HomeMy WebLinkAboutMiscellaneous - 432 JOHNSON STREET 4/30/2018 �1 C9353)
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II' ?0`' �� BOARD OF HEALTH
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120 MAIN STREET TEL. 682-6483
NORTH ANDOVER, MASS. 01845 Exc 2 3
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 mrior to date of abandonment and be accompanied with
a copy of the sewer connection permit.
Name Al' 9'eec o Phone
Address
Contractor hired for work:
Name N,q C,4'e'� Phone
Address '4OD1'- rt'
Date for scheduled abandonment
Method of septic tank abandonment (check one) .
( ) removal ( ) sandfill NA crush ( ) other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
1--, /
Inspect ' g Ag t Da e
Comments
N-0 1075
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass.
Application by the undersigned is hereby made to connect with the town sewer main in NSI)A.� Street,
subject to the rules and regulations of the Division of Public W rks.
The premises are known as No. ^� ��- Street
or subdivision lot no.
Owner Address
DaNr 1 ax
Contractor Address
A is is Signat re
�SS•v�r
PERMIT TO CONNECT WIT SEWER M N
The Division of Public Works hereby giants permission to_ �'�� I�l
to make a connection with the sewer main at �--� <�7�1��-_ .4`_ AStreet
subject to the rules and regulations of the Division of Public Works..
sion of P Ii Works
By
Inspected b
P Y
Date
See back for rules and regulations