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HomeMy WebLinkAboutApplication for Abandonment - Permits - 1725 TURNPIKE STREET 3/10/2020 SAILEDI� o MAR °2020 TOWN OF:. Rrlj H TN')FPARTM�Vle,� BOARD OF HEALTH 120 Main Street North Andover,MA 01845 978-688-9540 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section 310 CMR 15.354 Of the State Environmental Code, Title V Name G 11'1AIC Phone (�7N 9z 9` 2 Address /'1Z S- Contractor hired for work: Q Name ,�L/-'i�/ JW11% 91-40 /1-V6 Phone 0 7'0 Address T/1-1x q l}/1l `�� � . WA ®lf�-2 Date for scheduled abandonment 1"Iet-6Y /9 7�v Z©�� The se c ys m at the above address has been abandoned according to Title V specifications. Si ature f Contractor Met of septic tank abandonment(check one). ( )removal ( ) sandfill Kcrush ( ) other /�Name of Offal Hauler � ' f �'L�% �Gf 7 Ca�/.' This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVES ONLY ,�L 3�1v�2�va Inspecti Agent Date VT ;' 1`' � ; " ." '�_� }'! �y'• 'm d. ''�l�x�� '", e��t � i�, Via.' # , r 3 3 L yyT, •` y j r Ti h .. ,. 4 M1 y � \ t o1 , CL 00 M15 N t CL g : 1, 7 LL vq- tm pia J 3z O IA co c0i, I �fi �a r �t � '7 t � •�.� �T�'ti t 1-�'�9 aT _ � t' O g =tea_ s �.�n,�a�' �3�txl • � �y �.�• ���, t/7 M L 3/10/2020 20200310_082959.jpg / P7 ^ n Y r w P R r o e-1' t, 14 gyp: 3Y� s i G,A 0 x`T,7p tfC. s r r� y� a R t �. t.Jp._. ,. r•t"_� � fir,,.''' F ,.e_.. ,e' t � yt 34.N _ r w Q Y.h J car�y, https://mail.google.com/ma!Vu/O/?tab=rm l#inbox/KtbxLxGPngbbzdsHjchwQgvtZKjQDmCkFg?projector=1&messagePartid=0.1 1 2 w b, � r sir 4 i l A 7 sX + t� I }q j to c " N O OI f0 O as N �. O N fit: U CL CD U v cm ca i tiv o �� � �{a i�� � �a �� ','•fir a �•'.`'" >, o i O � I � 01