HomeMy WebLinkAboutMiscellaneous - 295 FOREST STREET 7/18/2001 66 L.JT"I 11='10N ROAD, WE-STFORD, MA 01886 (978)692-839,5) FAX (978)692-0023 1-800-649-TEST
Report Number 57484.2 Report Date: 7/18/01
Client: Sample Information:
Ralph Joyce Lot B(295)Forest St.
121 Collins Landing N.Andover,MA
Weare NH 03281
Sampled by: Client Date Received: 7/1.6/01 Date Sampled: 7/16/01
Certificate of Analysis
Test Parameter EPA Limit Results Units
Total Coliform(P) 0 0 per100ml
Fecal Coliform(P) Absent Absent per100ml
E.coli Absent Absent per100ml
This water sample as submitted,meets all State,Local and Federal(EPA)requirements for Coliform Bacteria.
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Massachusetts Certification#MA048 Michael P, Carlson, for
New Hampshire Certification#2739 Thorstensen Laboratory Inc.
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Rtmort Doe: Jul.)20,2000
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Thucader Jt'clls 7tdL1A� a 5arwirfia
03054 i S 13d 9
Mtrf L(4 a(295)Form Street
Mez2 fi 73 ha,Andover,MA
Sa le Yiby; L.4bStaff' Cart; 7notg(1
"Totdi Colrtom(i') 0 . 0 per 1 t1
A (P) 0.05 001005 ms/L
colcium No Lima 91.3 mg/L
CqWr(S) 1.3 <0.02 rrtylL
iron(3) 0.3 0, 10.11 z /L
L eW i p) 0.015 mg.1
lytaamalum,, No Lima 1.9 rAWL
14speanne(9) 0.05 0.07 rr g1t
Paumium f14r 3Ttec. 3.2 VIWL
Se ium "28 55.4 r g/L
A atitatty(S) Noe 113.5 mg)L
Attuxaonia V*1,Spec, -0.03 mg/L
Chloride( ) 20 17,7 rxig.l
Cblorme Not Sp w., X0!02 tL
Color(S) 13 a 150 CPU
Cautducdvity Not mac. 298 unt4owcm
1?lutyrtde(S) 4,0 2.8 WWI,
Hardmu No Lifft1t 31 Moll,
tvitaarem(as h)(11) 10 0.22 Mgt
Wkwitaa fat N)(p) 1 eo 01 mss L
VH(R) d.S-9.5 7,9 SU
Oder(S) 3 2 TON
Salphares(S'1 250 4,2 mS"L
TilrWity hint Oqw, 140 NT*-;
9udymmat p"I'MA neg
N'7=`woi tattad.c V&Lua EPA STD,T NT C-l'oe Ntmwroas To Cewwn
"-Ncicaround BumW Noted,"-EPA Advisory lrtexxlx,I-%F;xCVe&A dOwry Lftalt
(P)-Pxiniary RPt1 S td,(g)-Seconfty EPA Smdard(y iky affut fieAthatios
of uriwk n%w4tee,i e. a°t,ccyl0t�tt.tt,��.Colt pr gat
11iis water sfir.Tl&as submined,is comidert,�1 Safe to drhik aUat^diAS W EPA
g :delims,However,aAc or rnere Wanwim exceeds EPA ampb$ary standard
at deyyoOd by the 4 skgm
'kt,
Ntaaatubusaug saw Garfiflod i qpvrl for
Testing Labolmtor; -0 MAWS Thorgiomen Lahomory Inc.
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4o sue BOARD OF HEALTH Z 7
ss'"NUSE NORTH ANDOVER, MASS.
APPLICATION FOR WELL AND PUMP PERMIT
Permit # Date 1p Z7 f C�
A permit is requested to: drill a well install a pump
LOCATION: ,L
� U /k z-2 e--5 7 Lot #
Owner �� l �r�� / ,Z�d ss� Z/2/111��/rv�'l Tel
Well Contra . Add. ' Z Tel
Pump Contrctr / � 5- Add. Tel 6e)-3
WELLS (To be completed at time of pump test. )
Type of well Use
Diameter of well Size of casing
Depth of bed rock Depth casing into bedrock
Seal been tested? Yes (_) No (_) Date of test
Depth of well Water-bearing rock
Depth to water Delivers GPM for
(how long?)
Drawdown feet after pumping hours at GPM
Date of completion
Signature of well contractor
PUMPS (To be filled in before installation. )
Name &size of pump Type
Size of tank Pump delivers GPM
Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_)
Sleeve used to protect pipe? Yves (_) No (_) Type well seal
Date
Signature of pump installer
Date water analysis report submitted to Board of Health
Plumbing inspector Wiring inspector
Board of Health
06/20/3000 11:05 603465351 SKILLIIJGS AFJD SONS PAGE 02
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06/0/2000 11:05 6034653512 SKILLINGS AHD SONS PAGE 03
130ARD OF Ill ALT"
Mass
Town of North Andover , �
Date lar
ermit it—
APPLICATION.°..�. ._.
-�
_ roll WELL & PUMP 1'LRMI'T . Application
ication .is hereby made for permit too cfri L1' a well � pP
ode to install ( ) a Pump system.
. Lot 41 . . . . .
ocatio,n: Address --
,wner• AddVess
Address ® ` Tel . -
,ell Contractor Osf3 _
,ump Contra -tor
J
_Address _
,� Tel . .
)ELL CONTRACTOR (To be completed at tiliic of I�urnh t'cst: )
;ype of well Well used for '
d
Size of Casi.nR
iameter of Well
DcpLh casing; into heel Rock
]e P th of ]led Rock
aas seal Tested? Yes (®) No (®) Date. Of- 'Testing
Depth of " & - ®- Well Ended in W11-1.t- Material
Depth to WaterP Delivers Cals . Pcr Min . for 4 hou
G I'
Dr�awdown feet after pumping
hours' a PI
Date of' Completion
Si ur eI xacLOx
4 ;cxdt: a:�ir;fir:. .cit:c;cir::x:. .;it,':Xi.':. . ••
PUMP INS'T'ALLER (To be' f-i.11cd in' before in ;Lal.].7Cion )
Pomp TYI'c Used
S*x ze & Name Pump
water pump Delivers GPM Size of
Pipe Material Used in Well : Cast Iron (�) ( n) v:ini 'cd (�) I'l cast is (�1
well Pit. ( ? or Pitless ,Adaptor ( ®)
14as sleeve�use d to . protect pipe? Yes (�) NO(—) 'l.'ype or 1\3111e well Seal
Hate
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D, t'e Water anal ysi-s'. r'ep6r t- °submitted to iloarcl of 91ea) l°h
Di- -e release given tD owner of re.cord & Rlclg . Insp
health Inspector
06/20/2000 11:05 603465351 SKILLINGS AND SONS PAGE 04
13 OA IZ I7 OF
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Town of portly Am
Date
APPLICATION FOR WELL & 1 Ut1�' 1 LRr1S C n lieation
'piication . is hereby made for permit to drill a well _ PP
)de to install t_) a pump system'.
Lot
cation: Address �S � Cc1 .
aT9C'r Address �a
ell Contractor -.� Address � .
ump Contractor lr -
Address �i Tel a� e
ELL CONTRACTOR (7o be completed at time of pkillip L'cst )
®�
ype of Well 14ell used for
)iameter of Well Size of Casing
)epth of fed Rock Depth Casing into Lcd Rock
!as Seal Vested? Yes (�) No (�) Date. of Tcsting
)epth -•o•f:.���d-� •® _. hell t�ndcc! i« Wl�:�.t- Material
)enr_h to Water Delivers Gals . Per Hin . for 4 hau
Drawdown feet after pumping --hours- a GP11
Date of Completion
Si urc e ractor
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PUMP INSTALLER (To b.�'• f•i.11cd i.nv bcloi:c instillation )
Size & Name Pump ®1'timp Type Used
- •a
Water Pump Delivers GPM Size of
Pipe Material Used in Well : CnsL Iron (_1 Cal voni zed
Wc11 pit ( ) or Pitless -AdapCer (®)
Was sleeve used to protect pipe? Ycs (®) NO(_) Typc or Nalnc Well Seal
Date
r I ru, ii� ®li� �dr�M1
D^ te Water analysi's'. repdrt. 'submitted to hoard of Health
Dn _e release given 1p owner of record & 111c1g .- Insp
�Ile,)i. Lh T.nspector
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Department of Environmental Management/Division of Water Resources
WELL COMPLETION REPORT
WELL LOCATION GE40RAPHIC DESCRIPTION
Address ,) N (SE W of
(feet)
— (circle)
City/Town
v �
7e r (road)
Well owner
C�r>/� a S � a l� N S i( j W of
Address (circle) i-
(mi.fn tenths)
0111`_`1`_`Im-e �
intersect. WI
Board of Health permit obtained: yes, ,no❑ "road
WELL USE WELL DATA
Ct�,.• � ft. ?
Domestic Public❑ Industrial ❑ Total well depth -
Monitoring El Other Depth to bedrock ¢ ft.
W ter bearing rock/uncohsol!dated material:
Method drilled ✓' Co el
r.� Descriptions
Date drilled F r '' /F -� Water-bearing zones:
CASING 1) From -uvc To
Type r `"� fi° 2) From To s
Len th ft. Dia( D.)�—in. 3) From o I
�•��
Length into bedrock ft. Gravel pack well: dia.
Protective well seal dia.
Screen:
Grout ❑ Other Slot# length from_to_
STATIC WATER LEVEL (all wells)
'2_62
4
Static water level below land surface *6 ft.
Date—+
WELL TEST(production wells) f
„0x .. .,,
Drawdown ter' after pumpfrtg hr, min. at 9P t
How measured Recovery o ft. after A') hr. min.
r`
LOG of FORMATIONS COMMENTS
Materials From To §
Driller � � .�
Firm
i '
r6 ,f
Address "a Av �s`
1 City/Town �
Supervising Driller Reg.# )
gnatur•6t su rising regist fe ell driller
Please print firmly �
I BOARD OF HEALTH COP
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