HomeMy WebLinkAboutMiscellaneous - 8 HIGH WOOD WAY 4/30/201811)
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BOARD OF HEALTH
120 MAIN STREET TEL. 682-6483
NORTH ANDOVER, MASS. 01845 Exc23
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 copy of the sewer connection permit.
Name Phone a.1- r7la-�i
6^ A
Address cir
Contractor hired for work: /
OName Phone
Address
Date for scheduled abandonment_
Method of septic tank abandonment (check ne).
( ) removal ( ) sandfill ( crush
Other
( ) other (describe
below)
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Inspecting Agent
Comments
Date
1,067
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. ----,
19 �6
Application by the undersigned is hereby made to connect,with the town sewer main in �� �C t� Street,
subject to the rules and regulations of the Division of Public Works.
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The premises are known as No. Street
or subdivision lot no.
Owner
L�
Contractor
z 41
p d 14254 L 7
Address &'F _ 2-2-3G
Address
pplica 's Signa
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at--,---.
subject to the rules and regulations of the Division of Public Works..
Inspected by
Date
By
See back for rules and regulations
Street
Division of Public Works