HomeMy WebLinkAboutMiscellaneous - 20 HIGH WOOD WAY 4/30/2018Y
i
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
TEL. 682-6483
. Ext23
This form must be submitted to the Board of Health no less than
five '(5) days mrior to date of abandonment and be accompanied with
Name Phone, ZZ 2_&
Addres®
Contractor hired for work:
Name Phone c fl_
Address
Date for scheduled abandonment
Method of septic tank abandonment (check one).
( ) removal ( ) sandfill ( crush
Other
( ) other (describe
below)
PLEASE DO NOT WRITE IN THE SPACE BELOW
F-eR HEALTH AGENT'S USE ONLY /
6
Insp nZ D to
Comments