HomeMy WebLinkAboutMiscellaneous - 160 BRIDLE PATH 4/30/2018 160 BRIDLE PATH
J ;
210r104.c-0076-0000.0
ov� S wex
i
BOARD OF HEALTH
27 CHARLES STREET
NORTH. ANDOVER, MA 01845
TELEPHONE# (978) 688-9540
.4 PPL ICATION FOR ABANDONMENT
()F SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title V
Name-.--
ame._ .._- v�i_,���. rzPhone (p L+
.Address _ to
Contractor hired for work:
Name..._` mow= Liz o�4 L a v� Phone $-6-1-2655L-
-
-l-2655L--
Address..... aG,, 1 �' � T WS
Date for scheduled abandonment
The sertic system at the above address has b abandoned according to
Title V specifications.
Signature of tOntractor
Me oci of'septic tank abandonment (check one). O removal O sandfill
( crush (; ) other
Name of OffalThisform must be returned to the North Andover Board of Health.
Pl. ',:�S 1, 1)O No,r WRITE IN THE SPACE BELOW FOR HEALTH
REPRESENTATIVE'S USE ONLY.
Inspecting Agent Date
DEC 1 8
IAJVZ-R T E`L Z-VA 7-10AIs
AT 1101-1S6 - -
OZ
101-1S6 - . �
B
OX IAIZE"T
6 ox Ol1TLET -157 9.S
END oF867D . . . . /S7. .5"9
t NCr
�O
O_
li
I I
X23.3 ZS S Viyoo�SQ1 JF.
J oE _ AMY' "OM y0usE70
s�R s 7,4�1K WAS NO T/rV PLACE i
° A& /0°1 sb' AT Tl.,,LfE' OF /NSPEC T/O�t/.
p Z- /SOO GA[LDA/
SEPriG r,4AIk
i
SUBSUFc'�ACE c W,4GE /SP0SAe— SYS7—,E7114 �I
JCALE : / = �O� DATiE: 142 - 79
538 50 8.2/I�L.� PAry y
,(_/D. A kIDO//E,2. , IV-4,56 -
0
Ac56 .0 T 26 LDCAT/OAl: L.DT 26, BRAV/6S PAT No.Avoov-ne,1A4
/.33 A C.
C)
h andover
consultants No`/42
s�"usz
B Tilton Street, Methuen , Moss.
Tel. 687- 3828
//S D,4�'A W/AJ C7 , W/T!-1 .47-74C-'A-/ED
/S AA-)7- .4,5 Q l'U.4,�A�✓TF-F ,
T/-/AT 7-11e,.' i+
-. .- - - - --. -..:T.c---a--�_ ,....z ..._ _._------- ___ __ _•.......__- -..�,.r.-..�,r���_��.-�._._.��r....r..mac--=�--_.�-....�-_ �.av�--.--..---_---------__ __ .