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BOARD OF f -IE 1L CE -f
146 .MAIN STREE-F
TELEPHONE# (508) 688-9540
,4PPLIL':� 7'10. FOR .4BANTDOIVr ILVT
OF SCBSC,'R1--:-1 CF_ DISPOS,4L S YS7Ea-1
(SEPTIC SYS Mklb
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title V
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Name %f flJ ,. r f,� Phone
Address_ rF�1 �r�11.(lP>D Ido-,
Contractor hired for work:
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Name �3���•y�d,yt Phone 686 -,584-5
Address 29;0 GI { X17 ,�� A-7 z>yep X44
Date for scheduled abandonment
The septic system at the above address has been abandoned according to
Title V specifications.
ignature of Contractor
Method of septic tank abandonment (check one). () removal () sandfill
V crush ( ) other
Name of Offal Hauler
This form must be returned to the North Andover Board of Health
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH
REPRESENTATIVE'S USE ONLY.
VVI q�
Inspecting Agent Date
Date.
41
OWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ...................
has permission to perform .... L,�-14 ..........................
plumbing in the buildings of I ....................
at. . vl� C-. A .), ....... North Andover, Mass.
Fee. ..JP.-. . Lic. NoJ-.). .. .....
PLUMBING INSPECTOR
Check # tY37� ,
6591
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Check one:
Rna[ura ofCrvmer
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ceft/ that All of the details and inj=,ij,,
!have submitted for entered) in above APPfi=tiOn we true and z=urata to the bell of my
knowledge and that all plumbing wort: and installations Performed under W permh i:�.for
Piulinent protijiong at the Mmachusaft state PI this APPH:ation vAll be in compliance with all
Plum I
Or- and Chapter 14) of the Gen I Laws,
By
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Type of License: Wader Journeyman D
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-"F-fLduLjn waives trits reQuirement
Check one:
Rna[ura ofCrvmer
ir Dr CAvners Apent Agent
-
1hereby
ceft/ that All of the details and inj=,ij,,
!have submitted for entered) in above APPfi=tiOn we true and z=urata to the bell of my
knowledge and that all plumbing wort: and installations Performed under W permh i:�.for
Piulinent protijiong at the Mmachusaft state PI this APPH:ation vAll be in compliance with all
Plum I
Or- and Chapter 14) of the Gen I Laws,
By
--'IWO r-JumDer
Type of License: Wader Journeyman D
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A"PPR NL f License Number
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