HomeMy WebLinkAboutMiscellaneous - 171 APPLETON STREET 4/30/2018 "171APPLETON STREET
210/037.B-0057-0000.0
Address 01 1�1� 6gi S 7-- Title of File Page of
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Num• Action Department
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Board of Appeals — Board of Health — Planniing Board --Conservation Commission — Building Department
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BOARD OF HEALTH
Y
120 MAIN STREET
TEL. 682-6483
SS HUS �1`h NORTH ANDOVER MASS. 01845 Ext23
A�M
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15.354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
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.
Name �� �� �/ Phone
Address
Contractor hired for work:/
• Name � f� /-S Phone
Address—
Date
ddress Date for scheduled abandonment
Method of septic tank abandonment (check one) .
( ) sandfill (�crush ( ) other (describe
removal ( mow)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Inspdcting Agent Date
Comments
•
. YN° 970
0
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. r 19
Application by the undersigned is hereby made to connect with the town sewer main in / Street,
subject to the rules and regulations of the Division of Public Works./
The premises are known as No. Street
or subdivision lot no.
Owner Address
Contractor Address 22
cant's Signature
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to-
to make a connection with the sewer main at ( �4 Street
subject to the rules and regulations of the Division of Public W r s..
Division of Public Works
By
Inspected by
Date
See back for rules and regulations
I •