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Home My WebLink AboutApplication - 81 SAW MILL ROAD 7/15/2003 Town of North Andover, Massachusetts Form No.a Oq "ORYN BOARD OF HEALTH P p ,y•b,, �.''' DESIGN APPROVAL FOR "SSACHl156�� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant �� Test No. Site Location I //� ✓ : Reference Plans and Specs. ®� /® ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. A CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. 7 C'1 -Z Town of North Andover 7 Charles Street North Andover, NIA 01845 SEPTIC PLAN SUBMITTAL DATE OF SUBMISSION: June 26,2003 ENGINEER: Peter M. Mirandi, R.S. Telephone#: 978-774-3001 Fax#: NA E-mail: PMMirandigaol.com HOMEOWNER NAME: Sam Narayanan. SITE LOCATION: 81 Sawmill Road NEW PLANS: YES $225.00/Plan X Check#: to be received (Includes 1"and one Re-Review Only) REVISED PLANS: YES $ 60°00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO NA LOCAL UPGRADE FORM INCLUDED: YES NO NA OFFICE USE ONLY DATE TO CONSULTANT: When the submission is complete(including check): 1. Date stamp plans 2. Complete the DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM form 3. Attach rile and route to the Health Director for review Page 1 of 1 °le hiaie, Pamela From: PMMirandi@aol.com - - Sent: Wednesday, July 02, 2003 11:42 AM To: pdellechiaie @townofnorthandover.com Subject: Re: Septic Plan Submittal Form for Town of North Andover .flee sepP c: pbin forrn, p&ora crw°d a H Oheir, rIrraw.unieriu.i. tfior� fzxc pt my b ,,I r:::ncirel r,efer io the su-ie Pe.l r° K n ar rnw~ssar4e daled 7/1/12003 9�O2 �4 AM i::cisfe ru S lauudca -(I )erne, voro r es: 85, or,31 Sa rniH? FIease change if incorrect. Thanks 7/2/2003 Page 1 of 'dleChieie, Pamela From: P'MMirandi @aol.com Sent: Tuesday, July 01, 2003 8:35 AM To: pdellechiaie @townofnorthandover.com Subject: Re: Septic Flan Submittal Form for Town of North Andover Dear Pameh, ,.I t ached is the ,5eqa fic Plcan Sacbl nit-lalFlacYn for 85 W WI Road. A check hc s cd e.rad 1Aee n forwarded la you .from Wer Real Q .nOW Management, nt, Ptic.a.nm mVWy me imma.MPra n; nf .l1his pr'oces's is caul of order in an maa:n , .V'hc.:ank you for ymn, a��,issisi,a:ana::anw°; in ° i°Q i s ma 1. er Ira ier.° WK 7/1/2003 Fa—pw — Massachusetts epartment of Environmental Protection Bureau of Resource Protection —Wastewater Management Program { ~ Form 9A - Application for Local Upgrade ApprovaI Required by 310 CMR 15°403(1) 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. 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 a septic system constructed in accordance with either the 1 978 Code or 310 CMR 1 5.000. A. Facility Information Important: When filling out 1. Facility Name and Address forms on the computer,use Rater Real Estate only the tab key Name — to move your 81 Sawmill Road cursor-do not use the return Street Address key. North Andover MA 01845 ---- ----- ----- ------ — ---- ----- City State Zip Code rah 2. Owner Name and Address: Sam Narayanan/Pater Real Estate F.O. Box 13.31 Name Street Address Derry NH -- -- ------- - -- - --- City State 03038 603-437-0771 Zip Telephone Number 3. Type of Facility (check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 bedroom dwelling 5. Type of Existing System: ® Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): As form 9-A d rev.5/02 Application for Local Upgrade Approval• Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection — Wastewater Management Program Form 9A - Application for Local Upgrade Approval Required by 310 CMR 15.403(1) A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: 440 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: Replace the existing SAS and septic tank with a new 1500/1000 gallon combo septic tank/pump chamber and a leaching field . 3. Local Upgrade Approval is requested for: ❑ Reduction in setback(s)—describe reductions: 9-foot reduction from the 20-foot required setback between SAS and foundation wall. ® Percolation rate for 30 to 60 min./inch: 33.3 min./inch ❑ Reduction in SAS area of up to 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 ❑ Relocation of water supply well (explain): form 9-A•rev.5/02 Application for Local Upgrade Approval* Page 2 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection — Wastewater Management Program Form 9A - Application for Local Upgrade r v l Required by 310 CMR 15.403(1) ❑ 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 evaluatormustbe a member or agent of the local approving authority. High groundwater evaluation determined by: Peter M. Mirandi, R.S. 05-22- 03 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: insufficient area 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: expense 3. A shared system is not feasible: no neighbors to collaborate at this time 4. Connection to a public sewer is not feasible: Not available form 9-A•rev.5/02 Application for Local Upgrade Approval* Page 3 of 3 -- Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wastewater Management Program Form 9A - Application r O Required by 310 CMR 15.403(1) 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." September 14, 2003 F acility Owner's Signature .. ,- Date Sam Narayanan Print Name Peter M. Mirandi, R.S. April 28, 2003 Name of Preparer Date 30 Washington Street Danvers Preparer's address City/Town 01923 973-774-3.001 State/ZIP Telephone -- NOTE: 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, Division of Watershed Management, upon issuance by the local approving authority and before commencement of construction. form 9-A•rev.5/02 Application for Local Upgrade Approvals Page 4 of 4