sewage disposal system
at as described in the application for
Disposal System Corrstructi—Permit No. ,dated
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
ton,1,E5 Riv.E11M A V SUIbn co,30staL rAA Date Board of Health
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