HomeMy WebLinkAboutApplication - 524 REA STREET 7/14/2009 [F-70:,- pPminervtlpp i ""Wl`
BOARD OF HEALTH
OSGOOD STREET
NORTH ANDOVER, MA 01845
TELEPHONE# (978) 688®9540
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 15.354
of the State Environnnntal Code, Title V
Name ,. ...� k, -� �,,. Phone
Address
Contractor hired for work
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Phone
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Address
Date for scheduled abandonment
The septic system at the above address has been abandoned according to Title V
specifications.
Signature of Contractor
Method of septic tank abandonment (check one). ( ) removal sandfill ( µcrush
( ) other
Name of Offal.Hauler
This form must be returned to the North Andover Board of Health.
PEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH
/ REPRESENTATIVE'S USE ONLY.
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Date
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APPLICATION FOR � � .�ERVrC.E'� & .:
NNECTrON
North Andover, Mass. `,i ll
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Application by the undersigned is hereby made to connect with the town sewer main in Street,
subject to the rules and regulations of the Division of Public Works
The premises are known as No. `I' Street
or ubdivision lot no _
Owner Address
Contractor � Addr)s' � �----��---
applicant's Signature —
PERMIT TO CONNECT ITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at
- �''–� �'"� .Street
- subject to the rules and regulations of the Division of Public Works..
111vision of Public.: Works
By
s
Inspected by
Date
See back for rules and regulations
Homes and Demolition PROPO:00)AL
New Construction-Additions-Site Work- Tank Removal
Fully Insured-MA Lic#065128
Rob H.a;-(!PCFe sh _!vm W RK TO BE PERFORMED AT:
978-361-7430 978-457.0494
NAME Vl tl 11A W-- NAME
ADDRESSE1.q I `L G�.� ADDRESS
PHONE NO. i�t ! �' ��I - J��� PHONE NO._
We hereby propose to furnish the materials and perform the labor necessary for the completion of
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All material is guaranteed to be as specified, and the above work to be performed in accordance with
the drawings and spec submitted for above wor and om leted in a bstantial workma�
manner for the sum of I su t
Dollars($ - )
with payments to be made as follows. /
Respectfully submitted
►n --Ri I I
Per
Any alteration or deviation from above specifications NOTE-This proposal_ ay be withdrawn by us
involving extra costs will be executed only upon written if not accepted Within1 days.
order, and will become an extra charge over and above
the estimate. All agreements contingent upon strikes,
accidents,or delays beyond our control.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You
are authorized to do the work as specified. Payments will be made as outlined above.
Signature
Date Signature