HomeMy WebLinkAboutMiscellaneous - 208 SOUTH BRADFORD STREET 4/30/2018 (2)rL
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BOARD OF HEALTH
27 CHARLES STREET
NORTH ANDOVER, MA 01845
TELEPHONE# (978) 688-9540
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM
Pursuant to Section 310 CMR 15.354
of the State Environmental Code, Title V
Name Phone
Address of?
Contractor hired for work:
Name V w a ta�Phone_ 47, 2.5' - 3-2- z z
Address „ kud,,
Date for scheduled abandonment b G - 00
The septic system at the above address has been abandoned according to
Title V specifications. e, V
Signature of Contractor
Method of septic tank abandonment (check one). () removal () sandfill
( ) crush ( ) other
Name of Offal Hauler
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.
10
Inspectin Agent Date
s
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. 1�
Application by the undersigned is hereby made to connect with the town sewer main in �d ^ r 4 6f 170! Street,
subject to the rules and regulations of the Division of Public WArks. n n
The premises are known as No.
or subdivision lot no.
Owner
'J
Contractor
CaA/5C "V A I DAI
Address
Address
Applicant'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
subject to the rules and regulations of the Division of Public Works..
Inspected by
Date
By
See back for rules and regulations
Street
Street
Division of Public Works