Loading...
HomeMy WebLinkAboutLocal Upgrade Approvals - 535 SALEM STREET 10/31/2017 Commonwealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval -- 7 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. FacilityA. Information - 2017 Important: When filling out 1. Facility Name and Address: TOWN OF NORTH ANDOVW forms on the HEALTH DEPARTMENT computer,use Winning Family_Irrevocable Trust only the tab key Name _......_ to move your 535 Salem Street cursor-do not __....._._.�__ _.....m..__ _._..._._ �_.._._. use the return Street Address key. North Andover MA 01845 CitylTown State Zip Code 2. Owner Name and Address(if different from above): Name ..__.. ......__ __.... Street Address _._.....� Cityfrown State —_..__... �.__._ _ .._.... _...._ ........._ _w._� Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential © Institutional ❑ Commercial ❑ School 4. Describe Facility: Existinq Failed Cesspool to be replaced with conventional se tic system 5. Type of Existing System: Privy ® Cesspool(s) ❑ Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): j Existina cesspool to rear of existing house Local Upgrade Approval.doc•rev.7106 Application for Local Upgrade Approvals Page 1 of 4 Commonwealth of Massachusetts City/Town of North Andover a Fora 9A -- Application for Local Upgrade Approval DER 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: 330 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: Install a 1,500 gallon concrete septic tank, H-20 rated concrete d-box, and pipelstone 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 1 ft. Percolation rate 6 min./inch Depth to groundwater 4 (required) 3 re uested ft. Local Upgrade Approval.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 evaluatormustbe a member or agent of the local approving auth ity. High groundwater evaluation determined John D. Sullivan III, PE, CSE 712B117 Evaluator's Name(type or print) Sign re 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: An upgraded leaching field with a 4 foot groundwater separation would require a retaining wall and POSE;ibly a pump system which is economically unfeasible. 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: Any alternative system is not required. The only reduction would be in groundwater separation and the seasonal hiah groundwater table was clearly identified during soil testing. Local Upgrade Approval.doc-rev.7106 Application for Local Upgrade Approval*Page 3 of 4