HomeMy WebLinkAboutMiscellaneous - 592 OSGOOD STREET 4/30/2018 592 OSGOOD STREET `
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BOARD OF HEALTH
120 MAIN STRFrT TEL. 682-6433
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CN,;SE��s NORTH ANDOVER, MASS. 01845 E:<cZ3
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 cony of the sewer connection permit.
Name Phone
Address '5— Q s a
(--\ Contractor hired for work:
Name -Phone—
Address_28'LrT
D C a,,.� ,��e� L4
Date for scheduled abandonment
Method of septic tank abandonment (check one) .
( ) removal ( ) sandfill ( ) crush ( ) other (describe
belcw)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT ' S USE ONLY
Inspecting Agent Date
Comments
N 1143
C
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. 19
Application by the undersigned is hereby made to connect with the town sewer main in 7 zo' . Street,
subject to the rules and regulations of the Division of Public Works. 1 /
s92The premises are known as No. Street
or subdivision lot no.
Owner i Address
zoo
Contractor Address
pplicant's 'gnature
OF
7_/0AJ
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