HomeMy WebLinkAboutApplication for Abandonment of Septic System - Permits - 676 OSGOOD STREET 7/1/2020 BOARD OF HEALTH
124 Main Street
North Andover,MA 01845
978-688-9540
A PPLICA TION FOR ABAN1 OMMEtdT
Oj,'SUBSUP,F,4C,E DISPOSAL SYSTEM
Pursuant to Section 310 CUR IS,354
Of the State Environmental Code, Title V
Name���5 _._q _ Phone
Address
Contractor!tired fir work:
Name r Phone
Address
Date for scheduled abandonment 0!!�
'b septic systems at the above address:has been abandoned according to TitloV'specifications.
51,Ac5 ��41b,, u,�
�44aco
Con rector
Method of septic tank abandonment(check one). removal ti )sandfill Ve other
Name of Offal Hauler �J��-��r� ��• � � J��/Jr .�%n�c.�
Tharform mW be returned to the North Andover Board of Health. � 00 �
PLEASE ISO NOT WRITE IN THE SPACE BELOW
FOR HEALTH REPRESENTATIVES ONLY
1n pectic gent Date
7/l/2020 20200626_101757.jpg
�t{ � � 4 xl•�i mac.,"�• p f. � a; } � c4 s - �.�
{g
4,,. '
VO
IN
t< L`
�u
y y,
https:Hmail.google.com/mail/u/0/?tab=rml#inbox/KtbxLzFvTFJWdH HpMXSnIDGQPDGXJdrVgV?compose=GTvVIcSHwsFCgIVWMwjfZGZIRZHGbBq
L/l bBgJHZHIZJZjfA^WMAlbo_sSMHSoInAlJ=asodwoo6nbAiPfXJadbJaluSXWdHHPMfdlAdz-jxgl>{/xoqu!#�wj=qel�,/0ln/I!ew/woo,al600b-I!ew//:sdlly
51
NIP
a
t'
.i
t
iC
Y t'
�• i, �1 r y; �.�,dr .t f<r��"�3" �T'" 'p�} E .,`'° �.� M �ri"e j `�'e}n��-
fi
z
t;{ i.�.•.
�'qj ^k
T y�
s .y.. .�
i
- w
bdf M6 M 9Z900ZOZ OZOZ/l/L