HomeMy WebLinkAboutMiscellaneous - 37 BRENTWOOD CIRCLE 4/30/2018a
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 prior to date of abandonment and be accompanied with
a copy of the sewer connection permit.
Name 'R, L C)-1 fi-FZ'T� Phone T7 —"-7� CS
Address
Contractor hire(d�' for work:
_ -
O Phone 3J) - a6aa
Address " bL WnsygAJT
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
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