HomeMy WebLinkAboutBuilding Permit #Exception - 47 BOXFORD STREET 10/17/2007 NORTH
BUILDING PERMIT c� �q,�o �bgtio
TOWN OF NORTH ANDOVER �i b'i. ='
APPLICATION FOR PLAN EXAMINATION o y
� o �
Permit NO: Date Received 10- 1 -4 - 6Date Issued:
IMPORTANT: Applicant must complete all items on this-page
1yr �"� �c
s
CATi`C�.tal,� ��X44rti
((V i9
p z.�w(IOW�I.ER `�IE..�.
r( ,�:."' >,1.���a .rt �`' r��✓r ;,4 f r. "S: �fi ,� t_� t.F r{s P rt t }- t r �' ti :r
•�� yn.r .a �, � }!E x rx ,� x r �"w'm r� "� +'�1�5'2. � .�P�Tlrtt s s `'w F'i �a^,+`','.si'�'"( s;c.9� �K at aM w r >�{,� �. ° ( � .-.
IAO .Y PACS% a wtitG �T1iC�ft,F �soricistrct n fi� ti x des
�,.m
ox
0
TYPE OF IMPROVEMENT PROPOSED USE
Resi Non- Residential
New Building One famil
Addition Two or more family industrial
A teration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Dg,Zolition Other
peptic tt etl , n loot�la�ra WeflandsWatersl�et1 I)�str t, `
t ry r ( J
�. ,`,a er/•SeweT - �. '(, �... � � �. J��x . r 3., ��,���- �
S
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name:
Phone:
Address: 11-k—Vj.,
f ��... ....,}.:'yi to xr-. .'x 5.
-
"k...£.1'S 4 } ...�. § :•� �sY } a t' 2 YT '�. k fNy S 3 F4
r�
r 3 r N.^",i.'t' t5r -a, u 6 ✓ aer y
Atidlress ' '" 7,_V.Y tS m l y �s�1v1 � V. SL u ,M1
0
9 '>" n} {."r^" �,�25 'a``� L� r_ .. r fr �Y�x: r
S ��rwsoro�asru �or�LcenseLL � p Oahe1
z > 2a Kf i'Ig g' 1(
p
r�rx�e'Im roaremi�tl� ense. `,. .u, M Exp fat .
ARCHITECT/ENGINEER Phone: Ju,
Address: A y Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ V, U FEE: $ y)
Check No.: Receipt No.:
NOT#,: Persons contraac-ting with unregistered contractors do not have ac ss t7the1oa7tYfU,1tg11
Signature o ,�gent/Owne f Signature of cor,tracto t
Plans Submitte Plans Waived Certified Plot Plan Stamped Plans
GE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales
Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
0
DATE REJECTED DATE APPROVED
PLANNING &.DEVELOPMENT`
COMMENTS
ATE REJECTED DATE APPROVED
CONSERVATIO
COMMENTS N~Gl � �>� "IP Ind NA111�.
DATE REJECTED D=PROV
HEALTH
COMMENTS ; .oe�;,•� . a ��.na,.-�� yl� -=L j���--,.a.� �r��'
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
Located at 384 Osgood Street
FIRE DEPARTMENTTemp hum slier on`"si#e
P yes no
Located at 7124 Main Street
Fire£Dep art mentsignature�da"te_ .
i
September 19, 2007
I
Susan Y. Sawyer, REHS/R.S.
Public Health Director
North Andover Board of Health
1600 Osgood Street
North Andover, Ma. 01845
Re: 47 Boxford Street North Andover, Ma.
Construction of Porch Addition
Dear Susan:
This letter is being written in regards to proposed construction
of a porch addition for my above referenced property.
I understand that the construction of this addition requires I
install a new subsurface sewage disposal system, the plans for which
have been approved.
I hereby agree that construction of the septic system will commence
prior to June 1, 2008 and will be completed no later than August 1, 2008.
This is for your information and should you have any questions, please
contact me at my residence phone# 978 725-8858.
Thank you.
Sincerely,
14,
Peter J. ullivan
L
NORTH
O� �t�eo 16�ti
--6 O L
O
,
O�q[OCMI[w,wKM`y1
�9SSAC HUS���y
PUBLIC HEALTH DEPARTMENT
Community Development Division
August 9, 2007
Peter Sullivan
47 Boxford Street
North Andover, MA 01845
RE: Septic System Design, 47 Boxford Street,North Andover, Map 106A, Lot 64
Dear Mr. Sullivan,
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 New England Engineering
Services, dated August 8, 2007. This plan has been approved. The approval includes a Local
Upgrade Approval as found attached. This plan is valid for two years from the date of this
approval.
The design has been approved for use in the construction of an onsite septic system for a 3-
bedroom house (maximum 7-room). 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.
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
y
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.
Sincerel ,
usan Y. SawWer,
Public Health Director
Encl: list of licensed septic system installers
Form 9B for owner records
Cc: New England Engineering Services
'1 1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com
r
Commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Fonn 9B
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. The system owner shall provide a copy of the Local Upgrade Approval to the
appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource
Protection,Title 5 Permitting Program, upon issuance by the local approving authority and before
commencement of construction.
A. Facility Information
when fines out 1. Facility Name and Address
fomes on the
computer,use Peter Sullivan
only the tab key Name
to move your 47 Boxford Street
cursor-do not
use the return Street Address
key. North Andover MA 01845
CdyiTown State Zip Code
m
2. Owner Name and Address(if different from above):
Name
Street Address
Citylrown State
Zip Code Telephone Number
3. Type of Facility(check all that apply):
X Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow 330
g per 310 CMR 15.203: gPd
5. System Designer Ben Osgood Jr. PE X RS
Name
1600 Osgood St North Andover MA
Address CitylTovan State,ZIP
B. Approval
1. Local Upgrade Approval is granted for.
Reduction in setback(s)—specify:
See attached list
I
❑ Reduction in SAS area of up to 25%: SAS skoe sqtt %reduction
47 Boodbrd Street Form U Missing Into 5.8.07•rev.5W mel Upgrade Approval. Page 4 of 1
I
commonwealth of Massachusetts
City/Town of
Local Upgrade Approval
Form 9B
I
B. Approval (continued)
Reduction in separation between the SAS and high groundwater.
Separation reduction R
Percolation rate mdn finoh
Depth to groundwater it
❑ Relocation of water supply well (explain):
I
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
N.Andover Health De
Approving Auft* f
Susan Sawyer, Director 24 818/07
Print or Type Name and Title re Date
ZF P
47 Boxford Street Form U Missing info 5.8.07•rev.5102
Local Upgrade Approval•Page 2 of 2
r
I
I
N Ew ENGLAND ENGINE EMG SERVICES, INC.
1600 Osgood Street
Building 20 Suite 2-64
North Andover, MA 01845
Tel: (978) 686-1768 • Fax: (978) 327-6138
Benjamin C. Osgood, Jr., P.E.
August 1,2007 Au
President g
Susan Sawyer
North Andover Board of Health
1600 Osgood Street
North Andover, MA 01845 RECEIVED
Re: 47 Boxford Street,North Andover AUG - 12007
TOHEALLTH D EP TOF NORT�i ER
Dear Susan:
This letter and the enclosed plans are being submitted to address the comments in your
letter regarding 47 Boxford Street North
Andover dated July 19,2007. The comments
are addressed as follows:
1. The septic tank notations have been corrected.
2. The design utilizes a leach field because it is obvious that a trench system could
not be installed on the lot due to the area constraints.
3. A copy of the referenced plan in general note# 11 is enclosed. This plan was
prepared by a surveyor in 1956 and is on record at the registry of deeds. Our
design plan indicates the two front pins which were found in the field marking the
front corners. These pins correspond to the dimensions shown on the referenced
plan.
4. The local upgrade request for has been corrected and is enclosed.
5. The local upgrade request form has been corrected and is enclosed.
6. The local upgrade request form has been revised to list a reason as to why an
alternative system is no feasible.
7. The water line location has been corrected.
8. The impervious barrier was shown on the plan previously. The revised plans have
a wider line on the plan view to make the location of the barrier clearer.
9. The leader has been corrected.
10. The leaders indicating the locations of the test pits and the inspection port have
been corrected.
11. A copy of the specified septic tank detail is attached. Shea makes two septic tanks
which are 2000 gallon Monolithic tanks and we generally specify the heavier one.
If the lighter one were to be used the tanks would still be heavy enough to
overcome buoyancy.
{
12. The dimensions of the tank are correct based upon the enclosed specification
sheet downloaded from the E.F. Shea website.
Also, I have also enclosed a sample deed restriction limiting the number of bedrooms in
the home to three.
If you have any questions,or need additional information,please do not hesitate to
contact this office.
Sincerely,
Benjamin C. Osgood,Jr. .E.
President
J
� a
UU2000. 1/14/2M4 10:58 Nl
13'-0"
II it
20" DIA CLEANOUT COVER I '
3 PLACES it
11 LI
II �--- _ II
__�/ 11
, � _
1 . ,
11 11
II 11
11 11
I1 11
H I1
I "
' II
PLAN VIEW
7"
PLASTIC '' ' ,i PLASTIC
PIPE SEAL3" PIPE SEAL
4" DIA INL � ; 4" DIA
0 OUTLET
L
LIQUID LEVEOPTIONAL
BAFFLE WALL 6'-0"
4'-7"
4'-4"
4" SHEA
-y
1
I--2" TAPER 4"
SECTION VIEW
WEIGHT
ITEM NO. TK-M2000 STANDARD 21,225
TK-M2000H H2O 21,225#
TK-M20002C STANDARD 22,325
NOTES: TK-M20002CH H2O 22,325#
1. CONCRETE: 4,000 PSI MINIMUM AFTER 28 DAYS.
2. DESIGN CONFORMS WITH 310 CMR 15.00, DEP
TITLE 5 REGS, FOR SEPTIC TANKS.
_Q
3. ALL REINFORCEMENT PER ASTM C1227-93.
2 93. NEW ENGLAND
4. BAFFLE WALL OPTIONAL FOR TWO COMPARTMENT TANKS. CONCRETE PRODUCTS INC.
5. TEES AND GAS BAFFLE SOLD SEPARATELY. SEPTIC TANK MONOLITHIC
6. TONGUE & GROOVE JOINT SEALED WITH BUTYLE RESIN. 2000 GALLON
7. ALSO AVAILABLE IN H-20 LOADING.
WILMINGTON, MA (978) 658-2645 -- AMESBURY, MA (978) 388-1509
NOTTINGHAM, NH (603) 942-5668 PAGE 82.5
'ORES 7-
31,,300'SoF.
0
�'5 ,669Lt7;S Fr. Lor/7
75.a-5+F'
V
tiLar/6
8 I
S°
pb0 y
i
X05 �0 m u
4 ,S>Fr 7A
0" R $SOO;kF.
'T Lor 3 Lor 2 Lor/
F0
57400'5o.rr •i
of Lar 4'o"b
2/6p?;foFr y E
4?900 Sa.Fi 4y
Lo>- 7 Lor 6 700 SF, 4 8
SAL Etij STS - FARRWOOD ACRES NP/ -
FFT
an o/' Land in
NORTH ANDOVER — MASS.
SCa/e GOfeet /0 an inch-
NOCo�np:/d;n pa�,,;an,a�o,d d pa,,,e,.,loads• Februai- 9,/956
NORT,4
*►moo. jr
ACHUS
Health Department
July 19, 2007
Mr. Benjamin Osgood, P.E.
New England Engineering Services, Inc.
1600 Osgood Street -Building 20, Suite 2-64
North Andover, MA 01845
Re: Proposed Subsurface Sewage Disposal System at 47 Boxford Street,Map 106A Lot 64
Dear Mr. Osgood:
The proposed wastewater system design plan for the above site dated July 3, 2007 and received
on July 10, 2007 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.
V 1. The Septic Tank Provided note, in the Design Data section, specifies a 1,000 gallon tank
while other details and notes throughout the drawing specify a 2,000 gallon tank. Please
_,,revise as appropriate
The design utilizes a field configuration in lieu of trenches. Please provide and
explanation as to why trenches were not used (15.240(6))
3. Due to the request for a Local Upgrade Approval to reduce the setback distance from the
leach field to the property line please provide reference to a plan which bears the stamp
and signature of a Massachusetts Licensed Land Surveyor(15.220(3))
4. The reduction in setbacks section of the Application for Local Upgrade Approval lists a
t� different reduction in the setback distance from the leach field to the property line than
does the plan. Please clarify which is correct
Please revise the Application for Local Upgrade Approval, Section B3 to correctly list the
design percolation rate
�6. Please clarify Part C of the Application for Local Upgrade Approval to indicate why an
alternative system is not feasible at this location
L_i7. Please clarify the location of the water supply line as it currently is depicted originating
from the stump
t>-�8. Please depict the location of the impervious barrier which appears in the scaled system
profile on the site plan
1600 Osgood Street HEALTH DEPARTMENT Page 1 of 2
Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.com
North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476
9. Please correct the label for the inspection port which appears to be pointing in the wrong
location on the scaled system profile
"Please clarify the location of TP1/PTI and the inspection port on the site plan
,—.1 l:Tease verify the weight of the septic tank specified as it appears to differ from the
published weight listed in the manufacturers literature
12. Please verify the dimensions of the septic tank specified as it appears they differ from the
1__f-published dimensions listed in the manufacturers literature
While not a reason for disapproval it appears that the system does not require venting. For
aesthetic purposes you may want to re-visit that component of the design.
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.
Sincer
Susan Y. Sawyer, REHS S
Public Health Director
cc: Owner
File
1600 Osgood Street HEALTH DEPARTMENT Page 2 of 2
Building 20;Suite 2-36 E-Mail:healthdept@townofnorthandover.com
North Andover,MA 01845 Phone:978.688.9540 Fax:978.688.8476
Page 1 of 2
4
DelleChiaie, Pamela
From: Marianne Peters [mpeters@millriverconsulting.com]
Sent: Monday, July 16, 2007 12:14 PM
To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela;
Sawyer, Susan
Subject: FW: 47 Boxford Street-(NEES) Plan mailed to Mill River 7/11/07 for review
Importance: High
THIS PLAN WAS RECEIVED IN TODAY'S MAIL(7/16).
From: DelleChiaie, Pamela [mai Ito:pdellechiaie@townofnorthandover.com]
Sent: Wednesday, July 11, 2007 12:30 PM
To: Marianne Peters
Cc: Sawyer, Susan
Subject: 47 Boxford Street - (NEES) Plan mailed to Mill River 7/11/07 for review
Importance: High
New plan review will be forthcoming. Thank you.
-----Original Message-----
From: Marianne Peters [mailto:mpeters@millriverconsulting.com]
Sent: Friday, June 29, 2007 11:41 AM
To: DelleChiaie, Pamela
Subject: RE: New procedure for plan reviews
IT'S NOT YOU; IT'S NOT THE POST OFFICE; IT'S WHOMEVER DELIVERS THE MAIL; OUR PAYROLL
ENVELOPES GO THERE SOMETIMES.....
From: DelleChiaie, Pamela [mai Ito:pdellechiaie@townofnorthandover.com]
Sent: Thursday, June 28, 2007 5:11 PM
To: Marianne Peters
Subject: RE: New procedure for plan reviews
Importance: High
Okay. I have always sent the mail to 2 Blackburn Center, but who knows, the post office could have
overlooked it, and sent it to the other.....?......Hopefully this new system will help track things better for us.
Thanks.
-----Original Message-----
From: Marianne Peters [mailto:mpeters@millriverconsulting.com]
Sent: Thursday, June 28, 2007 4:47 PM
To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela;
Sawyer, Susan
Subject: New procedure for plan reviews
In speaking with Susan recently about a plan which we did not receive(which could be due to many
factors, one of which is that the Cape Ann Medical Center has an address of 2 Blackburn Drive and
we're 2 Blackburn Center(I know; makes no sense...especially for 911 reasons...), let's try the
following procedure to try to keep track of the plans.
- Send us an e-mail with the address of the plan in the subject line("47 Boxford St plan being
sent June 28)
- Immediately upon receipt, I'll send back an e-mail acknowledging receipt
7/16/2007
Page 2 of 2
w
t - (I've been stamping the date received anyway on the actual plan, so I'll keep doing that)
- When it's completed, we'll e-mail the review (as we do)with "47 Boxford St plan review
attached)
That way, we won't even necessarily have to open the e-mails, but it'll trigger us to watch for it; save
the e-mail in our in-boxes, etc.
Let's see how this works....
Thanks!
Marianne Peters
Mill River Consulting
2 Blackburn Center
Gloucester, MA 01930
978-282-0014 ph
978-282-0012 fx
www_millriverconsu Iti ng co_m
7/16/2007
Page 1 of 2
DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Wednesday, July 11, 2007 12:30 PM
To: 'Marianne Peters'
Cc: Sawyer, Susan
Subject: 47 Boxford Street-(NEES) Plan mailed to Mill River 7/11/07 for review
Importance: High
New plan review will be forthcoming. Thank you.
-----Original Message-----
From: Marianne Peters [mailto:mpeters@millriverconsulting.com]
Sent: Friday, June 29, 2007 11:41 AM
To: DelleChiaie, Pamela
Subject: RE: New procedure for plan reviews
IT'S NOT YOU; IT'S NOT THE POST OFFICE; IT'S WHOMEVER DELIVERS THE MAIL; OUR PAYROLL
ENVELOPES GO THERE SOMETIMES.....
From: DelleChiaie, Pamela [mailto:pdellechiaie@townofnorthandover.com]
Sent: Thursday, June 28, 2007 5:11 PM
To: Marianne Peters
Subject: RE: New procedure for plan reviews
Importance: High
Okay. I have always sent the mail to 2 Blackburn Center, but who knows, the post office could have
overlooked it, and sent it to the other.....?......Hopefully this new system will help track things better for us.
Thanks.
-----Original Message-----
From: Marianne Peters [mailto:mpeters@millriverconsulting.com]
Sent: Thursday, June 28, 2007 4:47 PM
To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela;
Sawyer, Susan
Subject: New procedure for plan reviews
In speaking with Susan recently about a plan which we did not receive (which could be due to many
factors, one of which is that the Cape Ann Medical Center has an address of 2 Blackburn Drive and
we're 2 Blackburn Center(I know; makes no sense...especially for 911 reasons...), let's try the
following procedure to try to keep track of the plans.
- Send us an e-mail with the address of the plan in the subject line ("47 Boxford St plan being
sent June 28)
- Immediately upon receipt, I'll send back an e-mail acknowledging receipt
- (I've been stamping the date received anyway on the actual plan, so I'll keep doing that)
- When it's completed, we'll e-mail the review (as we do)with "47 Boxford St plan review
attached)
That way, we won't even necessarily have to open the e-mails, but it'll trigger us to watch for it; save
the e-mail in our in-boxes, etc.
Let's see how this works....
I
7/11/2007
Page 2 of 2
Thanks!
Marianne Peters
Mill River Consulting
2 Blackburn Center
Gloucester, MA 01930
978-282-0014 ph
978-282-0012 fx
www.millriverconsulting..com
I
7/11/2007
TOWN OF NORTH ANDOVER T#*
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1.600 OSGE.)OD STREET; B17I LDI G 20; SUITE 2-3()
NORTH ANDOVER MASSACHUSETTS 0.1.845
978.688.9540-.Phone
Susan Y.Sawyer,REHS/RS 978.688.8476 FAX
Public Health Director E-MAIL:healthdel.)tLi,townofnorthandover.cotn
WEBSITE.,:htt:p:4!r,kww.towtioiilorthaudover.com
SEPTIC PLAN SUBMITTAL FORM
RECEIVED
Date of Submission: 11ALIUO JUL 1 0 2007
Site Location: 17 &Y&d s1 IND, &dDU`Cr TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Engineer:
New Plans? Yes 225/Plan Check# (includes I't submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes ✓- No
Local Upgrade Form Included? Yes I/ No
Telephone#: q��'�d w "�7� Fax#: 9?da 7- 71p,�
E-mail:
Homeowner
Name:
OFFICE USE ONLY
When the submis ion is complete (including check):
➢ Date stamp plans and letter
➢ Complete and attach Receipt
➢ Copy File; Forward to Consultant
➢ Enter on Log Sheet and Database
I
` Commonwealth of Massachusetts
City/Town of No. Andover
w
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.
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 Peter Sullivan
only the tab key Name
to move your 47 Boxford Street
cursor-do not Street Address
use the return
key. No Andover MA 01845
City/Town State Zip Code
tab
2. Owner Name and Address (if different from above):
Same as Above
efR 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 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):
Leach Field
Form 9A Application for Local Upgrade Approval revised•rev. 7/06 Application for Local Upgrade Approval* Page 1 of 4
Commonwealth of Massachusetts
City/Town of No. Andover
W 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 I
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: 330gpd
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: Unknown
date of inspection
2. Describe the proposed upgrade to the system:
Replace leach field and system components
3. Local Upgrade Approval is requested for(check all that apply):
® Reduction in setback(s)—describe reductions:
Please See Attachment
❑ 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.
< 2 Min/ inch
Percolation rate min./inch
Depth to groundwater 4ft.
I
Form 9A Application for Local Upgrade Approval revised•rev.7/06 Application for Local Upgrade Approval* Page 2 of 4
Commonwealth of Massachusetts
City/Town of No. Andover
w
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:
Randy Burley 6/28/07
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:
No other location on the lot
2. An alternatives stem approved pursuant to 310 CMR 15.283 to 15.288 Is not feasible:
Infiltrator chambers are an alternative system used to reduce the system footprint and make the
requested offset waivers smaller than would otherwise be required. A pretreatment system would be cost
prohibative.
Form 9A Application for Local Upgrade Approval revised•rev.7/06 Application for Local Upgrade Approval* Page 3 of 4
Commonwealth of Massachusetts
City/Town of No. Andover
Form 9A - Application for Local Upgrade Approval l
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
N 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:
No other adjacent land is available
4. Connection to a public sewer is not feasible:
Public sewer is not available in the area.
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."
Facility Ow is SignatureDate 7
Benjamin C. Osgood Jr. P.E. (Agent for Owner)
Print Name
New England Engineering Services, Inc.
Date
1600 Osgood Streeet No. Andover, MA
Preparer's address City/Town
01845 (978)686-1768
State/ZIP Code Telephone
I
Form 9A Application for Local Upgrade Approval revised•rev. 7/06 Application for Local Upgrade Approval* Page 4 of 4
Attachment to Form 9-A Local Upgrade Approval Form for 47
Boxford Street listing the required offset reductions.
1. Reduction in the offset distance between the leach field and the foundation wall
from 20 feet required by Title 5 section 15.211(1) to 15 feet.
2. Reduction in the offset distance between the leach field and the property line from
10 feet required by Title 5 section 15.211(1) to 8 feet
3. Reduction in the offset distance between the septic tank and the foundation wall
from 10 feet required by Title 5 section 15.211(1) to 5 feet
4. Reduction in the offset distance between the bottom of the leach field and the
estimated seasonal high ground water from 5 feet required by Title 5 section
15.211(1) to 4 feet