HomeMy WebLinkAboutCorrespondence - 1440 SALEM STREET 11/12/2008 oRr'
0
KOCHAt 4wvd ws "
SS h9U5
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
John Daghlian
1440 Salem Street
North Andover, MA 01845
Date: November 12,2008
Re: Application for: addition;garage,fancily room, tivorksh.op at 1440 Salem Street
Dear John,
Your application for the addition has been reviewed by the Health Department. The application
was deficient for the reasons we discussed on the phone. Please submit the requested items so
that we may assist you in moving forward in the process:
1. x Missing inforination
2. x Passing Title 5 inspection of septic systcrn required
3. ❑ Location of structure not acceptable
4. ❑ Undersized septic system
To address the problem(s):
If#1 is checked, please supply:
a. Hoor plan of'existing hoi-ne .._ all morns (plan for addition is sufficient already
unless sonne existing roonrs are changing; in size)
1 . `submit plot plan shoring house, septic system and proposed project in scale.
Distances must ineet"l"itle V requirements. l.,eaching area nrrrst be >tl teet ft•om yr
t foundation and the tank rnust be 10 feet from the loundation.
If#2 is checked:
a. l lave the septic system inspected by a certified 'ritie 5 inspector to determine
whether it is operating properly:
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com
Please feel free to call the Health Office at 978®688®9540 with any questions you may have,
Sincerely,'
Susan Sawyer, REHS/ S
Health Director
Cc: Building Department
File
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Commonwealth of Massachusetts
- --------- City/Town of
- -- Form 9A - Application r v l
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 desig r. above-the- i t,in .ap�,raved
capacity of an on-site system constructed in accordance with either the 1978 W 15. 00.
A. Facility Information AUG 0 4 x"00
Important:
When filling out 1. Facility Name and Address: RAAQ',�OF NORI�. 4 sNDCV ER
foms on cormputert use o_1-J c� u°'f64 AA DG PA& C NT....
only the tab key Name
to move your
cursor-do not - -use the return Street Addre s r
key. A
City/Town State Zip Code
2. Owner Name and Address (if different from above):
Name ! Street Address
City/Town St to _
Zip Code Telephone Number
1 Type of Facility(check all that apply):
Residential ❑ Institutional ❑ Commercial ❑ School
4. Describe Facility:
t
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
-
t5form9a.doc>rev.7/06 Application for Local Upgrade Approval* Page 1 of 4
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincerely,
Susan Sawyer, REHS/RS
Health Director
Cc: Building Department
File
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
FORTH
q1 E ,
0
O cocci<.iwK. 1•
��SSAC HUS���y
PUBLIC HEALTH DEPARTMENT
Community Development Division
October 13, 2009
John Daghlian
1440 Salem Street
North Andover, MA 01845
RE: Septic System Design, 1440 Salem Street,North Andover, Map 106A, Lot 20
Dear Mr. Daghlian,
The North Andover Board of Health has completed the review of the septic system design plan
for the above referenced property, submitted on your behalf by Frank Nichols, dated September
8, 2009, last revision date October 7, 2009 received on October 9, 2009.
The design has been approved for use in the construction of an onsite septic system. The 440
gallons per day (max 4-bedroom or 9 room total), has been approved for use in the construction
of a replacement, Title V, subsurface disposal system. This approval is valid for two years from
the date of the approval in accordance with current local regulations and during this time a
licensed septic system installer must obtain a permit and complete this work, and a Certificate of
Compliance be endorsed by the installer, designer and the Town of North Andover.
The approval includes a Local Upgrade Approval for the request to have only one test pit within
the area of the proposed system and a reduction of the 12 inch separation of the ground water
elevation and the tank inlet and outlet tees. Please keep a copy of the attached document for your
records.
This approval is subject to the following conditions:
1. If site conditions are found in the field to be different from those indicated on the design plan
and/or soil evaluation, the originally issued Disposal System Construction Permit is void,
installation shall stop, and the applicant shall reapply for a new Disposal Systems
Construction Permit.
2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic
system installer or other representative to ensure that all other state and municipal
requirements are met. These may include review by the Conservation Commission, Zoning
Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector.
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
The issuance of a Disposal System Construction Permit shall not construe or imply
compliance with any of the aforementioned requirement
Please note that this system will be equipped with a Zabel Filter on the outlet tee. This filter must
be maintained annually according to manufacture specifications.
Your effort to provide a properly functioning septic system for your dwelling is appreciated. The
Health Department may be reached at 978-688-9540 with any questions you may have.
Sincerely;
` S, san Y. Sawyer, REHS/
Public Health Director
Encl: list of licensed septic system installers
Cc: Frank Nichols, P.E.
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
Commonwealth of Massachusetts
City/Town of
u � Y
a
Local Upgrade Approval
Form 913
41M Svy`�
DEP has provided this form for use by local Boards of Health if they choose to do so.
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility Information
Important:When
filling out forms 1. Facility Name and Address
on the computer,
use only the tab John Daghlian
key to move your Name
cursor-do not 1440 Salem Street
use the return
key. Street Address
North Andover MA 01845
Q City/Town State Zip Code
2. Owner Name and Address (if different from above):
Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility (check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow per 310 CMR 15.203: 440
gpd
5. System Designer: Francis Nichols ® PE ❑ RS
Name
PO Box 185 Carver MA, 02330
Address City/Town State,ZIP
B. Approval
1. Local Upgrade Approval is granted for:
❑ Reduction in setback(s)—specify:
❑ Reduction in SAS area of up to 25%:
SAS size,sq.ft. %reduction
1440 Salem St 9b 10.13.09•rev.7/06 Local Upgrade Approval, Page 1 of 2
Commonwealth of Massachusetts
€ � a
City/Town of
a a
Local Upgrade Approval
Form 9B
�M
B. Approval (continued)
❑ 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):
® 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
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
')
North Andover Health Dept t
Approving Authority
Susan Sawyer 10/13/09
Print or Type Name and Title Signature Date
1440 Salem St 9b 10.13.09•rev.7/06 Local Upgrade Approval* Page 2 of 2
Mlle hl ie, Pamela
From: DelleChiaie, Pamela
Beat: Tuesday, October 13, 2009 11:36 AM
To: 'jdaghlian @newtonma.gov'
Cc: 'fnichols @newtonma.gov'
Subject: Septic- 1440 Salem Street-Plan Approval
Attachments: SKMBT_60009101311190.pdf
Importance: High
Hello,
Attached is your septic plan approval letter. Please call the office if you have any further questions.
Best regards,
I'rarrre:�l,r 17c°11cC:frirc�:�
f ealth Delyare-rr ant Assista tit
-FOWN 01' NOR,rH ANDOVE1.t.
Health Department
1600 Osgood.Str.•e.et.
Building 20;Suite 2-36
North.Andover,MA 01845
97&688.9540- Phone
97&688.8476- Fax
L)de11echiaie @townofrrortliarici.over.coi,n - E,rnail.
11 t�:0 lwww.towiiofrrorr:li,,iiiclovc r.c,c) n -Websit:e
t�Tcrtcrs;
ffc.•opivr1 to B0 1:f 16fc rr b r,s--Refixrc nc e C.61)y Only _110 response r°cquCste cl at this trrrrc,
Front: noreply @townofnorthandover.com [mailto:noreply @townofnorthandover.com]
Sent: Tuesday, October 13, 2009 12:19 PM
To: DelleChiaie, Pamela
Subject: Message from KMBT 600
Frank iu hols, RE
Consulting Civil Engineer
P.O. Box 185 Ph: 508-560-7411
Carver, MA 02330 Fax: 508-866-7024
October 7, 2009
Susan Y. Sawyer, Health Director C
1600 Osgood Street
Buildin 20; Suite 2-36 ����14( ,r N()krHM"fl)(YA >>
N. Andover, MA 01845
Re: Response to Review Comments — 1440 Salem Street (John Daghlian)
Ms. Sawyer:
In response to your review comments I have revised the plan and respectfully submit my
revisions for your approval. The review items are in Italics and have been paraphrased.
Specifically:
Comment1: One test pit within the proposed leaching area — DEP approved Form 9A has been
submitted for your review and approval
Comment 2: Benchmark within 50'-75'of the proposed components— a second benchmark
within 75' of the system components has been added to the plan
Comment 3: Magnetic Marking Tape— a note specifying this requirement has been added to
the plan
Comment 4: Show all watercourses or wetlands within 150'—there are no watercourses or
wetlands within 150' of the proposed system components. A note has been added to the
revised plan.
Comment 5: Provide a Disclaimer relative to no wetlands within 100'— a disclaimer has been
added to the revised plan
Comment 6: Irrigation well within 100'of the Proposed Leaching Field— the proposed leaching
field has been shifted to achieve a 100' separation from the existing irrigation well
Comment 7: Breakout Elevation has not been met—the proposed grading has been revised to
' comply with the 15' breakout requirement
, Comment 8: Soil Logs for TP's 3 & 4—test pits 3 & 4 as identified on the submitted plan were
,
� excavated only to a depth of 3' minus. At this depth the original leaching system was
encountered. The test pits were abandoned and not logged.
Comment 9: The Elevation & Depth of Percolation test was not provided—the percolation
depth and relative elevations have been added to the revised plan.
Comment 10: Effluent Tee requirement, Maintenance & Access Cover— a Zabel Filter, Model
A1800 has been added to the plan. The pump chamber detail was revised to include a 24"
diameter watertight access cover to grade. A note relative to the annual maintenance has also
been added.
Commentl 1: Watertight Tanks— plan notes have been revised to indicate all concrete
structures are to be watertight (Sewage Disposal Note 3 & Pump Chamber Note 2)
Comment 12: Separation Distance between ESHWT& Tank Inverts— please find attached
DEP approved Form 9A requesting a Local upgrade Approval for a reduction in the separation
distance
Comment 13: Tank Loading Specification—the plan notes have been revised to specify that
both the septic tank & pump chamber are rated for H-10 Wheel Loading
Comment 14: Building Sewer Installation requirements— a note has been added to specify the
proper installation of the sewer line in full compliance with Title 5
Comment 15: Invert Elevations of DBOX— a note has been added to specify that all outlets of
the DBOX are to be installed at the same elevation
Comment 16: Outlet Pipes from DBOX— a note has been added to specify that all outlet pipes
exiting the DBOX are to be level for a minimum of 2'
Comment 17: Model Number of Shea DBOX— the plan has been revised to indicate the
correct model number of the Shea DBOX
Comment 18: Pump Performance Curve— please see attached.
Comment 19: Manual Operation Switch requirement— Pump Chamber Note 2 has been
revised to specify the manual operating switch requirement
Comment 20: Pump Chamber Access Cover—the pump chamber detail has been revised to
include a 24" diameter watertight access cover to grade
Comment 21: Field excavation to extend 6"into natural soil—the field cross section detail has
been revised to meet this requirement
trust that the revised plan and attachments address your comments. If however you should
need additional information please feel free to contact me.
Sincerely,
r
ran�e ichols, PE
Lic. No. 41554
Cc: John Daghlian
[gGOULDS PUMPS Submersible
Sewage Perm
IMMININEEMEM
"'886
6
I
s
r Prosurance available for residential applications.
APPLICATIONS against component damage starting torque. w Power Cable:Severe duty
Specifically designed for the on accidental reverse rotation. •Built-in overload with rated,oil and water resistant.
following uses: w Fasteners:300 series automatic reset, Epoxy seal on motor end
•Homes stainless steel, •%and%HP—16/3 SJTOW provides secondary moisture
•Sewage systems w Capable of running dry with 115V or 230V three barrior in case of outer jacket
•Dowatering/Effluent without damage to prong plug. damage and to prevent oil
•Water transfer components. •%and 1 HP—14/3 STOW wicking.20 foot standard
w Designed for continuous with bare leads. with optional lengths
SPECIFICATIONS operation,when fully Three phase(60 Hz): available,
submerged, •Overload protection must be Motor Cover 0-ring:
Pump: provided In starter unit, Assures positive seating
•Solids handling capabilities: o Y2-1 HP—14/4 STOW with against contaminants
2"maximum, MOTORS bare leads. and oil leakage.
•Discharge size:2°NPT. w Fully submerged in high w Bearings:Upper and lower w Consult factory for infornia-
•Capacities:up to 185 GPM, grade turbine oil for lubrica- heavy duty ball bearing tion on 575 V models.
•Total heads:up to 30 feet tion and efficient heat construction,
TDH, transfer.All ratings are within w Designed for Continuous AGENCY LISTINGS
•Temperature: the working limits of the Operation:Pump ratings are ° "
104•F(4000)continuous motor. within thematar Tested to UL 710ond
140OF(6000)Intermittent, csAaz.asoesie1 dada
•Soo order numbers an w Class B Insulation, manufacturer's recommended By Caution slandmds
Singlo hase 60 Hz: working limits,can be c us 5
reverse side for specific HP, •All single phase models operated continuously
voltage,phase and RPM's feature capacitor start without damage when fully Goulds rumps is tso oaot�riou�si�;rml,
available. motors for maximum submerged.
FEATURES Mans FEET
16 c0........ _.. _. ..
i MODEL 3886
w Impeller.Cast Iron,semi 12"S
open,dynamically balanced, -- RPM 1725
non-clop with pump out 40 s
vanes for mechanical seal —* 10GPM
00
protection.Optional Silicon
10
bronze Impeller available, wst
w Casing:Cast iron volute WS07E
type for maximum efficiency, wsriso *-
Designed for easy installation
on A10-20 slide rail.
w Mechanical Seal:SILICON n wsoan
CARBIDE VS.SILICON
f
CARBIDE sealin g faces for
superior abrasive resistance,
stainless steel metal parts,
BUNA N elastomers. o o _, .. .
20 40 co 80 too 120 140 X00
w Shaft:Corrosion-resistant t t — t w
stainless steel,Threaded '" ° o ro is zo CAPA Y 30 ss 4„
design,Lockout on three Goulds Pt11'1'tl
phase models to guard
��.ro tr.�.��.f"Pam�"� � ,rt r �..,._ o
C..... .... IT Irr;ltt tits
f NORTH
�9SSACHUSEt�
Health Department
September 25, 2009
Francis A.Nichols, P.E.
Frank A. Nichols, P.E. Consulting Civil Engineer
P.O. Box 185
Carver, MA 02330
Re: Subsurface Sewage Disposal System Plan for 1440 Salem Street,Map 106A, Lot 20
Dear Mr. Nichols:
The proposed wastewater system design plan for the above site dated September 8, 2009 and
received on September 18, 2009 has been reviewed. Unfortunately,the plan cannot be approved
until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or
North Andover regulation that.is not met by this design follows each item.
1. There is only test pit in the proposed soil absorption system area. A Local Upgrade
Approval for only having one test pit in the soil absorption system area must be requested
(3 10 CMR 15.405(k)).
2. A benchmark within 50'-75' of the proposed system components is required (3 10 CMR
15.220(4)(q)).
3. Please specify all system components shall be marked magnetic marking tape (3 10 CMR
15.221(12)).
4. Please show all watercoarses or wetlands within 150' of the system(NA 8.02(r)).
5. Please add wetland disclaimer if there are no wetlands within 100 feet of the proposed
leaching facility(NA 8.02(s)).
6. A 100 foot setback distance is required from the existing irrigation well (NA 5.02).
7. The breakout elevation is not met on the down slope side of the proposed leaching
facility. Please revise the finish grading to meet the breakout requirement(3 10 CMR
15.255(2)).
8. Please provide the soil logs for test pits#3 and#4 (NA 8.02 (n)).
9. The elevation and depth of the percolation test was not indicated (NA 8.02(n)).
10. An effluent filter is required when use a pump chamber(3 10 CMR 15.23 1(10)). Please
indicate to the brand and model to be used. Also note the required annual maintenance
necessary(3 10 CMR 15.227(7)). Please depict the access cover above the septic tank
outlet at finish grade as required with an effluent filter(3 10 CMR 15.227(7)).
11. Please indicate that the septic tank and d-box shall be watertight(3 10 CMR 15.221(1)).
1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1
Building 20;Suite 2-36 E-Mail: healthdept @townof north and over.corn
North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476
12. It appears that the septic tank and pump chamber inverts provide less than a 12 inch
separation to the ESHWT of 100.00'. Please propose a Local Upgrade Approval for less
than 12 inch separation between the tank inverts and the ESHWT(3 10 CMR 15.227(5)).
13. Please indicate whether the septic tank and pump chamber are H-10 or H-20 loading (3 10
CMR 15.226(3)).
14. Please provide notes that the building sewer line shall have watertight joints,pipe laid on
a compact firm base and pipe laid on continuous grade in a straight line (3 10 CMR
15.222(5-8)).
15. Please provide a note that all the outlets of the d-box shall be at the same elevation(3 10
CMR 15.232(3)(b))•
16. Please provide a note that all the outlets of the d-box shall be level for the first two feet
(3 10 CMR 15.232(3)(c)).
17. The SHEA d-box model number references a 6 outlet d-box. Please depict the correct
model number.
18. Please provide the pump performance curve for the proposed pump (3 10 CMR
15.220(4)(r))•
19. Please indicate that a manual operating switch shall be provided (NA 12.01).
20. The access cover above the pump chamber outlet is required to be at finish(3 10 CMR
15.231(5)).
21. The excavation of the leaching facility is required to extend 6" into the natural soil (NA
9.02).
Please feel free to contact the office with any questions you may have. We look forward to
working with you to obtain a wastewater treatment and dispersal system which will be in
compiiaiivv with all reg'uiati�in0 and as.s---protection of pub, health tnuid the environment
of
North Andover.
Sincerel ,
Susan Y. Sawyer, REHS/RS
Public Health Director
cc: Rev. Arshag Daghlian
File
9a R-r
P.ID
ayam 4
cocw,ena K. n
&S A u
PUBLIC HEALTH DEPARTMENT
Community Development Division
John Daghlian
1440 Salem Street
North Andover, MA 01845
September 22, 2009
Re: Application for: addition garage,family room, workshop at 1440 Salem Street
Dear Mr. Daghlian,
On November 12, 2008 a review letter was sent to you in regards to the building permit
submitted for your property listed above, In response to the concerns outlined in the letter, you
engaged an engineer to begin the process of installing a new septic system. Soil tests were
preformed and the Health Department received the septic plans on September 21, 2009. In
addition, today an email was sent by you indicating your intention and desire to move forward
with the installation in 2009.
With receipt of your intent in writing, the Health Department has considered your request to
begin construction on the proposed addition prior to the septic plan approval. Please note the
plans have been sent to our consultant for review and generally take two weeks to review,
although regulation allows for 45 days. The Health Department appreciates your effort in this
matter and sees no issue with signing the "Form U" at this time.
Below is a link to the approved septic installers, but note that it has not been updated with the
2009 information. Most have renewed, however please be sure to verify that any installer you
hire has a 2009 license to install in this community.
fit t} :OOwv✓vLY ( nofni rtlLancIove�,.q>r�/l'a:F�;s/IJ ttrlc verb l l althl pticirrstallet s pcl
Since1' ly,
f
Susan Sawyer, REHS/RS
Public Health Director
Cc: Gerald Brown, Inspector of Buildings
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnortliandover.coni
Sep 22 09 11 : 32a Dpw nDMIN
0177961 050 pm2
Frank
Consulting Civil Engineer
P.O.Box 185 Ph:508-560-7411
Carver, MA 02330 Fax:508-866-7024
September 21, 2009
Susan Y.Sawyer, Health Director
1600 Osgood Street
Building 20;Suite 2-36
N. Andover, MA 01845
Re:local Upgrade Approval Bequest—1440 Salem Street(John Daghlian)
Ms. Sawyer:
On behalf of my client,John Daghlian, I respectfully request the following Local Upgrade Approval
pursuant to Section 15.404 (Maximum Feasible Compliance)and Section 15.405 (Contents of Local
Upgrade Approval)of Title 5 of the State Environmental Code (DEP Form 9A attached). Specifically:
Section 15.405(1J(k)—To allow the Proposed Leaching Field to be designed utilizing one deep-
hole excavation and not the required two holes.
This upgrade request is necessary due to current site conditions which prevented the excavation of the
second deep-hole within the proposed leaching field footprint.
Sincerely,
Fr k Nichols, PE
Lic. No. 41554
Cc:John Daghlian
Sep 22 09 11 : 32a DPtd RDMIN
6177901050 p. 3
Commonwealth of assachuse
City/Town of North Andover
Form 9A - Application
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(9), 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 1976 Code or 310 CMR 15.000.
A. Facility Information
Important:
When filling out 1. Facility game and Address:
forms on the
computer,use Rev.Arshag Daghlian
only the tab key Name
to move your 1440 Salem Street
cursor-do not
use the return Street Address
key. North Andover MA 01645
Cityfrown State Zip Code
r�
2. Owner Name and Address(if different from 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:
Single Family Residence
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) Conventional ® Other(describe below):
6. Type of soil absorption system(trenches, chambers, leach field, pits, etc):
trenches
FORM 9A.doc•rev.7106 Application for Local Upgrade Approval,Page 1 of 4
Sep 22 OS 11 : 33a DPW RDMIN 617758 1050
p. 4
Commonwealth of Massachusetts
INCEff 1001 City/Town of North Andover
Form 9A - Application
4 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
Design flow of proposed upgraded system 455
gpd
Design flow of facility: 440
gpd
B. Proposed Upgrade of ystem
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:
Applicant proposes to install a new 1500 gallon capacity septic tank, 1000 gallon capacity pump
chamber and a conventional leaching field of 1,820 sq. ft.
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 size,sq.ft. Rio reductlon
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft —
FORM 9A.doc•rev.7/06 Application for Local Upgrade Approval*Page 2 of 4
Sep 22 OS I1099a DPW nDMIM 61779610601
P. 5
Commonwealth of Massachusetts
City/Town of (North Andover
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 ra a 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 evaluator mustbe a
member or agent of the local approving authority.
High groundwater evaluation determined by:
Evelualor'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:
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
FORM 9A.doc•rev.7106 Application for Local Upgrade Approval,Page 3 of 4
Sep 22 09 11 : 33a DPW nEIMIN 6177961050
p. 6
Commonwealth of Massachusetts
Cityrrown of North Andover
Form 9A — Application r 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:
4. Connection to a public sewer is not feasible:
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."
V`;lnf-_,+-A�, , iz� -r -�ter- 9121109
Facility OWne f`s Sigtrature _ Date
Rev Arshag D 'ghlian
Print Name
Frank Nichols, PE 901!09
Name of Preparer Date
PO Box 185 Carver
Preparers address City/Town
MA 102330 508-560-7411
State/ZIP Code Telephone
FORM 9A.doc rev.7/06 Application for Local Upgrade Approval*Page 4 of 4
Commonwealth of Massachusetts
- — City/Town of North Andover
Form 9A - Application
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.
R E CE I%
A. Facility Informati on
Important:When
filling out forms 1. Facility Name and Address:
on the computer, I Owl 1 0I 1')r�i�I I V �i�l�a�"a`/Ek"'. :
use only the tab John Da hlian , I i I�A i�key to to move your Name °
cursor-do not 1440 Salem Street
use the return --- --
- --------- --------- ----------------
key. Street Address
North Andover MA 01845
---------------- -----------------------------
r�s City/Town State Zip Code
2. Owner Name and Address(if different from 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:
Single Family Residence
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
trenches
t5form9a for ESHGWT Sep.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4
Commonwealth of Massachusetts
City/Town of North Andover
Form Application r ade Approv
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
9Pd
Design flow of proposed upgraded systems
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:
Applicant proposes to install a new 1500 gallon capacity septic tank, 1000 gallon capacity pump
chamber and a conventional leaching field.
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 size,sq.ft. %reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction ft
Percolation rate min./inch
Depth to groundwater ft
t5form9a for ESHGWT Sep.doc•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4
Commonwealth of Massachusetts
City/Town of North Andover
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):
® 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 evaluator must be a
member or agent of the local approving authority.
High groundwater evaluation determined by:
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:
C-A).5 pic l)-e mo?lITcr /Ay 24n)
t- OW—mc—F niz&4. kz— S,CT. Pv,41niC fu c_Kcc°SS '4f 2S®/s do�ltn/
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
t5form9a for ESHGWT Sep.doc•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4
Commonwealth of Massachusetts
City/Town of North Andover
Form 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:
4. Connection to a public sewer is not feasible:
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 CM 15.405(2).
❑ Other(List):
D. Certification
"l, 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."
o"//,� /,t�— — ,/ z ,
F ci y ner's Signature Date
j J n Da hlian
4 lint Name
Frank Nichols, PE 10/5/09
Name of Preparer Date
PO Box 185 Carver
Preparer's address CitylTown
MA/02330 508-560-7411
State/ZIP Code Telephone
t5form9a for ESHGWT Sep.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4