HomeMy WebLinkAboutApplication - 351 REA STREET 5/3/2000 yauwrey ._--_----
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gSAC14 S BOARD OF HEALTH
smc"`� � NORTH ANDOVER, MASS.
APPLICATION FOR WELL AND PUMP PERMIT
Permit # Date . .., ..w,. 3
A permit is requested to: drill a well 1/ install a pump
ON a f l a. E .7= .
LOCATI � � Lot
Owner . �
(.. .. <' Address �s. Tel `r
Well Co '
ntrctr r6'(� (` Ic ' 1a 0 (__,Ko. Add � � ` rA el Cl� ? 'l
ern ���5���'l�.� rc.� ��' �`��. �; '� _��...
WELLS (To be completed at time of pump test. )
Type of well L,...6 4 Use ( . '., a/�
•
Diameter of well_ Size of casing
n
Depth of bed rock ".1c, Depth casing into bedrock ° "
"� (_) No (�) Date of test
Seal been tested. Yes ��� �
Depth of well �y'. Water-bearing rock
p �a Delivers 4-7, GPM for "�° O(_�k "
Depth to water ����° "�• �� '
(how long?)
Drawdown , , feet after pumping ..�' urs at GPM
Date of completion � - Cn � �
Sinature of well contractor
PUMPS (To be filled in before installation. )
Name & size of pump ZdMlYlt Type
Size of tank „ .M Pump delivers , 1 GPM
Pipe used in well: Cast iron (_) Galvanized (_) Plastic ( t )
Sleeve used to protect pipe? Yves _) No Type well seal /"< ley
Date
Signature f pump installer
Date water analysis report submitted to Board of Health
Plumbing inspector Wiring inspector
Board of Health
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(603) 898.4232 * Fax (603) i�l)8 581
(3810)9S)"�.•�l��UMP
Terry Joyce Sample Number 1034$ WATER
50 Second St. SYSTEMS
No. Andover,MA 01845 978 682-7633 Artesian Wells
Pumps
Booster
SAMPLE MOM: 351 Rae St. Flo.Andover,MA(11345 Jet Submersible
Deceived (05110100 ) Sump
Motor Controls
Test Results ****=Over MCL Maaxhmmi Contauninant Level Parts&Accessories
___®_________________________________________________________ Pipe& Fittings
II 8.25 (6.5-8.5 EPA See Std) Water Tanks
Hardness (as CaCO" )----- 5.0 (75 PPM EPA See Std)
Chlorides_____________®______ 39.0 (250 PPM EPA See Std)
Sodium_____________________ 65.0 (250 PPM EPA See Std) SEWAGE
Nitrates_____________________ c0.20 (10 PPM EPA Pri Std) SYSTEMS
Iran _______________________ <0.10 (0.3 PPM EPA See Std) Alarm Systems
Manganese--------------- <0.05 (0.1 PPM EPA See Std) Alternating Panels
I'rrmps
E-Coli Bacteria------------ A (0 PPM EPA Pri Std) Effluent
Coliform Bacteria________ A (0 PPM EPA Pri Std) Sewage
Screen Alpha_______________ <10 (15 PPM EPA See Std) Parts&Accessories
_____________________________________®_____________________________________________________________________-_ Pipe&Fittings
Tested by New Hampshire Certified Lab#
Results entered by;
WATER
This sample meets EPA safe drinking standards based on the tests listed above. TREATMENT
Aeration Filters
If you have any questions please call Policy Well & Pumj) at 603-898-4232 Cartridge Filters
Chemicals
Softener Salt
Page 1 of 1 Well Sanitizer
]Neutralizers
Reverse Osmosis
Sand Separators
Water Conditioners
SERVICES
24 Hr. Emer. Serv.
Portable Puller
Hoist Truck
Water Testing
Pr°oviditw Pr ofi!ssirrnal [,V' er°Ser vic e Sind, 1966
FROM POLIC`t PHONE HO. May. 1b 2000 10:09AM P4
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t ' wELL COMPLETION REPORT
WELL LOCATION
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�j Length into bedrock ra1•� re. Gr�vp peck.11, –
�) Prot®Olive Well goal:
$' gmiiC wAT9R LEVEL 1911 wafft+! I
hut"water l6val,tolcw lor®SUrlace 4 ft Lale
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mow m®asvrod Recovery !l. after
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�'" •''`� BOARD OF HEALTH
,SSACHUSES NORTH ANDOVER, MASS .
APPLICATION FOR WELL AND PUMP PERMIT
Permit # Date � - 3
A permit is requested to: drill a well V install a pump (�
LOCATION: 5 ( � t� e 5--, Lot #
Owner �e rr V V o yr_ 2 Address 5�5' /-VCWA) S Tel l7�- G,a -?(�3,3
' q4 �G--erfe�'w,4l
Well Contrctr jerd �esj_h,� t�eKo. Add.ta,344161x Tel '2
Pump Contrctr P� (cc Cie(( ,)vupCd. Add.No, `'?,M cJ, Tel cTCb
WELLS (To be completed at time of pump test. )
Type of well E) �; _ Use 5-1,04/e
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? Yes (_) 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