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HomeMy WebLinkAboutMiscellaneous - 59 BONNY LANE 4/30/2018 59 BONNY LANE 2101062.0-0056-0000.0 r ��- BOARD Ot HEALTH 1-t6 MAIN STREET TELEPHONE# (508) 688-940 � 1 O gQra � I PPLICA TION FOR .4B-A-, DO, -I"fLiVT OF SUBSURFACE DISPOS4L S rSTE�1 (SEPTIC SYSTEV) ti Pursuant to Sectiot? 310 CMR 1-5.354 � 0 of the State Environmental Code, Title !% Name �C o S' C 0 CC! Phone Address Contractor hired for work: Name ) C- Phone 6o j Address Date for scheduled abandonment tt 9"/ The septic system at the above address as been abandoned according to Title V specifications. (igria lire of Contractor Method of septic tank abandonment (check one). O removal O sandfill (�) crush ( ) other Name of Offal Hauler This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. / 1 � 14 Inspecting Agent Date VL i 1 H Lo T t� o 0 t�.1 t� ,,� t��► Pte,�.e s�1 ,`\� L-E VA-r i to tom$':►, �\ 1 NV PIPE QItT -H5E1�a-1 E�ci 5 1 AIV PIPENTQ - _ _ _ 1K,v PIpE-QUT-O.ErA&j!L t 4a _" cJ i2.F' J D�'� -� �J��.--. 1 N V_ P t PE 1 ATO-�.$©X______I d 0 G:, _ _.. .. _ -z- - � _ --- __- INV" PIPE Of IT.P-AaX - '�'? f G'� _ .�►`�5T = — ,ryv -13 ` K OF i _ d 17 f SCA.L—M 221?8 Q .'.C►fr�3_��,c %' F 4ZANK. GC3Et_►N1�.S 't$eJGtA.TE� �7GtiA��' �.N Cwt hl!✓£� _ � I�-�I b� g s I .4N tx�✓�t�. '3`r rel r�- 15.rpt ovum�Z