HomeMy WebLinkAboutMiscellaneous - 85 SOUTH BRADFORD STREET 4/30/2018 (3)•r„
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15.354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
TEL. 682-6483
Exr23
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 i Phone
Address
Contractor hired for work:
Name 2, ty e, r Q
Address '
Date for scheduled abandonment
Phone
Method of septic tank abandonment (check one).
( ) removal
Other
( ) sandfill ( ) crush
( ) other (describe
below)
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Ins pe "' g Agent Date
Comments > / ." '�, `✓ � �
N 1122
0
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. �� 19
Application by the undersigned is hereby made to connect with the town sewer main in 15) Street,
subject to the rules and regulations of the Division of Public Works.
The premises are known as No. 05 �;�) 3Lr,
� l Street
or subdivision lot no.
Owner /
Contractor
C
AArl-
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..
By
Inspected by
Date
See back for rules and regulations
0
Street
Division of Public Works