HomeMy WebLinkAboutMiscellaneous - 32 ESSEX STREET 4/30/2018 ------------------
32 ESSEX STREET
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210/103.0-0043-0000.0 `
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Address .3� _�5s�x S7` � Title of File Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals — Board of Health — Planniing Board — Conservation—Commission — Building Department
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HO R T iy
BOARD OF HEALTH
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° • 120 MAIN STREET TEL. 682-6483
,SSACMUSE� NORTH ANDOVER, MASS. 01845 Ext23
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 �,U��'� Phone
Address
Date for scheduled abandonment
Method of septic tank abandonment (check one) .
( ) removal ( ) sandfill ( ) crush ( ) other (describe
below)
Other
PLEASF-- O NOT WRITE IN THE SPACE BELOW
, --FOR HEALTH AGENT'S USE ONLY
Insp yg/1�ge Date
comments
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover,Mass. U 19
Application by the undersigned is hereby made to connect with the town sewer main in —�7 CX, Street,
subject to the rules and regulations of the Divisions of Public Works
The premises are known as No. ✓Z 2 LAX Street
or subdivision lot no.
Owner Address
Contractor Address
�A plicant's Signature
ZZ
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at Street
subject to the rules and regulations of the Division of Public Works..
Division of Public Works
By
Inspected by
Date
See back for rules and regulations
� � d0 �Opa OG3D�Q _
27483
Lawrence 688 1181 Haverhill 373-7151
Salam,NH 603-898-1554 Plaistow,NH 603-382-3322 DATE OF ORDER
Methuen 686-2214 Andover 475-4711 Newburport 462-4661
CUSTOMER'S R N N M M NS HELPER NDATE
LL TO ORDIAK N
ADDRESS
�1, y C] DAY WORK
CITY CONTRACT -
I� C] EXTRA
JOB NAME AND LOCATION _
JOB PHONE
7
G
of
TOTAL AMOUNT
No one home ❑ Total amount due Total billing to
Signatur 4/ for above work:or be mailed after
mcompletion
I h by ackn ledge the satisfactory copletion _ - .--
�� Of Ute-ahme_tlascJ+��
TERMS;C.O.D.
Because of the nature of the t00TEN ®
that all payments be made to
A FINANCE CHARGE compute �vm
an ANNUAL PERCENTAGE A
unpaid by the 10th of the mon
Septic Tank Pumping•DrainCleaning
Leachfields•Sewers Installed&Repaired
A service charge of$15.00 will Law.688-1181 Andover 475-4711 Haverhill 373-7151
Newburyport462-4661 Salem 898-1554 Plais.382-3322
FAST 24 HOUR EMERGENCY SERVICE,
Glenn Daigle -
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k.
e5:
i
i i it I jig �
w0 SM
� i SII '
SEPTIC SYSTEM INSPECTION FORM
ADDRESS G�sex
DATE INSPECTED
PROPERLY FUNCTIONING? L]'J N
WEATHER CONDITIONS
COMMENTS :
a
WATER QUALITY TES 1 F-b o JZESULTS?
DYE TEST PERFORMED? Y N
DATE?
SKETCh:
