6 septic repair local upgrade approval Commonwealth of Massachusetts
City/Town of Northampton
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.
C. Explanation (continued)
3. A shared system is not feasible:
Not. Applic.
4. Connection to a public sewer is not feasible:
No sewer.
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 Owner's Signature Date
William Kowa! t-A-fre- -oue 10 *-
Print Name
Alan E. Weiss /,�-r/ ) 0821 2008
Name of Preparer Date
350 Old Enfield Road Belchertown
Preparers address City/rown
MA
9/r
State/ZIP Code Telephone
t5foniea•rev.7/06 Application for Local Upgrade Approval Page 4 of 4
Commonwealth of Massachusetts
City/Town of Northampton
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:
Peter McErlain
Evaluators 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:
due to grades and property lines.
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
would not change geometry.
t5foml9a•rev.7/05
Application for Loral Upgrade Approval*Page 3 of 4
15fomi9a•rev.7/06
Commonwealth of Massachusetts
City/Town of Northampton
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
I cal 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:
Design flow of proposed upgraded system
Design flow of facility:
B. Proposed Upgrade of System
330
gpd
330x1.5
gpd
539
gad
1. Proposed upgrade is(check one):
® Voluntary ❑ Required by order, letter, etc. (attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301:
2. Describe the proposed upgrade to the system:
New septic tank and I. field.
date of inspection
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 sae,sq.ft. %reduction
® Reduction in separation between the SAS and high groundwater
Separation reduction
Percolation rate
Depth to groundwater
5-4 ft
ft.
2
min.nch
4
R
Application for Local Upgrade Approvals Page 2 of 4
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Commonwealth of Massachusetts
City/Town of Northampton
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 QA 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 1E000 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 15415.
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
1. Facility Name and Address: 'V,�
William Kowal a- L e�7 E 1�-OLv_I-Q- L.—
Name
6 Country Way
Street Address
Northampton
City/Town
2. Owner Name and Address(if different from above):
Ma
State
01062
Zip Code
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:
Existing 3 Bedroom home.
5. Type of Existing System:
❑ Privy ❑ Cesspool(s)
® Conventional ❑ Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field pits etc)
L.tank.
t5form9a•rev.7/06
Application for Loral Upgrade Approval*Page 1 of 4
COLD SPRING ENVIRONMENTAL
CONSULTANTS INC.
• 21E Site Investigations
• Subsurface Investigations
• Pollution Remediation
• ISP on Staff
• Forensic Septic Investigations
August 22 2008
Northampton Board of Health
RE: Septic System Residence Repair
Local Upgrade Approval
(Kowal,6 Country Way)
• Percolation Tests
• Septic Designs
• Regulatory Compliance
• Recycling and Solid Waste
• Second Opinions
With the intent of full compliance with 310 CMR 15.000, (Sanitary Septic Code, Title
V), and the understanding that maximum feasible upgrade should be achieved to
maximize protection of public health and safety and the environment, a Local Upgrade
Approval is requested for the repair of the system at the above mentioned property. It is
the opinion of the writer that strict enforcement of the code would be manifestly unjust
(310 CMR 15.410). The following Local Upgrade Approval is noted:
-lack of 5'of minimum groundwater separation to the bottom of the
Stone of the absorption system(310 CMR 15.405,11,1), 4' proposed.
(The situation requires this approval in order to minimize fill
placement in order to not create problematic surface runoff patterns
associated with excessively and unnecessarily raising the ground near the
Property lines and driveway.).
It is understood that the system was sized using an appropriate percolation test and soil
identification technique approved by the Massachusetts DEP that utilizes the most
conservative/appropriate loading factor for that soil (Class 1) (Pere=2 Min/In). It is also
noted that the site is served by public water and that there are no wells noted within 150
feet of the SAS (See Plan). It is my opinion that, given all the possible scenarios for a
new disposal system, and due to spatial constraints,this plan best meets the intent on the
Sanitary Code. It is understood that my client must provide you this letter. In addition, a
copy of the Local Upgrade Approval from your board and a Plan copy must be sent to
Mass. DEP, 436 Dwight St., Springfield, 01103,by the owner, after your approval and
prior to the start of construction.
Please feel free to contact me should you have any questions.
Sincerely,
Cold Spring Environmental Consultants, Inc.
`.n
Alan V. Weiss,M.S., R.S.
President, Principal
Hydrogeologist,Registered Sanitarian Lic. #933
350 Old Enfield Road•Belehertown,MA.01007•Phone:411323.5957 Fax 413.323.4916
email:aeweiss @charter.net