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HomeMy WebLinkAboutMiscellaneous - 1027 GREAT POND ROAD 4/30/2018 (2)t O N V O l � � Ilg Z i o 0 o � i O D O f0 BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) PURSUANT TO SECTION 310 CMR 15.354 OF THE STATE ENVIRONMENTAL CODE, TITLE V A TEL. 682-6483 Exr23 This form must be submitted to the Board of Health no less than five (5) days prior to date of abandonment and be accompanied with a copy of the sewer connection permit. -7'V� -3� Name �� IV Phone Address /02:-� �) fE-b Contractor hired for work: 0 Name C N/-/ZO CQ Ad S) O c -Y-fiy Phone Address 73 To V Date for 'scheduled abandonment G-/4 Method of septic tank abandonment (check one). ( ) removal ( ) sandfillcrush ( ) other (describe below) Other PLEASE DO NOT WRITE IN THE SPACE BELOW FSR HEALTH AGENT'S USE ONLY InspecLPrgent C i� � at71 - De I APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass.f V; (j�' ?�� 191--9-L � F�f ��—�1 Application by the undersigned is hereby made to connect with the town sewer main in Street, �7T� �r. subject to the rules and regulations of the Division of Public Works.. The premises are known as No. %© `7 • l_.'%Z���� i ct-�I �C/ Street or subdivision lot no. Owner t/ Contractor 414 a tC-> Address Address f Applicant's Signa re PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants p, to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date r Divis' n of Public Works By 1 6/04 rules and regulations BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext23 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) PURSUANT TO SECTION 310 CMR 15.354 OF THE STATE ENVIRONMENTAL CODE, TITLE V Fel five (5) days prior to date of abanctonmenr ana pe accompaniea wiLn a cogy of the sewer connection permit. Phone Addres. OContractor hired for work: Namer ! A./ ) 40 Address % % EO Phone Date for scheduled abandonment Method of septic tank abandonment ( ) removal Other ( ) sandf ill (check one). (gush ( ) other (describe below) PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH AGENT'S USE ONLY fy �� Inspe ng gen _ ate Comments v N° 0 1063 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. XX19 Application by the undersigned is hereby made to connect with the town sewer main in L71� 'r.-744::2 i5==a Street, subject to the rules and .regulations of the Division of Public Works� Pere/ The premises are known as No. %0 z7 61�� �—Gi' Street or subdivision lot no. Owner Contractor Z : H 0 Address Address Applicant's Sign re PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at subject to the rules and regulations of the. Division of Public Works.. Inspected by Date By See back for rules and regulations Street Division of Public Works