HomeMy WebLinkAboutMiscellaneous - 104 MEADOWVIEW ROAD 4/30/2018 (2)BOARD OF HEALTH
146 MAIN STREET
TELEPHONE# (508) 688-9540
APPLICA TION FOR ABANDON;! :fN'T
OF SUBSG'RFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 13.334
of the State Environmental Code, Title V
Name �crr
'� Phone
Address ,P./
Contractor hired for work:
L
Name 41-,, - k��r pct &0 l� Phone
Address 4� L; f _
Date for scheduled abandonment `�' Z Z &�
The septic system at the above address has been
Title V specifications. ,
Signa
d according to
Contractor
Method of septic tank abandonment (check one). () removal () sandfill
W crush ( ) other
Name of Offal Hauler iG
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.
Inspecting Agent Date
Fe
COMPLAINT NUMBER DATE:
#32 JUNE 23, 1993
COMPLAINTANT:ANONYMOUS CLOSE DATE: J vN6-
ADDRESS: PHONE:
OWNER • �OjEPN Z'/rA STEGGR PHONE # • z:�c96 - 7
ADDRESS: mc,,gDbco GA /V,
INSPECTION DATE: ORDER L DATE:
COMPLAINT:HOMEOWNER DE-LEADING HOME HIMSELF. PAINT DUST BLOWING AROUND
OUTSIDE. CHILDREN PRESENT.
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