HomeMy WebLinkAboutMiscellaneous - 293 HILLSIDE ROAD 4/30/2018 (2)OUT,
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INVOICE
Bateson Enterprises Inc.
fomwdy Ray Fbtwa
111 Argilla Road * Andover, Mass. 01810
Soldto-���
Tel. (617) 475-1474
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SIZE
DESCRIPTION
UNIT TOTAL
500
1000
1500
2000
\j
2500
Ai�4:�-
14 A
AMOUNT DUE
Received bv �'
W 4 , &
Name
Addre
BOARD OF IIEALTFI
146 MAIN STREET
TELEPIJONE9 (-508) 68.8-9540
OFSUBSURFACE D1SJ10S,-11LS!ST`1--A,f
(SEPTIC SYS TEv)
Pursuant to Sectiot? 3 10 CMR 15. 3 5 4
of the State Environn7elltal Code, Tille P'
Contractor hiredfor work:
Name
Addrc
Date for scheduled abandonment 7 7
The septic system at the above addre�s 7hs bee -n aba
I -jadoned according to
Title V specifications.
Signature �f Cont;kor--
Method of septic tank abandonment (check one). removal sandfill
A), crush ( ) other
Name of Offal Hauler
Thisform must be returned to the North Andover Board of Health
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEATTH
REPRESENTATIVE'S USE ONLY.
a,; Ile
Ins
,�ecting Agent Date'