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HomeMy WebLinkAboutMiscellaneous - 35 BONNY LANE 4/30/2018 (2)th i BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM + (SEPTIC SYSTEM) TEL. 682-6483 Ext 23 s 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 4 Phone Address Contractor hired for work: ,,99 Name �vl,�_ � Phone � o' Address > -v , A/� Aloael— Date for scheduled abandonment Method of septic tank abandonment (check one). ( ) removal ( ) sandfill) crush ( ) other (describe below) Other PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH AGENT'S USE ONLY Date Inspecting Agent : I Comments 1 e 52,\.St.� S►�, ML.F.yA►T i atI . E 5xdfl,6:u lo�j��9c s u I U -T uur.FAC., . L)IsP, 405"'Y'bi EM HA S e-8,Lit tw 4 PA -r M; %-Z t (a � Acawt