HomeMy WebLinkAboutCorrespondence - 322 BOSTON STREET 5/7/2010 DelleChiaie, Pamela
From: Marianne Peters [mpeters@millriverconsulting.cam]
Seat: Friday, May 07, 2010 1:43 PM
To: DelleChiaie, Pamela
Cc: Sawyer, Susan; Grant, Michele
Subject: RE: 322 Boston Street- Final Const. Request
This is scheduled to be done on Monday @ 9:30 with Isaac.
Have a great weekend all!
Front: DelleChiaie, Pamela [mailto:pdellech @townofnorthandover.com]
Sent: Friday, May 07, 2010 1:37 PM
To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley'
Cc: Bill Dufresne (brdufresne @comcast.net)
Subject: FW: 322 Boston Street - Final Const. Request
Importance: High
Hello,
Please call Bill Dufresne to schedule the Final Const. at 322 Boston Street. Thank you. His number is: (978) 502-6206.
Have a wonderful weekend everyone! It is gorgeous outside today!!!!!
,
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TOWN OF NO T11 A1'sDOVER
flealth Department:
1600 Osgood Street.
Building 20;Suite:2.36
North Andover,MA 01.845
978.688.9.540- Phone
978,688.8476-Fax
aclellecl,tai ()towi)ofiiortliandover.coi-r7-E-mail
]atU-.)://wv✓vt a.townofnort:laandove.r.coii)/Pa es/index Websit:e
Notes.-
/f'copied to BO I Alenihen,,� Refi rcncc C;ol)y l)rrly- rrcr r'csp>crrr,se requested at this time
From: Grant, Michele
Sent: Friday, May 07, 2010 12:49 PM
To: DelleChiaie, Pamela
Cc: Sawyer, Susan
Subject: 322 Boston Street
1
Hi,
the following is ready for a final inspection. Please call Mill River. Bill Dufresne called
2
DelleChiaie, Pamela
From: Sawyer, Susan
Sent: Wednesday, April 14, 2010 8:27 AM
To: Sawyer, Susan; 'dbelson @gmail.com'
Cc: DelleChiaie, Pamela
Subject: RE: 322 Boston Street
Attachments: SKMBT_60010040513570.pdf
Pam,
I sent this email on the 5"'. Did this get sent regular mail as well? If so, do you know when?
Thank you
Susan
Susan:
You noted over a week ago that you would be mailing the approval letter, and we have not yet received the hard copy
of it. Has it been mailed out yet?
Thanks...
--David
On Mon, Apr 5, 2010 at 2:14 PM, Sawyer, Susan<ssawyer townofnorthandover.com}wrote:
Mr. Belson, We will have this approval letter in the mail as well tomorrow.
Thank you for your patience.
Susan Sawyer
Health Director
htt www.townofnorthandoverrv.corr7 PaEes NAndoverMA Idea lth/septicinsta Ile rs pdf
From: nore townofnorthandQvLe &om.[mailto:norep. Cy. wnofnorthandover.c rm]
Sent: Monday,April 05, 2010 2:57 PM
To:Sawyer,Susan
Subject: Message from KMBT_600
From: Sawyer, Susan
Sent: Monday, April 05, 2010 2:15 PM
To: 'dbelson @gmail.com'
Cc: DelleChiaie, Pamela; 'brdufresne @comcast.net'
Subject: 322 Boston Street
Mr. Belson, We will have this approval letter in the mail as well tomorrow.
Thank you for your patience.
1
Susan Sawyer
a•ealth Director
titq,)I/Aw k. owriofriortliaridover.coMl.j�g sJ -MA healtij,) s r �aa I df
_gt _NAndover
From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com]
Sent: Monday, April 05, 2010 2:57 PM
To: Sawyer, Susan
Subject: Message from KMBT-600
11
I LIS
PUBLIC HEALTH DEPARTMENT
Community Development Division
March 25, 2010
David and Heather Belson
322 Boston Street
North Andover, MA 01845
RE: Septic System Design, 322 Boston Street, Map 107D lot 24
Dear Mr. and Mrs. Belson,
The North Andover Board of Health has completed the review of the septic system design plans,
for the above referenced property, submitted on your behalf by Merrimack Engineering Services,
dated February 3, 2010, last revised March 18, 2010. This plan has been approved. The approval
includes a Local Upgrade approval granted by the North Andover Health Department for the use
of a single deep hole within the proposed disposal area. Please keep a copy of this approval with
your household records.
The design has been approved for use in the construction of an onsite septic system for a 3-
bedroom house (maximum 7-room). In accordance with local subsurface disposal regulations
"Acceptable plans and any variances shall expire two years from the date approved unless
construction on the lot has begun". 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. In the event an imminent health problem
such as sewage backup into the dwelling is occurring, the North Andover Board of Health may
reduce the time period for which this plan is valid.
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.
The issuance of a Disposal System Construction Permit shall not construe or imply
compliance with any of the aforementioned requirement.
To: 322 Boston Road SAS ap royal letter March 25, 2010
Your effort to provide a properly functioning septic system for your dwelling is greatly
appreciated. The Health Department may be reached at 978-688-9540 with any questions you
may have.
Sincerely,
Susan Y. Sawyer, REHS/ S
Public Health Director
Encl: list of licensed septic system installers
Form 9$
Cc: Merrimack Engineering Services
Commonwealth of Massachusetts
City/Town of
Local Upgrade M Approval
a
aY Form 9
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 David and Heather Be_lson
key to move your Name
cursor-do not 322 Boston Road
use the return Street Address
key.
North Andover MA 01845
rQ City/Town State Zip Code
2. Owner Name and Address (if different from above):
stun
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: 330
gpd
5. System Designer: Vladimir Nemchenok ® PE ❑ RS
Name
66 Park Street North Andover MA, 01810 _
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
322 Boston Road form9b 3.17.10•rev.7/06 Local Upgrade Approval* Page 1 of 2
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 913
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
E Use of only one deep hole in proposed disposal area
F-I Use of a sieve analysis as a substitute for a pert test
List local variances granted not requiring DEP approval per 310 CIVIR 15.412(4):
List variances granted requiring DEP approval:
North Andover Health Dept. Z')
Approving Authority
Susan Sawyer, Health Director March 17, 2010
Print or Type Name and Title griature Date
322 Boston Road form9b 3.17.10•rev.7/06 Local Upgrade Approvalo Page 2 of 2
6
1 6 Z.
tr y c
LA w �.
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
March 1,2010
Vladimir Nemchenok
Merrimack Engineering Services
66 Park Street
Andover,MA 01810
Re: Subsurface Sewage Disposal System Plan for 322 Boston Street,Map 107D,Lot 24
Dear Mr.Nemchenok:
The proposed wastewater system design plan for the above site dated February 3,2010 and received on February 10,
2010 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. A Local Upgrade Approval for only having one test pit in the soil absorption system area must be requested.
Please revise the Form 9A and note the Local Upgrade Approval request on the design plan(3 10 CMR
1.5.405(1)(k)).
2. It appears that the bottom of the septic tank may be below the ESHWT. Please determine the ESHWT
elevation in the proposed tank location and provide buoyancy calculations if required(3 10 CMR
15.221(8)).
3. A riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches
below grade. Magnetic tape cannot be used as an alternative to providing a riser. Please modify the note in
the"Graphic Scale"on sheet 2.
4. Please specify all system components shall be marked magnetic marking tape including the septic tank(3 10
CMR 15.221(12)).
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 compliance with all regulations and assure
protection of public health and the environment of North Andover.
Sincerely;
4
Susan Y. Sa wyer REHS/
Public Health Director,
cc: David&Heather Belson
File
1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1
wilding 20,Suite 2-86 -Mail: healthdept( townofnorthandover.conr
North Andover, MA 01845 Phone:978.688.9540 Pax: 978.688.6476
M ERRIMAC K ENGINEERING SERVICES, INC,
PROFESSIONAL ENGINEERS e LAND SURVEYORS o PLANNERS
66 PARK STREET - ANDOVER,MA 01810 ® (978)475-3555,373-5721 e FAX(978)475-1448^ E-MAIL Info @merrimackengineering.com
March 9, 2010
Susan Y. Sawyer
Public Health Director , � ,..
1600 Osgood Street M
Building 20, Suite 2-36 ✓ � �
North Andover, MA 01845
RE: 322 Boston Street. OF Iq "R"I'�-f ANDOVER
H1..AL4° 1 W""'GIAR� MENT
Dear Susan,
We received your letter dated March 1, 2010, regarding the above referenced site.
We have revised the plan to include a note requesting an L.U.A. for only one test pit and
modified the Form 9A application, copy enclosed.
With regard to item#2 of your letter,the bottom of the tank is at the same elevation as
the more conservative e.s.w.t. el. 92.4, as such, buoyancy calculations are not necessary.
The reviewer should have been able to easily determine this from the plan details and
specifications. e"k" l` '-b e"°,— r :, I "'r- (
With regard to item#3 of your letter,the soil absorption system and the distribution box
are being constructed entirely in fill, as such,the minimum cover of one foot is proposed
over the leach field elevation 96.8. The top of the proposed distribution box is at
elevation 96.45. The top of the distribution box is only 4 inches deep and therefore no ��
riser is required. The plan specifies that magnetic marking IATTenbe provided or a riser and
cast iron cover if the depth is in excess of 9 inches. The requirement for the riser was
shown on the plan because in the past,your reviewer continuously makes this comment,
when in fact, no riser is necessary at all. The plan, as designed, complies with Title 5, and
the reviewer should be able to easily determine this by the details and specifications
l , .
shown on the plan.
With regard to item#4 of your letter, magnetic marking tape or a comparable means,
15.221 (12) is specified on all system components. The plan specifies 2 cast iron covers
over the inlet and outlet of the septic tank, magnetic tape over the distribution box and
magnetic marking tape over the leach field. This satisfies all requirements of Title 5 and
the reviewer should have been able to easily determine this from the details and ..m
specifications shown on the plan.
Page 2
March 9, 2010 (Susan Sawyer)
On behalf of our client, we respectfully request that the plan be approved as re-submitted
as we feel it is in compliance with all requirements of Title 5 and of the NA Board of
Health Regulations.
Very true yours, _
William Dufresne, Project Manager
Merrimack Engineering Services
MERRIMACK ENGINEERING SERVICES,INC,
66 PARK STREET-ANDOVER,MASSACHUSETTS 01810
Commonwealth of Massachusetts
City/Town of North Andover
Form l i tin for Local Upgrade Approval
--i 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
computer, use David & Heather Belson Residence
only the tab key Name
to move your 322 Boston Street
cursor-do not
use the return Street Address
key. North Andover MA 01845
City/Town State Zip Code
lab
2. Owner Name and Address(if different from above):
SAME
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:
3 BDRM. House
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
field
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4
Commonwealth of Massachusetts
City/Town of North Andover
a
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.
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design flow of existing system: unknown gpd
Design flow of proposed upgraded system 330
gpd
Design flow of facility: 330
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:
New 1500 gal septic tank, gravity flow to a leach field with 44 Infiltrator Chambers
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 0.5
ft.
Percolation rate min./inch
Depth to groundwater 3.5
ft.
t5forn-i8a.doc•rev.7/06 Application for Local Upgrade Approval-- Page 2 of 4
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
M 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:
Isaac Rowe 2-1-10
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:
Full compliance would result in raising the system even higher requiring a pump and additional fill and
grading resulting in unreasonable financial hardship
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4
Commonwealth of Massachusetts
City/Town of North Andover
r Application for CI p 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:
None 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 fo 'berate violations."
2-5-10
F%& - w is SkgriaturY Date
David Belson
Print Name
Bill Dufresne/Merrimack Engineering 2-5-10
Name of Preparer Date
66 Park Street Andover
Preparer's address City/Town
MA/01845 (978)475-3555 x-20
State/ZIP Code Telephone
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4
ttORTH
0
O Z.
a _ A
4 1b
SAC HU`✓���y
PUBLIC HEALTH DEPARTMENT
Community Development Division
March 1,2010
Vladimir Nemchenok
Merrimack Engineering Services
66 Park Street
Andover,MA 01810
Re: Subsurface Sewage Disposal System Plan for 322 Boston Street Map 107D Lot 24
Dear Mr.Nemchenok:
The proposed wastewater system design plan for the above site dated February 3,2010 and received on February 10,
2010 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. A Local Upgrade Approval for only having one test pit in the soil absorption system area must be requested.
Please revise the Form 9A and note the Local Upgrade Approval request on the design plan(3 10 CMR
15.405(1)(k)).
2. It appears that the bottom of the septic tank may be below the ESHWT. Please determine the ESHWT
elevation in the proposed tank location and provide buoyancy calculations if required(3 10 CMR
15.221(8)).
3. A riser to within 6 inches of finish grade is required above the distribution box if greater than 9 inches
below grade. Magnetic tape cannot be used as an alternative to providing a riser. Please modify the note in
the"Graphic Scale"on sheet 2.
4. Please specify all system components shall be marked magnetic marking tape including the septic tank(3 10
CMR 15.221(12)).
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 compliance with all regulations and assure
protection of public health and the environment of North Andover.
Sincerely;r
Susan Y. Sawyer,REHS
Public Health Director
cc: David&Heather Belson
File
1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1
Building 20;Suite 2-36 E-Mail: healthdept @townofnorthandover.com
North Andover, MA 01845 Phone:978.688.9540 Fax: 978.688.8476
TOWN OF NORTH ANDOVER
Office of COMMMITY DEVELOPMENT AND SERVICES b4
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
NORTH ANDOVER, MASSAC14USETTS 01845
978.688,9540 Phone
Susan V.Sawyer,RE S/16 978.688.8476-FAX
Public Health Director E-MAIL:healthdept 0itowndhorthandover.com
WEBSITE: http://www.townofnoilliandovei-.com
............11.111-Il-l�I'll11-1,.11.1 —.,-",.'.
SEPTIC PLAN SUBMITTAL FORM .1fw-I'VE 11"'
P"
fi
Date of Submission: Z-P- 10
'rcwti�5f�
Site Location:
VA9 4proh I
Engineer: Pwollg-lv-
New Plans? Yes / $225/Plan Check# (includes I"submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes v" No
Local Upgrade Form included? Yes V" No
Telephone#: 70) GHC5 Fax#: &70 )
E-mail:-6X P U
Homeowner
Name:
OFFICE USE ONLY
When the submission is complete (including check):
Date stamp plans and letter
Complete and attach Receipt
V, Copy File; Forward to Consultant
Enter on Log Sheet and Database
Commonwealth of Massachusetts
City/Town of North Andover
Application 0
— 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
computer, use David & Heather Belson Residence
only the tab key Name
to move your 322 Boston Street
cursor-do not Street Address
- -
use the return
key. North Andover MA 01845
City/Town State Zip Code
rah
2. Owner Name and Address (if different from above):
SAME
---------------------------- ----------------
Name Street Address
------------
City/Town State
r�
r Zip Code Telephone Number
�LU Type of Facility (check all that apply):
F
® Residential ❑ Institutional ❑ Commercial ❑ School
� 3C Describe Facility:
3 BDRM. House
5. Type of Existing System:
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
field
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval Page 1 of 4
Commonwealth of Massachusetts
City/Town of North Andover
A r m 9A — Applicati
a
wM 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: unknown
gpd
Design flow of proposed upgraded system 330
gpd
Design flow of facility: 330
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:
New 1500 gal septic tank, gravity flow to a leach field with 44 Infiltrator Chamber
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. °.'o reduction
® Reduction in separation between the SAS and high groundwater:
Separation reduction 0.5
ft.
Percolation rate 17
min./inch
Depth to groundwater 3.5
ft.
t5form9a.doc^rev.7/06 Application for Local upgrade Approval° Page 2 of
Commonwealth of Massachusetts
City/Town of North Andover
4 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.
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:
Isaac Rowe 2-1-10
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:
Full compliance would result in raising the system even higher requiring a pump and additional fill and
grading resulting in unreasonable financial hardship
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4
Commonwealth of Massachusetts
City/Town of North Andover
a
Form 9A — Application I Upgrade Approval
^A 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:
None 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 fo eliberate violations."
2-5-10
ility- w is natur Date
David Belson
Print Name
Bill Dufresne/Merrimack Engineering 2-5-10
Name of Preparer Date
66 Park Street Andover
Preparer's address City/Town
MA/01845 (978)475-3555 x-20
State/ZIP Code Telephone
t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4
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Commonwealth Of Massachusetts
City/Town Of
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for 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. ite Information
When filling out a
forms on the
computer,use
only the tab key ner Name
to move your +10 '"r, P 'r f x o y ?�y�x
cursor-do not ' t� °SSA !P key.
return , ° A� Lo `� State
street Address o
�
City/Town to Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
Dale Time Date Time
Observation Hole# --
ut
a c 2 a '� ------
Depth of Perc - --
Start Pre-Soak -
f� i5 h f p p qq
ttNt `° End Pre-Soak - -- - ---
LU
�FL<+
6 ( Time at 12" - — -
Time at 9" -
Time at 6" -- -
ip
Time(9"-6") - — --- -
Rate (Min./Inch) - - -- ---
Test Passed: Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
Test Performed By
Witnessed By:
Comments:
t5formU.doc•06/03 Perc Test^Page 1 of 1
