HomeMy WebLinkAboutMiscellaneous - 80 BONNY LANE 4/30/2018 (2)Q
BOARD Oh EIEALT'H
146 MAIN STREET
TELEPHONE# (508) 688-9510
.4PPLICATION FOR tBAADOA11!E,v7
OF SUBSURFACE DISPOS IL Sr:; TEM
(SEPTIC SYST&V)
Pursuant to Section 310 CMR 1 J. 354
of the State Environmental Code, Title V
Name g4y %-)Y' I'Q o Phone
Address �i5 ��L4 41.
Contractor (tired for work:
Name_
Address
Phone 6g6 ` 5845
Date for scheduled abandonment ° / 30 / ?L",
The septic system at the above address has been abandoned according to
Title V specifications.
Signature of Contractor
Method of septic tank abandonment (check one). (} removal () sandfill
(,v crush () other
Name of Offal Hauler 139 11;:z-0elt
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
C)Inspecting Agent Da
.�� ����n
TO: : NORTH ANDOVER, MASS. (;.y�'% 19 L;k: Z
+ r BOARD OF HEALTH
FROM: DESIGN ENGINEER Re: Soil Absorption
Sewage Disposal
System
This is to certify that I have inspected the constr
said disposal system at jW
Site. ocation
North Andover, Mass.
The grades and constr ction.Fnai
specifications dated ""r',l
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Prof .
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