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PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community Development Division
CERTIFICATE OF
COMPLIANCE
As of: 11/18/15
This is to certify that the individual subsurface disposal system received a
SATISFACTORY INSPECTION of the:
Complete Repair of an
On -Site Sewage Disposal System
By: John Shaw
At:
70 Raleigh Tavern Lane
Map 107A Lot 107
r North Andover, MA 01845
The +Issuance of this artifi cle shall not be construed as a guarantee that the system will function satisfactorily.
Michele Grant V J
Public Health Agent
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
V - 'W
PUBLIC HEALTH DEPARTMENT
(ommunity Development Division
TOWN OF NORTH ANDOVER
NOV 16 2015
TOWNALTH DEPART M OF NORTH � TER
SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( constructed; ( ) repaired;
By:
(Print Name)
Located at: :70 rLA L-6 j 6fl 7��% Ea_j�, j
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan, originally dated
5—_ and last revised on , with a design flow of
gallons per day. The materials used were in conformance with those specified on the
approved plan; the system was installed in accordance with the provisions of 310. CMR 15.000, Title 5 and local
regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on
the As -built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date:_ I 1-q 7715
51 u,, 04 62ta 9e
And — Print Name
Final Construction Inspection Date:
ffa! 0 -In
And — Print Name
Installer:
(Signature)
Engineer: Vile/'q'/ 4/�m'-"(Signature)
Engineer Representat a (Signature)
r ` -dt
Engineer Representative (ignature)
Date: %Z %/ /'!�'
And — y
rint Name
Date: // h2L, 'J�
X44014'11, Al;AKh V0ff__
And — Print Name
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
L
�a �F[r(c�l-k
Town of North Andover —
- AS -BUILT
1) `-Vi
'. All changes to the design plan have been reflected and noted on the as -built plan
2) As -built plan has a suitable scale; (1 inch = 40 feet or fewer for plot plans)
3) Street Address, Assessor's Map and Lot Number
4) Aot Lines and Location of Dwellings served by the system
5) `1 Locations, Elevations and Dimensions of As -built system components, including reserve (if applicable)
6) '. Ties to all tank openings, d -box, and leach area from dwelling or Permanent Structure
Setback distances are shown on the as -built plan from system components to:
� p Y P
N Subsurface, interceptor & foundation drains
Catch basins
Property lines
✓ , Dwellings or other structures
�I I Private water supply or irrigation wells
Watercourses or wetlands
8 Locations of Wells Drains Wetland Resdurce Areas within 150 feet of system
9) v Location of water, gas, electric lines, cable, control panel (if applicable)
10) V Location of Structures within 6 Inches of Finished Grade
11 r0riginal Stam & Si ature
P Signature
12) 1'1 cation and holder of any easements which could impact the system
13) I pervious Areas; Driveways, etc
14) / North Arrow
15) V Location & Elevation of Benchmark used
16) v STATEMENT ON PLAN (NA 5.3)
a. "I certify the locations, elevations, ties, cover material; exposed component covers etc.,
shown on this as -built substantially agree with the approved plan and have determined that the
break out elevations, if applicable, have been met."
Signature of Designer
Date
b. "If a STUCTURAL WALL IS PRESENT (NA 4.9) a Letter or statement on the as -built indicating
the wall - was, or was not, constructed in accordance with the intended design and any
manufacturer's s. ifcations."
Signature of Designer
Revised 3/17/15
Date
r
North Andover Health Department
(ommunity and Economic Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 70 Raleigh Tavern Lane MAP: 107A LOT: 107
INSTALLER: John Shaw
DESIGNER: Merrimack Engineering
PLAN DATE: 5/20/15
BOH APPROVAL DATE ON PLAN: 6/30/15
INSPECTIONS
TANK INSPECTION: 11/6/15
DATE OF BED BOTTOM INSPECTION: 11/9/15
DATE OF FINAL CONSTRUCTION INSPECTION: 11/13/15
DATE OF FINAL GRADE INSPECTION: 11/18/15
SITE CONDITIONS
Comments:
SEPTIC TANK
N/A Contractor reports any changes to design plan
® Existing septic tank properly abandoned
® Internal plumbing all to one building sewer
® Topography not appreciably altered
® Building sewer in continuous grade, on
compacted firm base
® Cleanouts per plan
® Bottom of tank hole has 6" stone base
® Weep hole plugged
® 1500 gallon tank has been installed
H-10 loading
® Monolithic tank construction
® Water tightness of tank has been achieved by
visual testing
® Inlet tee installed, centered under access port
® Outlet tee installed, centered under access port
(effluent filter)
® 24" inch cover to finish grade installed over one
access port
® Neoprene boots around inlet & outlet
Comments:
DISTRIBUTION -BOX
® Installed on stable stone base
® H-20 D -Box
N/A Inlet tee (if pumped or >0.08'/foot)
® Hydraulic cement around inlet & outlets
® Observed even distribution
® Speed levelers provided (not required)
® Schedule 40 PVC Pipe
Comments:
SOIL ABSORPTION SYSTEM (General)
® Bottom of SAS excavated down to C soil layer,
//
N/A
El
Comments: 39x28 with overdig
as provided on plan
Size of SAS excavated as per plan
Title 5 sand installed, if specified on plan
40 Mil HDPE barrier installed
Laterals installed and ends connected to
header (and vented if impervious material
above)
Elevations of laterals and chambers installed as on
approved plan
Retaining wall (boulder / concrete / timber/ block)
Final cover as per plan
SOIL ABSORPTION SYSTEM (Gravel -less Chambers)
® Brand and Model of Chamber: Low Profile
Standard Quick 4 Infiltrator Chambers
® Number of chambers per row: 7
® Number of rows (trenches): 6
Comments: Total Chambers = 42
FINAL GRADE
X Loamed
X Seeded
X Cover per plan
Comments:
DOCUMENTS NEEDED
X Certification of Installation Form submitted
By engineer and signed and dated by
Engineer and installer
X As -Built Plan
BM = 157.25
HR = 2.01
HI = 159.26
SYSTEM ELEVATIONS
ROD
ELEVATION
AS -BLT INVERT
ELEV
DESIGN INVERT
ELEV
Benchmark
Building Sewer OUT
3.90
155.01
155.0
Septic Tank IN
4.04
154.87
154.80
Septic Tank OUT
4.25
154.66
154.55
Distribution Box IN
4.60
154.31
154.30
Distribution Box OUT
4.77
154.14
154.13
Lateral 1 TOP
4.84
Lateral 1 INVERT
154.07
154.08
Lateral 2 TOP
4.84
Lateral 2 INVERT
154.07
154.08
Lateral 3 TOP
4.84
Lateral 3 INVERT
154.07
154.08
Lateral 4 TOP
4.84
Lateral 4 INVERT
154.07
154.08
Lateral 5 TOP
4.84
Lateral 5 INVERT
154.07
154.08
Lateral 6 TOP
4.84
Lateral 6 INVERT
154.07
154.08
Top of Chamber
Bottom of Bed/Chamber
5.48
153.78
153.80
CRITICAL SETBACK DISTANCES
Mark those distances checked in the field against the design plan and regulatory
setback
®
Property
Tank
SAS Sewer
®
line
10
10
®
Cellar wall
10
20
®
Inground pool
10
20
®
Slab foundation
10
10 --
®
Deck, on footings, etc
5
10
®
Waterline
10
10 101
®
Private drinking well
75
1002 50
®
Irrigation well
75
100
®
Surface Water
25
50
®
Bordering Vegetated Wetland ,
Salt Marsh, Inland / Coastal Banka
75
100
® Wetlands bordering surface
' Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA
wetland bylaws
water supply or trib. (in Watershed)
150
150
®
Trib. to surface water supply
325
325
®
Public well
400
400
®
Interim Wellhead Prot. Area
®
Reservoirs
400
400
®
Drains (wat. supply/trib.)
50
100
®
Drains (intercept g.w.)
25
50
® -
Drains (Other) Foundation
10 (5)
20 (10)
®
Drywells
20
25
' Suction line 222(2)
2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02).
3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA
wetland bylaws
0
SUMMARY OF INVERTS BUILDING TIES
SEWER 0 FDTN. 155.08 BLDG. CORNER A I B C D THIS PLAN & CERTIFICATION IS NOT
SEPTIC TANK IN 154.86 SEPTIC TANK OUT 23.7 29.9 - - A WARRANTY OF THE SUBSURFACE DISPOSAL
SEPTIC TANK OUT 154.59 DIST. BOX _38.3152.0 - - SYSTEM. IT IS A RECORD OF THE LOCATION
DIST. BOX IN 154.30 AND ELEVATION OF THE EXISTING SYSTEM
DIST. BOX OUT 154.13 COMPONENTS.
INV. IN CHAMBER 154.06
BOTT. CHAMBER 153.80 "1 HEREBY CERTIFY THE LOCATIONS, ELEVATIONS, TIES, COVER MATERIAL;
EXPOSED COMPONENT COVERS ETC., SHOWN ON THIS AS -BUILT SUBSTANTIALLY
AGREE WITH THE APPROVED PLAN AND HAVE DETERMINED THAT THE BREAK
OUT ELEVATIONS, IF APPLICABLE, HAVE BEEN MET."
APPROVED DESIGNS PLANS.
SIGNATURE OF DESIGNER DATE
LOT 13A
N (49,943 S.F.)
V "X BAND OW
MAGE WCH
�A � � N
ME OF B.V.W, j w
BY BA'48At0
DECK EDGE Of SMA
(0M 2014)
. ( '
'SBM. T.F..157.2s ZA
i
! o k
ta 15M G
SEPTI
7-i N FIELD
/4iINFILTRATOR
AMBERS ,
t V
q D BO j
i28 z
T INSPECTION
165.00' J
LEINE /lfl�NEMCHENOK
ti OF MSr ,� VLADIMIR L.
TAVERN
AS BUILT PLAN XeM�ONN!
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATED IN
. �', NORTH ANDOVER, MASS. /70 RALEIGH TAVERN LANE
NOV 16 2015 AS PREPARED
FOR
TOWN OF NORTH ANDOVER WALTER SO LE TM: 107A
HEALTH DEPARTMENT DATE: 11-12-15 TL: 107
SCALE: 1"=40' 0 20 40 80
MERRIMACK ENGINEERING SERVICES
es Paxic STREET
ANDOVER, MASSACHUSETTS 01810
Map -Block -Lot
Commonwealth of Massachusetts 107.-0107
Permit No
• BOARD OF HEALTH BHP -2015 -0298
------------
North Andover FEE
$250.00
P.1. ----- -----------------------
F.I. _—
DISPOSAL
WORKS GOI�ISTRUCTION PERMIT
Permission is hereby granted John -T. Shaw, III ------------------------------------------------
to (Construct) an Individual Sewage Disposal System.
ction Permit No. BHP -2 5.29 Dated Jul 08, 2015----_----
_ ------------------------------
atNo 70 RALEIGH TAVERN LAN----------------------------
wn on the application for Disposal Works Constru (�'
as shown FILE I-C-�°J
- OF HEALTH
Issued On: Jul -08-2015
-----------------
• •' '_`" ;•. Application for Septic Disposal System
TODAY'S ATE
Construction Permit - TOWN OF 250.0101 — ull Repair
NORTH ANDOVER, MA 01845 $125.00 - Component
Important: Application is hereby made for a permit to:
When filling out ❑ Construct a new on-site sewage disposal system*
forms on the
computer, use Repair or replace an existing on-site sewage disposal system*
only the tab key
to move your ❑ Repair or replace an existing system component —What?
cursor - do not
use the return A. Facility Information
kke/yjxf�,,��
�I Address or Lot #
rab
City/Town
2.- *TYPE OF SEPTIC SYSTEM*:
➢ ❑ Pump Gravity (choose one)
***If pump system, attach copy of electrical permit to application***
➢ ❑ Conventional System (pipe and stone system)
➢ 9 Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.)
➢ Pressure Distribution S.A.S. (No D -Box)
➢ ❑ Pressure Dosed (D -Box Present) S.A.S.
➢ ❑ Does the system require an effluent filter? Yes No
If yes, does plan specify make and model of filter? YES = (no further info. needed)
NO = (installer must specify brand of filter before DWC issuance)
What is the Make? What is the Model.
2. Owner Information
W e e r
Name /
2 /o%i O 4 cue r1J
Address (if different rom ab ve)
,oya min 1-e'.— /0-10 Ol W N�
City/Town State Zip Code
Email address Telephone Number
3. Installer Information
z�l a 4w ! �Li®c..�� w//04Lr 00c/ R(COC/o�bl`'
Name Name of Company
Address
City/Town State Zip Code
L �
7 �l�
��(CG�t1Gl, � the^�1
�
r I , m,(, ! + W Telephone Number (Cell Phone # if possible please)
4. Designer Information U /
ill -4400 ` /; /VC4--7r NP N O /V'
Name Name of Company
`6 6 locg:7 4
Address
City/Town State Zip Code
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit • Page 1 of 2
n•. Application for Septic Disposal System
TODAY'S DATE
Construction Permit - TOWN OF
NORTH ANDOVER, MA 01845 $ 250.00 — Full Repair
MW$125.00 -Component
PAGE 2OF2
A. Facility Information continued....
5. Type of Building: ]Residential Dwelling or ❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore -described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover. I understand that until a final Certificate of Compliance has been issued by
this Board of Health, the installed system is not approved.
Name
Date
-7'a/."
on App(Board f Health Representative)
)bro
me q Date
Application Disapproved for the following reasons:
For Office Use Only: /
1. Fee Attached.? Yes i/ No
2. Project Manager Obligation Form Attached? Yes V No
3. Pump Svstem? If so, Attach copy of Electrical Permit Yes No
Applicant received copy of
"Electrical Inspection Notes for Septic Systems" Yes No
Handout?
4. Reviewed approvalletter, all paperwork received. Yes No
Missing:
5. Foundation As -Built? (new construction only).
(Same scale as approved plan)
6. Floor Plans? (new construction only):
Yes No
Yes No
Application for Disposal System Construction Permit • Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
°70 e0 14'
41 70&6 v e e
(Address of septic system)
Relative to the application of
(Installer's name)
Dated 2 Td- Z5
o ay s ate
For plans by 14t-7err / P -i Q C/
(Engineer)
And dated
With revisions dated
I understand the following obligations for management of this project:
(Original ate
(Last revised date)
1. As the installer, I am obligated to obtain all permits and Board of Health approved plansrp for to
performing any work on a site. I must have the approved plans and the permit on site when any work is
being done.
2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any
other person not associated with my company schedules an inspection and the system is not ready, then
item three shall be applicable.
3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspection, without completion of the items in accordance
with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or
m�: co=an�:.
a. Bottom of Bed — Generally, this is the first (ls� inspection unless there is a retaining wall, which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc.
As -built of verbal OK (or e-mail to: healthdept(@townofnorthandover.com) from the engineer must
be submitted to the Board of Health, after which installer calls for an inspection time. Installer must
be present for this inspection. With a pump system, all electrical work must be ready and able to
cause pump to work and alarm to function.
c. Final Grade — Installer must request inspection when all grading is complete. Installer does not
have to be on-site.
4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others unlicensed to install septic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of my Ecense to operate in the Town of
North Andover, significant fines to all persons involved are also possible.
5. As the installer, I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached.
b. Inspection of the sand and stone to be used.
c. Final inspection by Board of Health staff or consultant.
d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other
components.
6. As the installer, I understand that I am solely responsible for the installation of the system as per the
approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer:
(Today's Date)
;;z —7 73
ame — Print) (Name — Signe
TOWN OF NORTH AIS®VER
NORTH ANDOVER, MASSACHUSE'T'TS 01845
Jackie's Law —
IWO
Permit
Permit Number
Date Issued
Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant Z411--1-1 cam-
Phone Cell 9 7
Street Address .X C 3 1-101-1161
City/Town
MA
ZIP
I -IAL -40v
�/tlA
0 / 916
Name of Excavator (if different from applicant)
Phone Cell
Street Address
City/Town
MA
I ZIP
Name of Owner(s) of Property BMJ a C 5 0 t
Phone Cell
Street Address `7 C) 1�r le., 9' � -/a- 4,�e rx)
City/Town
MA
ZIP
No
Permit Fee Received Yes
Other Contact
Description, location and purpose of proposed trench:
Please describe the exact location of the proposed trench and its purpose (include a description of what is (or is intended) to
be laid in proposed trench (eg; pipes/cable lines etc..) Please mussee reverse side if additional space is needed.
r
,,.vt
5e�a7lC 1� y�
Insurance Certificate #:
Name and Contact Information of Insurer:
Policy Expiration Date:
Dig Safe #:
-Name -o#-Competmt-Prerso/n4-as-defined-by-520-CMR-702): ---_ -- --.
Massachusetts Hoisting License # A/e 6 8
License Grade: A A
Expiration Date: pF 3 I
BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE
AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE
WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO
WORK PROPOSED, INCLUDING OSHA REGULATIONS, G.L. c. $2A, 520 CMR 7.00 et seq., AND ANY
APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT
AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL
COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW,
THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND
THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND
ALSO, FOR THE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY
THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK
FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND
REGULATIONS COVERING SUCH WORK.
THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY
TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY
THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED
THEREUNDER, INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE
LAW AND CONDITIONS OF THIS PERMIT, INSPECTIONS MADE TO ASSURE COMPLIANCE
THEREWITH, AND MEASURES TAKEN BY THE MUNICIPALI'T'Y TO PROTECT THE PUBLIC
WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH
INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY
THE MUNICIPALITY.
THE UNDERSIGNED APPLICANT, OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY
TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS
AND EMPLOYEES FROM ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS, AND EXPENSES
RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY
PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT.
APPLICANT SIGNATURE
- I DATE % ,y /�
EXCAVATOR SIGNATURE (IF DIFFERENT)
�Y
DATE
OWNER'S SIGNATURE (IF DIFFERENT)
DATE:
21Page
CONDITIONS AND REQUIREMENTS ]PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq.
(as amended)
By signing the application, the applicant understands and agrees to comply with the following:
ffm
iv.
V.
A.
No trench may be excavated unless the requirements of sections 40 through 40D of chapter 82, and any
accompanying regulations, have been met and this permit is invalid unless and until said requirements
have been complied with by the excavator applying for the permit including, but not limited to, the
establishment of a valid excavation number with the underground plant damage prevention system as
said system is defined in section 76D of chapter 164 (DIG SAFE);
Trenches may pose a significant health and safety hazard. Pursuant to Section 1 of Chapter 82 of the
General Laws, an excavator shall not leave any open trench unattended without fust making every
reasonable effort to eliminate any recognized safety hazard that may exist as a result of leaving said
open trench unattended. Excavators should consult regulations promulgated by the Department of
Public Safety in order to familiarize themselves with the recognized safety hazards associated with
excavations and open trenches and the procedures required or recommended by said department in
order to make every reasonable effort to eliminate said safety hazards which may include covering,
barricading or otherwise protecting open trenches from accidental entry.
Persons engaging in any in any trenching operation shall familiarize themselves with the federal safety
standards promulgated by the Occupational Safety and Health Administration on excavations: 29 CFR
1926.650 et.seq., entitled Subpart P "Excavations".
Excavators engaging in any trenching operation who utilize hoisting or other mechanical equipment
subject to chapter 146 shall only employ individuals licensed to operate said equipment by the
Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed
operator before any excavation is commenced;
By applying for, accepting and signing this permit, the applicant hereby attests to the following: (1) that
they have read and understands the regulations promulgated by the Department of Public Safety with
regard to construction related excavations and trench safety; (2) that he has read and understands the
federal safety standards promulgated by the Occupational Safety and Health Administration on
excavations: 29 CMR 1926.650 etseq., entitled Subpart P "Excavations" as well as any other
excavation requirements established by this municipality; and (3) that he is aware of and has, with
regard to the proposed trench excavation on private property or proposed excavation of a city or town
public way that forms the basis of the permit application, complied with the requirements of sections 40-
40D of chapter 82A.
This permit shall be posted in plain view on the site of the trench.
For additional information please visit the Department of Public Safety's website at www.mass.gov/dps
3 1 P a g e
Summaryof Excavation and Trench Safety Regulation 020 CMR 14.00 et seg.)
This summary was prepared by the Massachusetts Department of Public Safety pursuant to G.L.c.82A and does not
include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.c.82A, go to www/mass.gov/dps
Pursuant to M.G.L. c. 82, § 1, the Department of Public Safety, jointly with the Division of Occupational Safety,
drafted regulations relative to trench safety. The regulation is codified in section 14.00 of title 520 of the Code of
Massachusetts Regulations. The regulation requires all excavators to obtain a permit prior to the excavation of a
trench made for a construction -related purpose on public or private land or rights-of-way. All municipalities must
establish a local permitting authority for the purpose of issuing permits for trenches within their municipality.
Trenches on land owned or controlled by a public (state) agency requires a permit to be issued by that public agency
unless otherwise designated.
In addition to the permitting requirements mandated by statute, the trench safety regulations require that all
excavators, whether public or private, take specific precautions to protect the general public and prevent unauthorized
access to unattended trenches. Accordingly, unattended trenches must be covered, barricaded or backfilled. Covers
must be road. plates at least 3/" thick or equivalent; barricades must be fences at least 6' high with no openings greater
than 4" between vertical supports; backfilling must be sufficient to eliminate the trench. Alternatively, excavators
may choose to attend trenches at all times, for instance by hiring a police detail, security guard or other attendant who
will be present during times when the trench will be unattended by the excavator.
The regulations further provide that local permitting authorities, the Department of Public Safety, or the Division of
Occupational Safety may order an immediate shutdown of a trench in the event of a death or serious injury; the failure
to obtain a permit; or the failure to implement or effectively use adequate protections for the general public. The
trench shall remain shutdown until re -inspected and authorized to re -open provided, however, the excavators shall
have the right to appeal an immediate shutdown. Permitting authorities are fi►rther authorized to suspend or revoke a
permit following a hearing. Excavators may also be subject to administrative fines issued by the Department of
Public Safety for identified violations.
Summary of 1926 CFR Subpart P -OSHA Excavation Standard
This is a worker protection standard, and is designed to protect employees who are working inside a trench. This
summary was prepared by the Massachusetts Division of Occupational Safety and not OSHA for informational
purposes only and does not constitute an official interpretation by OSHA of their regulations, and may not include all
aspects of the standard.
For further information or a full copy of the standard go to www.osha. aov.
Trench Definition per the OSHA standard:
o An excavation made below the surface of the ground, narrow in relation to its length.
o In general, the depth is greater than the width, but the width of the trench is not greater than fifteen
feet.
Protective Systems to prevent soil wall collapse are always required in trenches deeper than 5', and are also
required in trenches less than 5' deep when the competent person determines that a hazard exists. Protection
options include:
o Shoring. Shoring must be used in accordance with the OSHA Excavation standard appendices, the
equipment manufacturer's tabulated data, or designed by a registered professional engineer.
o Shielding (Trench Boxes). Trench boxes must be used in accordance with the equipment
manufacturer's tabulated data, or a registered professional engineer.
o Sloping or Benching. In Type C soils (what is most typically encountered) the excavation must
extend horizontally 1 f/� feet for every foot of trench depth on both sides, 1 foot for Type B soils,
and % foot for Type A soils.
o A registered professional engineer must design protective systems for all excavations greater than
20' in depth.
continued
4 1 P a g e
• Ladders must be used in trenches deeper than 4'.
o Ladders must be inside the trench with workers at all times, and located within 25' of unobstructed
lateral travel for every worker in the trench.
o Ladders must extend 3' above the top of the trench so workers can safely get onto and off of the
ladder.
• Inspections of every trench worksite are required:
c Prior to the start of each shift, and again when there is a change in conditions such as a rainstorm.
o Inspections must be conducted by the competent person (see below).
• Competent Person(s) is:
Capable (i.e., trained and knowledgeable) in identifying existing and predictable hazards in the
trench, and other working conditions which may pose a hazard to workers, and
Authorized by management to take necessary corrective action to eliminate the hazards. Employees
must be removed from hazardous areas until the hazard has been corrected.
• Underground Utilities must be:
o identified prior to opening the excavation (e.g., contact Dig Safe).
o Located by safe and acceptable means while excavating.
o Protected, supported, or removed once exposed.
• Spoils must be kept back a minimum of 2' from the edge of the trench.
• Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep
heavy equipment and heavy material as far back from the edge of the trench as possible.
• Stability of Adjacent Structures:
o Where the stability of adjacent structures is endangered by creation of the trench, they must be
underpinned, braced, or otherwise supported.
o Sidewalks, pavements, etc. shall not be undermined unless a support system or other method of
protection is provided.
• Protection from water accumulation hazards:
o It is not allowable for employees to work in trenches with accumulated water. If water control such
as pumping is used to prevent water accumulation, this must be monitored by the competent person.
o If the trench interrupts natural drainage of surface water, ditches, dikes or other means must be used
to prevent this water from entering the excavation.
• Additional Requirements:
o For mobile equipment operated near the edge of the trench, a warning system such as barricades or
stop logs must be used.
o Employees are not permitted to work underneath loads. Operators may not remain in vehicles
being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6).
o Employees must wear high -visibility clothing in traffic work zones.
o Air monitoring must be conducted in trenches deeper than 4' if the potential for a hazardous
atmosphere exists. If a hazardous atmosphere is found to exist (e.g., 02 <19.5% or >23.5%, 20%
LEL, specific chemical hazard), adequate protections shall be taken such as ventilation of the space.
o Walkways are required where employees must cross over the trench. Walkways with guardrails
must be provided for crossing over trenches > 6' deep.
o Employees must be protected from loose rock or soil through protections such as scaling or
protective barricades.
51Page
Circle Insurance Fax ; 918-111-488
CERTIFICATE OF IIA
THIS CERTIFICATE= IS ISSUED AS A MATTER I -F INFORMATION ONLY
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,
BELOW. TMS CERTIFICATE OF INSURANCE, DOES NOT CONSTITU
REPRESENTATIVE OR PRODUCER, ANIS THE CERTIFICATE HOLDER,
IMPORTANT: if the certificate holder is an ADL)ITIONAL INSURED, tie
the terms and conditions of the policy, certain policies may require an e
certificate holder in lieu ofsuch endorsemanHa)
PRODUCER
Circle BusineSs3 Ins. Agcy, Inc
247 Newbury Street
Danvers, NIA 01923
INSURED
Wildwood Ex0avation Inc,
233 Holt Road
Andover, MA 01810
Jul 1 HARM MAN
BILIT I INSURANCE DATE(MM1DEYYYYY)
7'/7/15
AND CONFERS NO FIGHTS UPON THE CERTIFICATE HOLDER. THIS
EXTEND OR ALTER THE COVERAGE AFFORDED BY 'njE pOLICIES
TE A CONTRACT BETWEEN THE ISSUING INSURER(S), AWHORIZED
policy(iw') must ee endorsod. If SUBROGATION IS WAIVED, subject to
ndorsement A statement on this certificate does not confer 49hts to tie
CONTACT
NAME:
PHQNE —FAX
44.I5xc)' 1844
Na
AiSrJAIE35>
INSURER(S) AFPORDIM COVERAGE
NAIC 0
INSURERA; Travalers lns! r_ance
25674
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INSURER ...
INSURER D•
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INSURER E:
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COVERAGES CERTIFICATE NUMBER: REVISION NUM81=R:
THIS IS TO CERTIFY TI-191'THE POLICIES OF INSURANCE LISTED BELOW 14AVE BEEN iSSUCD 7'o THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PE=RTAIN, THE INSURANCE A1:FOROED BYTH= POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REI*)UCED BY PAID CLAIMS,
I POLYCVE..FF LP'fIINCYti I—
A GENERALUABILI'IY y 680217�t8508
X COMMERCIA OENEPALLIABILITY
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A WORKERS COMPENSATION 0822388313
AND EMPLOYERS' LIABILITY Y ! N
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(Mandatory in NH)
5/21/15 5/21/16
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$ 1,000,00
MED EXP (Arty Ono perBcn) ..` S
PRODUCTS - COMP/OP AGG I' $ 2 ,
6/23/15 $/29/15 ) MBINED SINGL- , 1
Eaeccloent)
BODILY INTI. (Per person) $
BODILY INJURY (Per acoiderd)
PR(?YEREY 1) GC ${f
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$
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DCSCRIPTION OF OPERAT)ONS / LOCATIONS /VEHICLES (AtEach AGGkD 107, Atl011iortal Ronnrks SchodulB, i[rroro ss cc
Pu q red)
CERTIFICATE
Town Of North Andover
1600 Osgood Street
North Andover, MA 01845
CANCELLATION
500,0
SHOUL) ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE E"PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORi7ANCE WITH THR POLICY PROVISIONS.
AU71,10RI2E2 REPRE SI=NTATIVE
J. MichRal
@ 1988.2090 ACORD CORPORATION, All rights reserved.
ACOR0 25 (2010105) The ACORD name and logo are registered marks of ACORD
Phone: Fax: ( 978) 475-2541 E -Mall;
1
North Andover Health Department
fommunity and Economic Development Division
June 30, 2015
Walter Soule
70 Raleigh Tavern Lane
North Andover, MA 01845
Re: Subsurface Sewage Disposal System Plan for 70 Raleigh Tavern Lane (Map 107A, Lot
107)
Dear Mr. Schmidt:
The proposed wastewater system design plan for the above site dated May 20, 2015 and received
on June 10, 2015 has been approved.
The design plan has been approved for use in the construction of a new on-site septic system for
a 3 -bedroom home utilizing a Quick 4 Low Profile Infiltrator Chamber system. This design plan
approval is valid until June 30, 2017.
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.
At a regularly scheduled meeting of the Board of Health, this plan received the following
approvals by the members.
Local Upgrade Approvals:
To reduce the separation distance from the soil absorption system to the estimated
seasonal high ground water table from 4' to 3'
Page 1 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
70 Raleigh Tavern Lane
North Andover Board of Health Variances:
June 30, 2015
To reduce the setback from the soil absorption system to the wetland resource area from
100' to 84'
This approval is also 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 (3 10 CMR 15.020(1))
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
and/or imply compliance with any of the aforementioned requirements.
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.
Sim erely.,
;r
Michele Grant
Health Inspector
Encl. Installers list
cc: Vladimir Nemchenok
File
Page 2 of 2
North Andover Health Department, 1600 Osgood Street, Suite 2035,
North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476
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Grant, Michele
From: Isaac Rowe <irowe@mill riverconsulting.com>
Sent: Wednesday, June 24, 2015 9:44 AM
To: Blackburn, Lisa; 'Pam Lally'
Cc: Grant, Michele; Isaac Rowe
Subject: RE: 70 Raleigh Tavern Lane
Attachments: 70 Raleigh Tavern Lane - BOH meeting approval letter DATE.doc
Lisa/Michele,
Attached is the BOH meeting approval letter for the initial review for the above referenced property. I did not find any
revisions that are required with this design plan. I left the dates in red so they can be changed after the BOH meeting.
The applicant is requesting a LUA and a NA BOH variance. Based on the existing site conditions I would recommend
approval for both requests. However, the BOH may want to ask the following question to the representative at the BOH
meeting:
- Considering the LUA being requested please explain why the leach field is proposed to be over
designed by 171 square feet?
Please let me know if you have any questions.
Thanks,
Isaac M. Rowe, R.S.
Project Manager
Mill River Consulting
6 Sargent Street
Gloucester, MA 01930-2719
Phone: 978-282-0014 ext.804
Fax: 978-282-1318
irowetcc millriverconsultina.com
www.miliriverconsulting.com
From: Blackburn, Lisa[mailto:LBlackburn(a)townofnorthandover.com]
Sent: Wednesday, June 10, 2015 9:15 AM
To: Dan Ottenheimer; Isaac Rowe; Pam Lally
Cc: Grant, Michele
Subject: 70 Raleigh Tavern Lane
Good Morning,
Mailing out septic plans for 70 Raleigh Tavern Lane.
Lisa Blackburn
Health Department
Town of North Andover
1600 Osgood Street, Suite 2035
North Andover, MA 01845
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS
66 PARK STREET • ANDOVER, MA 01810 • (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL Info@merrimackengineering.com
June 9, 2015
Board of Health
1600 Osgood Street
Suite 2035
North Andover, MA 01 845
RE: 70 Raleigh Tavern Lane
Dear Mr. Chairman and Members:
RECEIVED
JUN 10 2015
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
We have prepared a septic system upgrade design for the above referenced site.
The site has wetlands to the rear such that the predominance of the site is within the 100
foot buffer zone, as such there is inadequate area on site to place a septic and soil.
absorption system in compliance with your local 100 foot wetland setback, therefore a
variance is being requested to allow a soil absorption system 84 feet from a wetland. eelak
In addition to the local variance, an LUA is being requested to allow the system to be 3 ¢a `o 5 `
feet above the ESWT where 4 feet is -required. ranmg o t s LUA will allow a gravity
flow system as oppose o a pump dhnd pr Ings of approximately $4000-$5000
in materials, equipment and labor. Additionally it will minimize or eliminate a mound
directly in front of the house.
We feel that given the existing site conditions and constraints, the system as designed
provides an equivalent degree of environmental protection intended by Title 5 and failure
to grant the requests would be manifestly unjust considering all the relevant facts and
circumstances.
On behalf of the owner, we respectfully request this matter be placed on your June 25,
2015 BOH meeting agenda for consideration of these requests.
Very yUy yours,
William Dufresne, Project Manager
Merrimack Engineering Services, Inc
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES s r,...
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER, MASSACHUSETTS 01845
978.688.9540 — Phone
Susan Y. Sawyer, REHS/RS 978.688.8476— FAX
Public Health Director E-MAIL: healthdept0townofnorthandover.com
WEBSITE: http://www.townofnorthandover.com
SEPTIC PLAN SUBMITTAL FORM pECEIVED
r 2015
Date of Submission: a 2 _ JUN 10
Site Location: `��� L� ; �a 1 ,.� tzLo
T�H�,LTH DEPAR ME VIER
Engineer:
New Plans? Yes ✓ $225/Plan Check # 6 Y� 1 (includes Is' submission and one re-
review only)
Revised Plans?Yes $75/Plan Check #
Site Evaluation Forms Included? Yes V No
Local Upgrade Form Included? Yes No
Telephone #:19)) � ?� Fax #: (ej
E-mail:
Homeowner
Name: A I yrs n0fr_ 11r'/ i 9 j ,t fc--
OFFICE USE ONLY
When the submission is complete (including check):
➢ �/
Date stamp plans and letter
➢
Complete and attach Receipt
)0.
Copy File; Forward to Consultant
➢ I✓
Enter on Log Sheet and Database
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS
66 PARK STREET • ANDOVER, MA 01810 • (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL info@merrimackengineering.com
June 9, 2015
Board of Health
1600 Osgood Street
Suite 2035
North Andover, MA 01845
RE: 70 Raleigh Tavern Lane
Dear Mr. Chairman and Members:
RECEIVED
JUN 10 2015
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
We have prepared a septic system upgrade design for the above referenced site.
The site has wetlands to the rear such that the predominance of the site is within the 100
foot buffer zone, as such there is inadequate area on site to place a septic and soil
absorption system in compliance with your local 100 foot wetland setback, therefore a
variance is being requested to allow a soil absorption system 84 feet from a wetland.
In addition to the local variance, an LUA is being requested to allow the system to be 3
feet above the ESWT where 4 feet is required. Granting of this LUA will allow a gravity
flow system as opposed to a pump and provide a savings of approximately $4000-$5000
in materials, equipment and labor. Additionally it will minimize or eliminate a mound
directly in front of the house.
We feel that given the existing site conditions and constraints, the system as designed
provides an equivalent degree of environmental protection intended by Title 5 and failure
to grant the requests would be manifestly unjust considering all the relevant facts and
circumstances.
On behalf of the owner, we respectfully request this matter be placed on your June 25,
2015 BOH meeting agenda for consideration of these requests.
Very truly yours,
William Dufresne, Project Manager
Merrimack Engineering Services, Inc
s
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS
66 PARK STREET • ANDOVER, MA 01810 • (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL info@merrimackengineering.com
June 9, 2015
Board of Health
1600 Osgood Street
Suite 2035
North Andover, MA 01845
RE: 70 Raleigh Tavern Lane
Dear Mr. Chairman and Members:
RECEIVED
JUN 10 2015
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
We have prepared a septic system upgrade design for the above referenced site.
The site has wetlands to the rear such that the predominance of the site is within the 100
foot buffer zone, as such there is inadequate area on site to place a septic and soil
absorption system in compliance with your local 100 foot wetland setback, therefore a
variance is being requested to allow a soil absorption system 84 feet from a wetland.
In addition to the local variance, an LUA is being requested to allow the system to be 3
feet above the ESWT where 4 feet is required. Granting of this LUA will allow a gravity
flow system as opposed to a pump and provide a savings of approximately $4000-$5000
in materials, equipment and labor. Additionally it will minimize or eliminate a mound
directly in front of the house.
We feel that given the existing site conditions and constraints, the system as designed
provides an equivalent degree of environmental protection intended by Title 5 and failure
to grant the requests would be manifestly unjust considering all the relevant facts and
circumstances.
On behalf of the owner, we respectfully request this matter be placed on your June 25,
2015 BOH meeting agenda for consideration of these requests.
Very truly yours,
William Dufresne, Project Manager
Merrimack Engineering Services, Inc
r
Commonwealth of Massachusetts
City/Town of North Andover
Form 9A Application for Local Upgrade Approval
°�M ,Veyt 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.
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
rab
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
1. Facility Name and Address:
RECEIVED
JUN 10 2015
Walter Soule
Name T0VVN OF NORf 11 ANDOVER
70 Raleigh Tavern Lane HEALTH DEPARTMENT
Street Address
North Andover MA 01845
City/Town State Zip Code
2. Owner Name and Address (if different from above):
SAME
Name
Cityfrown
Zip Code
3. Type of Facility (check all that apply):
® Residential ❑ Institutional
4. Describe Facility:
3 bedroom house
5. Type of Existing System:
Street Address
State
(978) 683-7851
Telephone Number
❑ Commercial ❑ School
❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other (describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
Unknown
t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 1 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.
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
1. Proposed upgrade is (check one):
Unknown
gpd
330
gpd
330
gpd
® 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:
Total replacement (see plan)
3. Local Upgrade Approval is requested for (check all that apply):
❑ Reduction in setback(s) — describe reductions:
date of inspection
❑ Reduction in SAS area of up to 25%: SAS size, sq. ft. % reduction
® Reduction in separation between the SAS and high groundwater:
Separation reduction 1.0
ft.
Percolation rate 20
min./inch
Depth to groundwater 3.0
ft.
t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 2 of 4
Commonwealth of Massachusetts
City/Town of North Andover
o Form 9A - Application for Local Upgrade Approval
G,,M S �•" 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
Evaluator's Name (type or print) Signature
C. Explanation
1-15-15
Date of evaluation
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:
NA
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
NA
t5form9a.doc • rev. 7/06
Application for Local Upgrade Approval* Page 3 of 4
Commonwealth of Massachusetts
City/Town of North Andover
a
a 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:
NA
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
"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."
Facility Owne s Signature
Walter Soule
Print Name
Bill Dufresne/Merrimack Engineering
Name of Preparer
66 Park Street
Preparer's address
MA / 01810
State/ZIP Code
6-1-15
Date
6-1-15
Date
Andover
City/Town
(978) 475-3555
Telephone
t5form9a.doc • rev. 7/06 Application for Local Upgrade Approval* Page 4 of 4
Infiltrator Chamber UA technology Certification
I hereby certify that I have been given a copy of the Title 5 UA technology
approval letter, and the Owner's Manual for the above technology and I
agree to comply with all terms and conditions.
I further certify that I am aware that this design does not allow use of a
garbage grinder in the dwelling and that I understand my requirement to
repair, replace or modify or take any other action required by the
Department or the LAA if the Department or the LAA determines the
system to be failing to protect public health and safety and the environment.
signature:
Walter Soule
certified by: (please print)
date:
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Commonwealth of Massachusetts
City/Town of
w Percolation Test
° Form 12
;41M Sve 1
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:
When filling out A. Site Information
forms on the
computer, use Walter Soule
only the tab key Owner Name
to move your 70 Raleigh Tavern Lane
cursor - do not Street Address or Lot #
use the return
key. North Andover MA 01845
" ISI City/Town State Zip Code
�' (978) 683-7851
Contact Person (if different from Owner) Telephone Number
„ B. Test Results
1_1F_1�i
Witnessed By:
Comments:
t5form12.doc• 06/03 Perc Test • Page 1 of 1
Date
Time Date Time
Observation Hole #
P-1
Depth of Perc
57”
Start Pre -Soak
10:25
End Pre -Soak
10:40
Time at 12"
10:40
Time at 9"
11:20
M
Time at 6"
12:18
Time (9"-6")
58
Rate (Min./Inch)
20
Test Passed:
® Test Passed: ❑
Test Failed:
❑ Test Failed: ❑
William Dufresne
Test Performed By:
Isaac Rowe
Witnessed By:
Comments:
t5form12.doc• 06/03 Perc Test • Page 1 of 1
Grant, Michele
From: Isaac Rowe <irowe@millriverconsulting.com>
Sent: Wednesday, June 24, 2015 9:44 AM
To: Blackburn, Lisa; 'Pam Lally'
Cc: Grant, Michele; Isaac Rowe
Subject: RE: 70 Raleigh Tavern Lane
Attachments: 70 Raleigh Tavern Lane - BOH meeting approval letter DATE.doc
Lisa/Michele,
Attached is the BOH meeting approval letter for the initial review for the above referenced property. I did not find any
revisions that are required with this design plan. I left the dates in red so they can be changed after the BOH meeting.
The applicant is requesting a LUA and a NA BOH variance. Based on the existing site conditions I would recommend
approval for both requests. However, the BOH may want to ask the following question to the representative at the BOH
meeting:
- Considering the LUA being requested please explain why the leach field is proposed to be over
designed by 171 square feet?
Please let me know if you have any questions.
Thanks,
Isaac M. Rowe, R.S.
Project Manager
Mill River Consulting
6 Sargent Street
Gloucester, MA 01930-2719
Phone: 978-282-0014 ext.804
Fax: 978-282-1318
irowe aC -millriverconsultina.com
www.millriverconsulting.com
From: Blackburn, Lisa[ma iIto: LBlackburnCabtownofnorthandover.coml
Sent: Wednesday, June 10, 2015 9:15 AM
To: Dan Ottenheimer; Isaac Rowe; Pam Lally
Cc: Grant, Michele
Subject: 70 Raleigh Tavern Lane
Good Morning,
Mailing out septic plans for 70 Raleigh Tavern Lane.
Lisa Blackburn
Health Department
Town of North Andover
1600 Osgood Street, Suite 2035
North Andover, MA 01845
1
Blackburn, Lisa
From: Blackburn, Lisa
Sent: Friday, December 12, 2014 9:26 AM
To: Dan Ottenheimer; Isaac Rowe; Pam Lally
Subject: 70 Raleigh Tavern Lane
Attachments: 201412120935.pdf
Good Morning,
Please contact Bill Dufresne to set up soil testing. Thank you. Have a great weekend!
-----Original Message -----
From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com]
Sent: Friday, December 12, 2014 9:35 AM
To: Blackburn, Lisa
Subject: Message from "ComDev-Health-Ricoh"
This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002).
Scan Date: 12.12.2014 09:35:06 (-0500)
Queries to: noreply@townofnorthandover.com
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TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y. Sawyer, RENS, RS 978.688.9540 — Phone
Public Health Director 978.688.8476 — FAX
healthdept@townofnorthandover.com
www.townofnorthandover.com
APPLICATION FOR SOIL TESTS
DATE: MAP & PARCEL: 1 P17 A ( 1,r7
LOCATION OF SOIL TESTS: 7r P.1. E 16 H TkL/ Eg:::0 L—Alr1 L
OWNER: F -44A L - I E Iz- ? 0 U Ll-' Contact #: 6?J) � o3
APPLICANT: �ZA H P— Contact #:
ADDRESS:
ENGINEER: "[�WH 5:— r 1W61 tact#: 670 17c5 --,35;57r6' 5jrj X- Z-�
CERTIFIED SOIL EVALUATOR: I J , NFz&wr
Intended Use of Land: Residential Subdivision S' gle Family Hom Commercial �A
Is This: Repair Testing: V Undeveloped Lot Testing: Upgrade for Addition: DEC 2014
In the Lake Cochichewick Watershed? Yes No ✓ 7blrviv ur NJrt I K ANEjUVER
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership (Tax bill, or letter from owner permitting test)
➢ 8.5"x 11 " Plot plan & Location of Testine (please indicate test nit sites on the Plan
Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
➢ Only Certified Soil Evaluators may perform deep hole inspections.
➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic system disposal area.
➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH
representative.
➢ Full payment will be required for all additional tests within two weeks of testing.
Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health
showing the location of all tests (including aborted tests).
➢ Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval ate:
Signature of Conservation Agent: T Jl
cl) "�
Date back to Health Department: (stamp in):
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North Andover Board of Health
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Meeting Minutes
Thursday — June 25, 2015
7:00 p.m.
120 Main Street, 2°a Floor Selectmen's Meeting Room
North Andover, MA 01845
Present: Thomas Trowbridge, Larry Fixler, Frank MacMillan, Joseph McCarthy, Susan Sawyer, Michele
Grant, Lisa Blackburn
I. CALL TO ORDER
The meeting was called to order at 7:00 pm.
II. PLEDGE OF ALLEGIANCE
In. PUBLIC HEARINGS
A public hearing was held to amend the current tobacco regulations to raise the minimum legal sales age to
buy tobacco and electronic cigarettes from age 18 to age 21. Properly advertised and licensed permit
holders were notified. Frank explained reason why moving age to 21 was proposed.
Motion made by Dr. MacMillan to open the public meeting, Mr. Fixler seconded the motion.
Dr. MacMillan provides explanation on the proposal to increase the purchasing age to 21 within the Town
of North Andover.
Move that we amend our town regulation and that it be amended as one item.
1. Remove the definition of the word "Minor" in section 2.16
2. In section 2.22 remove the number "18" and replace with "21".
3. Delete the title in Section 3 and insert the following "Tobacco and Nicotine Delivery Product Sales to
Persons Under the Age of 21 Prohibited"
4. In Section 3. 1, remove the word "minor" and substitute it with the words "to persons under the age of
21."
5. In the last sentence of Section 3.2 remove "18" and insert "21"
6. In the first sentence of Section 3.3 remove "18" and insert "21"
7. In Section 10.1(a) remove "eighteen (18)" and insert "twenty-one (21)"
8. In Section 11.1(a) remove "eighteen (18)" and insert "twenty-one (21)"
Dr. Trowbridge opens up the floor to all persons present for discussion. Lary Fixler made statements
regarding the concerns of persons who feel raising the age to 21 would hurt armed service men. Mr. Fixler
notes that he believes that if asked, most service men and women would not object to methods that are
meant to keep tobacco out of the reach of the youth. Joe McCarthy voiced concern over your tobacco use
and listed various bits of morbidity and mortality data on second hand smoke and smokers. He believes it
will help limit the youth access to tobacco. He notes that many MA cities and towns have done this and is
2015 North Andover Board of Health Meeting
Page 1 of 6
Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman; Larry Fixler, Member/Clerk; Francis P. MacMillan, Jr.,
M.D.; Joseph McCarthy, Member, Edwin Pease, Member Health Department Staff: Susan Sawyer, Health Director; Debra
Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Lisa Blackburn, Health Department Assistant
4 surprised that the state of MA has not made this change already. He believes that it is something that should
be done and from a health and safety perspective it is a wise thing to do.
Ron Beauregard, Healthy Communities Tobacco Control Program, stated an editorial change in the
wording in item #2; should read 2.22 instead of 2.2.
Motion made by Dr. MacMillan to close the public hearing. Mr. Fixler seconded the motion. All were
in favor and the public hearing was closed.
Motion made by Dr. MacMillan to amend the regulation as previously stated in the record with the
editorial change pointed out by Ron Beauregard. Motion seconded by Mr. Fixler. All were in favor
and the motion was approved.
Dr. Trowbridge stated that the regulation will take effect on September 1, 2015. Mr. Fixler asked Mr.
Beauregard if there will be new signage to reflect the change. Mr. Beauregard stated that new signs are
available through the state, but our local regulation has a combination sign so he will change our sign to
reflect the change. Ron also noted that language should be changed before signing to note only "as
amended" for the September 1 start date. Cheryl Sbatra, Counsel to the Association of Health Boards of
Massachusetts, approached the podium and addressed the board. She discussed the amendment and the
effective date. A discussion ensued regarding the pros for increasing the minimum legal sales age from 18
to 21.
IV. APPROVAL OF MINUTES
A. Meeting minutes from April 30, 2015 and May 28, 2015 were presented for signature.
Motion was made by Mr. Fixler to approve the April 30, 2015 minutes. Motion was seconded by Dr.
MacMillan. All were in favor and the April minutes were approved.
Motion was made by Mr. Fixler to approve the May 28, 2015 minutes. Motion was seconded by Dr.
MacMillan. All were in favor and the May minutes were approved.
V. NEW BUSINESS
A. 526 Winter Street — Vladimir Nemchenok, Merrimack Engineering, requesting:
1. A variance of Section 3, table 1, Setback Distance Table, in the local septic regulations to allow the
septic tank to be 50 feet from a wetland where 75 feet is required.
2. A local upgrade approval for use of a sieve analysis as a substitute for a perc test.
Mr. Nemchenok reviewed the requests for 526 Winter Street. A discussion ensued regarding the septic plan
and placement of the septic system.
Dan Ottenheimer, Mill River Consultant, gave his approval for the request.
Motion was made by Dr. MacMillan to approve the variance of Section 3, table 1, Setback Distance
Table, in the local septic regulations to allow the septic tank to be 50 feet from a wetland where 75
feet is required. Mr. McCarthy seconded the motion. All were in favor and motion was approved.
Motion was made by Dr. MacMillan to approve the local upgrade approval for use of a sieve analysis
as a substitute for a perc test. The motion was seconded by Mr. McCarthy, all were in favor and the
motion was approved.
B. 110 Farnum Street— Vladimir Nemchenok, Merrimack Engineering, requesting:
1. Local upgrade approval to allow the septic system to be 4 feet above ground water where 5 feet
is required for full compliance. (note: this item was added after the agenda was posted)
2. Set back from the Septic tank and pump tank to a wetland from 50' and 73' respectively where
75' is required
3. Set back from the SAS to wetland from 100' to 63'.
2015 North Andover Board of Health Meeting Page 2 of 6
Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman; Larry Fixler, Member/Clerk; Francis P. MacMillan, Jr.,
M.D.; Joseph McCarthy, Member; Edwin Pease, Member Health Department Staff. Susan Sawyer, Health Director; Debra
Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Lisa Blackburn, Health Department Assistant
North Andover Board of Health
Meeting Minutes
Thursday — June 25, 2015
7:00 p.m.
120 Main Street, 2"a Floor Selectmen's Meeting Room
North Andover, MA 01845
Mr. Nemchenok reviewed the requests for 110 Farnum St. as discussion ensued regarding the septic plan
and placement of the septic system.
Dan Ottenheimer, Mill River Consultant, discussed the wetland issues on the plan and stated that the first
plans did not show the wetlands. He stated that it should have been identified back in May when
Conservation Commission told Merrimack Engineering to look into it. Mill River also asked that the
wetlands be double checked. Revised plans were submitted and again Mill River asked Merrimack
Engineering to review with Conservation. Mr. Ottenheimer stated that this is not good engineering practice.
The wetlands were approximated and are now 100 ft. closer to where the septic system is proposed and
where Merrimack Engineering identified it previously. Last minute revised plans were presented this
afternoon. Procedure concerns. Engineering firm did not look into it. Met with Conservation at 2:15 and
presented plans received at 2:30 in afternoon. The new plans have not been evaluated yet by Mill River.
Dr. MacMillan stated that he is not comfortable in putting plans forward that hasn't been properly vetted
reviewed by town consultants. The engineer stated that he received the job in March and the snow made it
hard to find the wetlands. Mr. Fixler made similar statements, noting to the consultant has not had time to
review it. In response to Joe McCarthy's inquiry about the issue, Mr. Ottenheimer detailed that there was
plenty of time and he is not comfortable with it either, as it just arrived this afternoon and Mill River has
not reviewed it. Mr. Ottenheimer noted his frustration that this could have been avoided if the town's
advice had been heeded. Mr. McCarthy noted his concern regarding the position the homeowner's are put
in now. The members expressed their concern and noted that next time this should not come in last minute.
The homeowner chose to speak on his engineer's behalf regarding wetlands and changes to the plan. He
stated that the Engineer walked the whole property and identified them in back of property. He said the
other area wasn't obvious. It is "perfectly dry, but it has wetland plants". The only plan changed would be
to move pipe closer to the house and move further from wetland.
Motion was made by Dr. MacMillan to delegate authority to Dr. Trowbridge to approve the plans
following review by Mr. Ottenheimer if there are no unexpected findings, and after consultation with
our consultant. Motion was seconded by Mr. McCarthy; all were in favor.
Motion was made by Dr. MacMillan to approve the LUA to allow the septic system to be 4 feet above
ground water where 5 feet is required for full compliance and all other requests as listed on the plan,
pending Mill River's review.
• To reduce the setback from the septic tank to the wetland resource area from 75' to 50'
2015 North Andover Board of Health Meeting Page 3 of 6
Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman; Larry Fixler, Member/Clerk; Francis P. MacMillan, Jr.,
M.D.; Joseph McCarthy, Member; Edwin Pease, Member Health Department Staff: Susan Sawyer, Health Director; Debra
Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Lisa Blackburn, Health Department Assistant
• To reduce the setback from the pump chamber to the wetland resource area from 75' to 73'
• To reduce the setback from the soil absorption system to the wetland resource area from
• 100' to 63'
• To reduce the separation distance from the soil absorption system to the estimated seasonal high
ground water table from 5' to 4'
• To reduce the requirement of soil test pits in the area of the proposed leaching facility from 2 test pits
to 1 test pit
The motion was seconded by Mr. McCarthy. All were in favor and motion was approved pending
Mill River's review.
Mr. Ottenheimer questioned Mr. Nemchenok about the size. Asking for 5ft instead of 411 to reduce cost and
ground disturbance, however made the system bigger which causes disturbance. Area is 795 sq. ft. instead
of 595 sq. ft. Cost to the owner and the degree of variance would be less and rationalization for shorter
height would be justifiable without extra 200 sgft. Mr. Ottenheimer does not believe that they have justified
their reasoning for building larger than they need. Homeowner tried to explain the reason for this based on
topography. Dr. Trowbridge questioned whether adding fill could be utilized rather than making the system
bigger. The consultant felt the reasoning to make the field larger did not justify the board's approval of the
variance, but acknowledged it was the board's decision
C. 70 Raleigh Tavern Lane - Vladimir Nemchenok, Merrimack Engineering, requesting:
WALK ON TO AGENDA REQUEST
1. Local upgrade approval to reduce the separation distance from the soil absorption system to the
estimated seasonal high ground water table from 4' to 3'.
2. To reduce the setback from the soil absorption system to the wetland resource area from 100' to 84'
Mr. Nemchenok reviewed the requests for 70 Raleigh Tavern Lane. A discussion ensued regarding the
septic plan and placement of the septic system.
Dan Ottenheimer, Mill River Consultant, explained the request for the reduction to the water table 4' to 3'.
Gave his explanation on why the requests are different on the two properties. He stated that rapidly flowing
soil needs to be 5' of separation. Silt/Clay soil only needs 4' separation. This allows for adequate treatment
of the effluent.
Dr. Trowbridge — Why is there another increased size of the field from 622 to 795 sq ft? This will increase
the cost to the homeowner an extra $1000 to $3000? Does the homeowner understand that they are paying
extra for a larger system than required?
Board members asked the homeowner, Walter Soule, if he understood about the additional money involved
in the plan. A discussion ensued regarding the additional cost to the septic plan and if the homeowner was
aware of the issue. The Board is making him aware and that this is something he can discuss with his
engineer. Mr. Soule thanked the Board for all their help.
Mr. Ottenheimer asks the question to Mr. Nemchenok of whether one could reduce the size and then reduce
the variance? Mr. Nemchenok did not offer any additional information. As background on this property,
Susan Sawyer explained the voluntary Title 5 that was done by the homeowner. A voluntary Title V
requires that no Title 5 report paperwork is submitted to the Health Department. Hence this was done
basically so an owner has additional time to replace the system.
Motion was made by Dr. MacMillan to approve the local upgrade approval to reduce the separation
distance from the soil absorption system to the estimated seasonal high ground water table from 4' to
3'. Motion seconded by Mr. McCarthy. All were in favor and the motion was approved.
Motion made by Dr. MacMillan to approve the reduction to the setback from the soil absorption
system to the wetland resource area from 100' to 84', Motion seconded by Larry. All were in favor
and the motion was approved.
2015 North Andover Board of Health Meeting Page 4 of 6
Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman; Larry Fixler, Member/Clerk; Francis P. MacMillan, Jr.,
M.D.; Joseph McCarthy, Member; Edwin Pease, Member Health Department Staff: Susan Sawyer, Health Director; Debra
Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Lisa Blackburn, Health Department Assistant
North Andover Board of Health
Meeting Minutes
Thursday —June 25, 2015
?:00 p.m.
120 Main Street, 2°d Floor Selectmen's Meeting Room
North Andover, MA 01845
Dr. Trowbridge asked about the process of approving variances and local upgrades. Mr. Ottenheimer gave
brief overview of guidelines of Title 5. Discussion followed.
The homeowner from t 10 Famum St. gave her thoughts regarding the septic installation process. She stated
she felt that there were miscommunications in the process. Stated she did not receive the disapproval letter,
however it was noted that the disapproval letter was sent out to them. Ms. Grant said the disapproval letter
and final approval letter goes to both the homeowner and engineer as a standard procedure. However, Ms.
Grant stated that it is not common practice for the homeowner to deliver the septic paperwork as
Merrimack Engineering has their clients do. The engineering company usually does that. It is the engineer
who should be guiding the homeowner through the process.
VI. COMMUNICATIONS, ANNOUNCEMENTS, AND DISCUSSION
A. Dr. Trowbridge discussed current septic regulations that need to be reviewed. Some regulations are not
being followed as they. Looking to take them out of the regulations. Maybe next month a discussion
can be had to review the regulations which would require a public hearing.
B. Susan discussed the trash truck that went into the lake at Flats Bridge in the morning. DEP, fire, police
responded. She and Michele met them. Emergency response team. Discussion ensued regarding the
response to the situation. Robo call was sent out to the residents. If call not received, please add name
to the list on the town's website. There was a minimal release of fuel. JRM Hauling are responsible for
the clean-up or anything else that might occur. Truck was permitted properly to come into town. No
fines were issued by the Health Dept. regarding the permitting of the truck. Discussion ensued. Water
treatment plant will increase testing for chemicals in the water. There will be a full investigation on the
incident.
C. Dr. Trowbridge — discussion on heroin epidemic. Meeting tomorrow with youth services, fire, and
police to discuss what can be done. Discussion ensued regarding drug use among youth and addiction.
VII. CORRESPONDENCE / NEWSLETTERS
VIII. ADJOURNMENT
MOTION made by Dr. MacMillan to adjourn the meeting. Mr. McCarthy seconded the motion and all
were in favor. The meeting was adjourned at 8:48 pm.
Prepared by:
Lisa Blackburn, Health Dept. Assistant
2015 North Andover Board of Health Meeting Page 5 of 6
Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman; Larry Fixler, Member/Clerk; Francis P. MacMillan, Jr.,
M.D.; Joseph McCarthy, Member; Edwin Pease, Member Health Department Staff: Susan Sawyer, Health Director; Debra
Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector; Lisa Blackburn, Health Department Assistant
Reviewed bv:
All Board of Health Members & Susan Sawyer, Health Director
Signed by:
— Z— � 9
Larty Fjv ,-Cl k of the Board
oard
2015 North Andover Board of Health Meeting
Date Signed
Page 6 of 6
Board of Health Members: Thomas Trowbridge, DDS, MD, Chairman; Larry Fixler, Member/Clerk; Francis P. MacMillan, Jr.,
M.D.; Joseph McCarthy, Member; Edwin Pease, Member Health Department Staff: Susan Sawyer, Health Director; Debra
Rillahan, Public Health Nurse; Michele Grant, Public Health Inspector, Lisa Blackburn, Health Department Assistant