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HomeMy WebLinkAboutHealth Permit # 5/14/2002 NUMBER Ar0q 40 THE COMMONWEALTH OF MASSACHUSETTS FEE �U�.. 17Q .. , . . � 2T�l .•/ r This is to Certify that .... t=? .. NAME ADDRESS IS HEREBY GRANTED A LICENSE For .....T/-'x ?. r-//l r/2Y. .....©. ...92�............ .............................................................................................. This licensee is granted in conformity with the Statutes and ordinances relating thereto, and expires...1 - - -----------------------------------unless sooner suspended or revoked. ----•--•---•----•--••--•--------•---•------------••---...---•--....-•---•.•---•---•---•--•- j ............--•--••--.....----•--•--••................•••........•-•-•-....... .. j -- 49.•-•-- ------•--•--- .-------•----------------•--•----••--••------...---••--•--••---•--•--- FORM 489 ....-..-..-•--•---------------------------------•--•----••-------•- H&W HOBBS&WARREN na ...................... @ p�c9�Yyy yy X470 BOARD OF HEALTH � sncwu�Ei w: NORTH ANDOVER, MASS . APPLICATION FOR WELL AND PUMP PERMIT Permit # ;r �® Date A permit is requested to: drill a well ' install a pump LOCATION: 6(a 'Q Uo Pk- Ile- Lot # Owner W!/l ']�C �L(4( Address '(4 X, el 4/ Well Contrctr dull''1e,f Add. � �� , i� /�7Te1 Pump Contrctr 4 j 3 Add. _N7 V Re/Tel �:r:°;»c`:r.:c•.':•},•x is x 7:7•a:is rr r"c ' •.7e x•x is�i.,:,,; rr•�e it•�*�e�r'3c:':��r',k�e�r it r'r�r ie 7l 7k�r yk 9r� M•Jr�t yk k 7k•fie�e�r�e•k 4r�c +r��e�c�c WELLS (To be completed at time of pump test. ) Type of well , Use Diameter of well i.ze 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 _ (now 1Utty , , Drawdown feet after pumping hours at GPM Date of completion Signature of well contractor PUMPS (To be filled in before installation. ) � I n Name & size of pump p el(W� �� (f 5,� T yp e SiG e o tEaiik� 6 rump 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 tr k mY " p . t6 " ° ( ( Massachusetts Department of Environmental Management Office of Water Resources 1145 9 "µ. TYPE OR PRINT ONLY - Well Completion Report 1. UI/ELLL� A[LO GPS{OPTIONAL) LATITUDE LONGIT DE Address � �ss at Well Location: t ° . L in "i� � �. �� Property Owner: f� I f ` = t (- _ -, Subdivision Name ) Mailing Adddre�ss f t ) _z a° / City/Town: s }r �.-� LlIy ) In}t,��'� City/Town: t.i V(j v /v)f�- 1� f ` Assessors Map Assessors Lot#- NOTE: Assessors Map and Lot # mandatory if no street address available Board of Health permit obtained: Yes Not Required ❑ Permit NumbelOLO,W Date Issued � 2 "WO K PERFORMED; . PR OSED USE . DRILLIIC MI;1 HOI3 01-New Well ❑ Abandon Domestic ❑ Irrigation ❑ Cale ❑ Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal M"Air Hammer ❑ Direct Push ❑ 'Re lace ❑ Other ❑ Industrial ❑ Other ❑ MuI52!2y ❑ Other WELL LOU Unconsolidated Consolidated : ITf� TO (use permanent landmarks with ais,"tans) W Permeability g" QN = � a t }1 From (ft) To (ft) High Low n (D m Other Rock Type 0. y_ ` i '> F�2;1 4 ' 7.!WELL CONSTRUCTION S. CASING Total Depth Drilled , From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type Date trilling Cpmp e t o ) t c 9. SCREEN From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 71. ADDITIONAL W LL INFORMATION From (ft) To (ft) Material Description Purpose Developed? Yes ❑ No Fracture Enhancement? ❑ Yes No Method Disinfected? Yes ❑ No 12.WELL TEST DATA(PRODUCTION WELLS).STATIC WA'TER`LEVEL (ALL WELLS) Yield Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (R. BGS) Date Measured Ground Surface (FT) -„ .. m 14 PERMANENT PUMP yy(IF AVAILABLE) 15.NAMEIADDRESS OF PUMP:INSTALLATION COMPANY Pump Description Horsepower Pump Intake Depth (ft) Nominal Pump Capacity (gpm) I COM MENTS 17:< II(ELL,[ FtILLEFt'S STATEMENT This well was drilled and/or abandoned under my supervision, according to applicable rules and regulations, and this report it 7011ete and correct to the best of my knowledge. Driller: V Supervising Driller Signature: �� N' Registration #: ! � F Firm. - / 1<w �v t ,� Date: .,. r°' Ri g Permit#: NOTE. W l Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD OF HEALTH,COPT' SKILL,"ING ELLS PUMPS w P ` April 10, 2002 Wilsred Welech 1507 Salem Street North Andover, MA 01845 Dear Wilsred: The following is an estimate for a drilled well and pump system to be installed at 49 Equestrian Drive in North Andover, MA. WELL Drilling: 12"pilot hole................................................................................................. $ 14.00/ft 6"well ........................................................................................................... $ 8.00/ft 8"pipe (casing).............................................................................................. $ 19.00/ft One8" drive shoe (seal) ................................................................................ $ 125.00 Permit (per town requirement) ...................................................................... $ 60.00 PUMP SYSTEM This is an estimate only. Your system can only be accurately priced one the well is completed. Sizes of pump, pipe and wire may vary. 1 '/2 HP Goulds submersible stainless steel pump system............................. $8,2150 Pump installed to 300'on 1 %2" steel pipe 600' 4" Schedule 40 PVC shroud Up to 100' 2"waterline Up to 100' 1 %2"return line Up to 100' electric line Up to 100' 2" styro-insulation V350 119 gallon water storage tank ADDITIONAL COST Grouting (if needed) ... $ 300.00 ® Plumbing: $75.00 per hour plus materials ® Pump Test and Lab Analysis (see note, per town requirement).,...... $ 250.00 ® Hydrofracking (if needed) .................. ...,. $1,600.00 .......................................... (Hvdro racking is a process that uses water under high pressure and volume in attempt to increase the gallons per ininute of the well.) • Over 100' offset piping (line fi°om well to hoarse)............................. $ 2.75/ft • Backhoe charges: $185.00 move charge, $85.00 per hour labor • Electrical to be wired by an electrician from well to house. • Massachusetts State Sales tax, if applicable, to be added at time of billing. 269 Proctor Hill Road > Hollis,NH 03049 - (603)465-3500 phone • (603)465.3512 fax ESTIMATE The following is an estimate only and is not the cost of your well. The actual cost cannot be calculated until the well is drilled. 12" Pilot hole drilled to 40' ($560), 6" well drilled to 500' ($4,000), 40' of 8" casing ($760), drive shoe ($125), permit ($60), 1 %2 hp pump system ($8,210.00), pump test & lab analysis ($250) and state sales tax ($118.44)................................... $14,083.44 NOTE: ■ Customer must hire electrician to wire pump system. ■ Owner acknowledges that Contractor does NOT guarantee the quality or quantity or water, if any, obtained by drilling. ■ Skillings and Sons, Inc. will try to minimize damage to the driveway and lawn, but due to the size equipment needed to drill a well, some damage may occur. Skillings and Sons, Inc. is not liable for repairs. ■ In the event there are drillings left over after the job is complete, Skillings and Sons, Inc. will put the drillings in a pile. Or, for a fee of$100.00, Skillings and Sons, Inc. can remove the drillings and dirt from the site. PAYMENT TERMS: • Two contracts are enclosed. Please sign and return one copy of the contract to Skillings and Sons, Inc. with a deposit of$1,500.00 prior to scheduling the well. Please retain the other copy for you records. • The balance, in full, is required within 30 days from the date of invoice (If the tank and offset are not hooked up within the 30 days, you may holdback $400.00, until the job is complete). ■ Interest is 1.5%monthly on all past due balances. ■ The cost for lab analysis is based on town requirements. There may be additional testing required by the town after initial testing is complete. You will be responsible for the payment of any follow-up testing that is required by the town. ■ Lab results will NOT be released until account is paid in full (If you are holding back for the tank and offset, the results will only be released if you paid up to that point) *We accept M terCar , Visa, Discover, American Express and cash or check. If you hav y ue ions, please do not hesitate to contact us. Wilsm i_ eh GJi necl a&e Jef uinn W eft les Telephone: (978) 618-9959 (cellular) (978) 697-1294 (cellular) (978) 258-0625 (fax)