HomeMy WebLinkAboutMiscellaneous - 145 SOUTH BRADFORD STREET 4/30/2018 145 SO BRADFORD STREET -d Street
210/103.0-0030-0000.0 \
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BOARD OF HEALTH
1146 MAIN STREET
TELEPHONE# (508) 688-9540
• APPLICA TION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM 2
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 13.334
of the State Environmental Code, Title v
Nameau �U Goe c Phone
AddresOA4 F2
Contractor hired for work.
Name L) G��'�,� Phone
Address :I�
Date for scheduled abandonment - 7 - Zy9
The septic system at the above address ha een abandoned ording to
Title V specifications.
V A.
Signature of ontr for
Method of septic tank abandonment (check one). ( ) removal ( ) sandfill
(�k) crush ( } other
Name of Offal Hauler Se C-
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.
Zaa
Inspecting Agent Date
Sol
t , ,
1570
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.
Application by the undersigned is hereby made to connect with the town sewer main inStreet,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. 1 4-.5— c> . ,� +�✓�. 1=0 Z7 t' Street
or subdivision lot no. ���
i--4 0 117 4 R,�;G� � 4-� �� ��.�.C) re) Z 0 5
Owner d W Address
t W. W L C��.I At--4 1-1> C)—/C: �T VVI Y
Contractor Address
cant's Signature
C�r15c (LVJ�t t�rJ -4Bc3.ralZt�
PERMIT TO CONNECT WITH 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..
Division of Public Works
By
x
Inspected by
Date
See back for rules and regulations
t.
I
FORM U - IAT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills //out this section*****************
APPLICANT: Phone
LOCATION: Assessor's Map Number Parcel 3 G
Subdivision / Lot(s) 3 G
Street �f' S , '��' �� St. Number .5'S
************************Official Use Only************************
RECOMMTL}AT ONS PF TQ AGENTS:
Date Approved /71 j
Conservation Administrator n Date Rejected
Comments IV0 dt�l1 � � S Ori( FL.
V,?b(J211�--Te LD Date Approved
Town Planner Date Rejected
Comments -4c06-!5S-
Date
4c0 - S-
Date Approved
Food Inspector-Health Date Rejected
,�-
-�t-, Date Approved
Septic Inspector-Health Date Rejected
Comments
Public Works = sewer/water connections
driveway permit
--Fire Department l2e���,�� �O-� Cc%�ucj ,J•►�n'c t'LTPCTd/'� wi �r5�4.ri M4��`'
'`Received by_ Buig Inspector Date
!N z 8 1995
NOTICE OF AGREEMENT
In order to obtain permission from the Board of Health to
construct and /addition to the existing structure at
S -s-, , which will result in a total
Address
of bedrooms I,
Number, Owner
being the owner of the premises at
Address
in North Andover, MA agree to the following:
1) Should a common sanitary sewer be constructed in the
street abutting the property, the sewer from said
dwelling shall be connected to the sewer regardless of
the condition of the subsurface disposal system.
2) If a common sanitary sewer is not constructed in the
street and the existing subsurface disposal system
should fail or causes a violation of 310 CMR 15. 02
(20) , the existing subsurface disposal system will be
replaced in accordance with the plan on file at the .
Board of Health Office.
3) If a common sanitary sewer is not constructed in the
street and should I desire to sell my property, the
existing subsurface disposal system will be replaced in
accordance with the plan on file at the Board of Health
prior to the transfer of the property.
I understand the conditions of this agreement as set forth
and agree to comply fully.
r
Owner's Signature
This agreement shall be recorded at the Registry of Deeds
and proof of recording shall be presented to the Board of Health
prior to the issuance of a building permit.
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l4 5 s. BRA�Fd�D ET.
lS! Av'oo vrk,
DATE DESCRIPTION AMOUNT
9/2/93 Pumped Septic Tank $145.00
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Bateson Enterprises, Inc. -Andow, MA 01810