HomeMy WebLinkAboutApplication - 17 LACY STREET 5/14/1984 Town of Yorth Andover.Mass .
Fermi t Date - - 19
APPLICATION FOR WELL & PUMP PERMIT
Application is hefeby made for permit to drill a well Application is
made to install (—) a pump systemV
Location: Address ' Lot
I7
S
Q .
V 0 ,�. ,-') S,-S
P2, Addres� Te I .
owne YIJ/ J/
r,�,A - 9 _ �.
Well Contract
ddress(y mar t I . . . . . . . .
Contractor "l, 0, / �2�1�',
Pump Contractor Address Tell
WELL CONTRACTOR (To be completed at time of pump test )
r.Type of Well Well, used for
Diameter of Well Size of Casing
Depth of Bed Rock Depth casing into Bed Rock
ell)
Was Seal Tested? Yes No Date of Testing 14,
Depth of Well \3bo Well Ended in What Material
Depth to Water __ ep Delivers Gals . Per Min . for 4 hours
Drawdown -feet after pumping -hours at Gpm
.......... J
Date of Completion d, )I
,)
Signature Pell Contracfor _ -
PUMP INSTALLER (To be filled in before installation) -
Size & Name Pump -pilillp Tyl--)e Used
Wa;er Pump Delivers- GPM Size of Tnnk
Pipe Material Used in Well : Cost Iron Calvanizrqi plastic
Well Pit ( -) or Pitless: Adapter
Was sleeve used to protect pipe? Yes (J NO(J Type or Name Well Seal
We
A*5*515 too to 1126 A A A 0 How V A A ON-
Date Water anal} is report submitted to Bonrd of HralLh
Date release given t) owner of record 131 elf; . Ti isp
Ilr I L I i T ns p c t o r
Pumps
� e VuNna}neoble
Jet
R1% 28 WINDHAM, N.H. 30 C.6rMQ"agrrI
[6031090-4232 [6171 007-SO08 0 Sewage
OR
lAnks
N=Mers
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0 I N"Carl U
E: 9t,R CONS-1- TEL.::I.. . N O. w C h a merea l
477 ANDOVER {.'i..l., 686°-3635 e N°„Irnu,atrW eer
NO AN):)f.;lVER I"iA 01845 a Cantr"lud r
VVaateer Vesdn g
L-OT NhwS" f OR iGlPLw ha:` T I CN a LOT L ; » i ✓aY =T Pump Parts
Motor
C'oN°uur°oha;
WATER TEST RESULTS 17 MAY 84 VVeaWr Se'hene;r Saah
Re'o-g n I C,K C r e r
I"IAE'i);)NES::lS::i 0 (0--50 Etil:"(::N S:a1°(lIw•IL:)AF`D) Rust & Raab Remover'
STANDARD) Potassium
MANGANESE t ((::)—. 05 RE G STANDARD)
(0—. 01 r �rEa1tC
HYDROGEN SULFIDE 0 R : STANDARD)
STANDARD)
E�" aetoe Hae� = C nuNSEh (FCIDI Y) !. : (6. 5-7. 5 REG
TURBIDITY 2 (0-20 I°•tl::l r S::;..1..f.1N):)(iRD) I-awn a"a Watering
CHLORIDES 10 (0-150 RE:::C S:y..i..ANL:)ARD) Systems
(w)OL.,,I h:{::1RM BACTERIA 0 (0 REQUIRED ';a..i..ANE3frti:iD) V'Vate r Heaters
4 #4t#..#e..}..ye.}...}e..}e..}{. ..qe..}{,.ye..3e..;q..qY.3�.}e..}..;t..q.. .. ..y,.q„qu..y..}t..y;.. ..y4.. ,. ..}e..y;,. ..;...q#.. ..pg.,y. ..qe,.ga..q¢..gy..}..;..q.,q{..gti. w SAw
l.:,I""IARGE::: FOR R t:aHEI` I CFlL ,,, BACTERIA TEST •qe•#e• $25. 0(::)
N-Neeaa.P: N'aara°nl:a
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ABOVE TESTS MEET REQUIRED STANDARDS AND BASED ON THESE, w Energy Saving
U,IA'1"I::::R IS SAFE FOR HOUSEHOLD USr}E::: AND HUMAN VVOlua
THERE ill=>;E OTHER LE:::S:iiS I:✓C;1P'iP'I(:»iN MINERALS WHICH H 4:d('tN AFFECT ®a DrIlle
DUALITY OF WATER. a Dr ven
Dug
Gravel
4..;haem&& 1 IeeeKs
Lasrale. Alearnil tta
C,or'd'tn"Q'aIs
Portable II"oaMn ) IPuller
E meNliwua.y Seen"vWee
C;Oula::ds
F een°n atear
Red jacket
Fairbanks Morse
V° aya"14;ne
fa queR.tr o1"V
VVeMlk FN"r°aal