HomeMy WebLinkAboutMiscellaneous - 0 LACY STREET 4/30/2018Defa,t,,,e,,t,,l Envimnrnental M.,
agement/Division of Water Resources
WATER WELL COMPLETION REPORT
WELL LOCATION
GEOGRAPHIC DESCRIPTION
Address—' eAr,\l S7
t -nn N S tt�W o I
IfeeT
City/Town- MAA1d_0V,,E
(Ar,
Well owner 4121A/d f.09 Al
(road)
Address 5;Q A"I
P" N VE W of
-VV
T,,,i. in tenths) (arcle)
Board of Health permit: yes E]
no
finersect. a - —
road)
WELL USE
WELL DATA
Domestic [id Public 0 industrial E]
Total well depth "Os ft.
lWater-bearing
Monitoring 0 Other
Depth to bedrock , ,I� I ft.
Methoddrilled &7-Ae�l
tock/tinconsolidated material:
Date drilled 2,/Le!�—Z
Description 4�u-d 6-0eV"
CASING
Water -bearing zones:
1) From To eK5
Type
2) From To
Length .�7_0 ft. Dia(.I.D.) C, in.
_590,
Length into bedrock ft.
3) From— To
Gravel pack well: dia.
Protective well seal:
Screen: dia.
Grout.E] 0therD8j),,:r.<A/o,,:: Slot O� length—from—t
STATIC WATER LEVEL
Static water level below land surface f t. Date 2,o�RA,,
WELL TEST
Drawdown- f t. after pumping lir.— min. at �O gpin
How measured- dA4XZ- Recovery --- Z-0-OZit. after—hr. min.1
I LOG of FORMATIONS 1COMMENTS
i
Driller
Mass. Registration*
F 1 r m - !:,-
Address
City/Town
10 ^A nr% ^� /U� A. - ^ ^ � I,
BOARD OF 111:ALT11
Mo
Town of North Andovcr,Hass.
kl
19 9
APPLICATION FOR WELL & I'U1,1I' PERm1'1'
'ication.is hereby made for permit
to install ( ) a pump system.
to (frill a well (k) . Application i„s
tion: Address LCL«{ ` ST— . • Lot
r ;��U�%� Address
Contractor Add ress_3/
Contractor Address Tel.
CONTRACTOR (To
be completed
at time
of pump test)
of Well bel C e-
c
Well
used for
Teter of Well
�''
Size
of Casi.ng
-.h o -f Bed Rock
llepth
casing into BedRock y°
Seal Tested? Yes
QK) No (r)
Date.
of Testing -W/4 /
h:.. o -f Ue i4—
.h to Water
Delivers Gals.1'er 1iin. for 4 hours
odown 1 5'0 feet after pumping `� _hours a /0.GPM
of' Completion
dna ure We j- Contractor
' INSTALLER (To be-- f-illcd in- before instal.I.ati.on)
_
A. Name Pump
--Purnp Type Used
Si•r.e of Tail c
�en> � -. Well Endcd in What- Material
2r Pump Delivers GPM
Material Used in Well: Cast Iron (_) G�)v;ini7ed (_) Plastic (_1
l
1 Pit (_) or Pitless,Adapter (_)
sleeve used to protect pipe? Yes (_) NO(r) hype or Name Well Seal
ti (ye r 'r S,f )*: , �, �1 �1 � 1 � C .,'� )'' � : IJ C � ��, U
Water analysi•s.repor--t •submitted to Board of Health
release given to owner of record & Bldg. Insp
Health lnspector
BOARD OF HEALTH
Town of North Andovcr,Mass.
Permit # Date 19IS6 .1
APPLICATION FOR WELL & PUMP PERMIT
Application is hereby made for permit to drill a well (,K). Application is
made to install (®<) a pump system'.
Location: Address tic S'TZE—r 7— Lot: # . ......
6D UJ CA gl
Owner r,,A4Address T Tel
- 5�/. AJ199Ajn0XK--T
P60f9149—
P
Well Contractor Aj_ CC) Address37--6612666-RM9 1
kt)O.Address
Pump Contra c tor ) WATel.
WELL CONTRACTOR (To be completed at time of purnp test)
Type of Well
Well used for &61 die-AICE
'Of
Diameter of Well Size of. Ccalsing—
Depth of Bed Rock Depth casing into Bed Rock <--1
Was Seal Tested? Yes 44) No
Depth --o-f--W-e1
2-ZL57-le
- --
Date. of Testing
Well Ended in What. Material eock
Depth to Water -30 Delivers ..,?6 _Gals.Per Min. for 4 hours
Drawdown feet after pumping __hours- a t GPM
Date of Completion 2!
Sign1tfureF' Wel l Contractor
PUMP INSTALLER (To be-- filled in—before i n s ta 11. a t i on)
Size ze & Name Pump 31y Pump Type Used
Water Pump Delivers GPM Size of .Tank x5ylj
Pipe Material Used in Well: Cast Tron,(–) GnIvnnized Plastic (It
Well Pit or Pitless Adapter (L. -r
Was sleeve used to protect pipe? Yes NO(4Type or Name Well Seal.A6&4-1S--
Date Water analysis report submitted to Board of 1,rdal'th
Date release given tDowner of record & Bldg.- Insp
Health Inspector
BOARD OF HEALTH --- —
A9A 1�
Town of North Andover,Mass. ,.
Permit #oL��' Date Q7�� �' 19k
APPLICATION FOR WELL & PUMP PERMIT
Application is hereby made for permit to drill a well (x). Application is
made to install (e() a pump system'.
Location: Address �AC V S, TZ CE %...Lot #. • • • • • •
Owner CDuJ'',C:��i3i , Address
Well Contractor UI(�."c, ('C) Address —qAjLf�vT`6E/>��C-TUGfIl• �J
Pump Contractor /,y���e��TU� ��uMP Address Tel. &5-9 911.1
WELL CONTRACTOR (To be completed at time of pump test) /
Type of WellN, LC —d Well used for ��sid,�NC
Diameter of Well �� Size of. Casing
Depth of Bed Rock Depth casing into Bed Rock
Was Seal Tested? Yes (V) No ( )
Depth ••af Wel I —
Date. of Testing
Well Ended in What. Material
Depth to Water- I
%,0/ Delivers _Gals.Per Min. for 4 hours
Drawdown feet after pumping hours -at GPM
Date of Completion_
71 —
Sign ure Werl Contractor
s' :c
-A-
'PUMP
PUMP INSTALLER (To be• f•i.11cd in- before installation)
Size & Name Pump � Pump Type Used
- - -- --- •--- — --
Water Pump Delivers S GPM Sire of Tank CXR -3%i.--'
Pipe Material Used in Well: Cast Iron ( ) G'11.v.-ini.zed ( ) Plastic (t�
Well Pit (—) or Pitless Adapter (L-�
Was sleeve used to protect pipe? Yes (^) NO(—, Type or Name Well
Date,
�1r�'r�tJlNY NY N4NY* NYl4�'r�M1MtiY�r�Y � � � � �, ,S� QT1�Gl1�G..j�
�4�4�Ir�r�Y�M�r��r�4��C►4�4►'rti'tti4�r':rti<u� ai'... ....c,c,:,c,......::...."r�:..,
Date Water analysi's repor-t submitted to Board of }•Tcal'th
Date release given tD owner of record & Bldg. Insp
Health Inspector
HLE COPV
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby make applicatigAi for a per it for a sewage disposal installation at
I will install this system in ac-
cord Once with all the laws of tMe Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 290. I will install a con-
crete septic tank of /0-a—o in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
.or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of / e U lineal..izsqaeaq�) feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
tile line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE �/ �,�//7 0
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
Signatu e o Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE 71
Signature f Inspecting Officer 17
Percolation Test 13 A -C i .c
Garbage Grinder p
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
4 l'o
1. NAME kE y A (Ai !rL DATE 11-3170
2. ADDRESS Ae� ST LOT N0. TEL.
3. NO. OF BEDROOMS .3 DEN YES N0_.kl_
4. GARBAGE GRINDER YES NO
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE:
LOCAL REGULATIONS
SHOULD BE READ CAREFULLY.
NOz-rit
ilk Ai
13ox ion 1-6
oi ri L,ivIt.
$ MILE TP -T-6
CHARLES B. MILLS & CO., INC.
55 Salem Street Lynnfield, Mass. 01940
-Z Phone 245-5515
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Windrush Farm
INSTALLER (To be-- filled in, before insta11,3ti_on)
--Pump Type Used
& Name Pump
ar Pump Delivers GPM Size of Tank-_
_
Material Used in Well: Cast Iron (_) C al vr�ni zed (_) Plastic
Pit ( ) or Pitless•Adapter (_)
sleeve used to protect pipe? Yes (_) NO(_) Type or Name Well Seal
�M*�F�M�'*�Mi��'r�Fi1r��►'��4t�t�4�4t�c*�r�4tM4t**�Y*�4Jr�'��4�Y�4�'rti'r�'r�'r�'rti`r,'t,,,;1�1�1J;G•'S:I�C �drdrrrtt4lr
e Water analysi's.repor-t •submitted to Board of health_
'e release given tD owner of record & Bldg. Insp
I ealth Inspector
BOARD OF III;ALT11
Town of North Andover ,Hass .
........_.
Date 19�f
Ilication.is
APPLICATION FOR WELL & PUMP PERI -IIT
here y made for permit to drill a well ('V�. Application i„s
to install (
a pump system.
I:tion: Address W1WQ(1Q5%A T-A60Lot #
r 1L 1TT�Q�pc,
Address
Contractor 1-C4E12 6
Contractor
Address Tel.
CONTRACTOR (To
be completed at time of pump test)
of Well
Well used for
Teter of Well
Size of Casing
•
r
:h.of Bed Rock
Depth casing into Bed Rock
Seal Tested? Yes
(_) No (_) Date. of Testing
Well Ended in What_Material
:h to Water
Delivers Gals.11er Hin. for 4 hours
idown feet
after pumping __hours• at __ GPM
�'of Completion
Sil;naturc lJe�l Contractor
INSTALLER (To be-- filled in, before insta11,3ti_on)
--Pump Type Used
& Name Pump
ar Pump Delivers GPM Size of Tank-_
_
Material Used in Well: Cast Iron (_) C al vr�ni zed (_) Plastic
Pit ( ) or Pitless•Adapter (_)
sleeve used to protect pipe? Yes (_) NO(_) Type or Name Well Seal
�M*�F�M�'*�Mi��'r�Fi1r��►'��4t�t�4�4t�c*�r�4tM4t**�Y*�4Jr�'��4�Y�4�'rti'r�'r�'r�'rti`r,'t,,,;1�1�1J;G•'S:I�C �drdrrrtt4lr
e Water analysi's.repor-t •submitted to Board of health_
'e release given tD owner of record & Bldg. Insp
I ealth Inspector
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NUMZFR � ' „`fi. r •e: .
THE Co MAS �� x FEE
w r t n SA
�� , CHU�E7TS
ti. a TOWN of T
{ 7 ° NOR H ANDOVER 3 gar 4 -0
.,. tr `. .
j :This is to Certify that ..
-i V�;xa .lei M�au�PAy
.....253...�I�dO��� $ ti �'e t $
et
Ori ADD ESS f ' {
„ IS HEREBY GRANTED
For S ._. Well Drillers: �A LICENSE ,
• Permit "=K e
....
Nort t
h And I
3 i�tredg 00 Lacy Street
{ over MA 018 4 5 w w� n
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This license is granted in conformity -'
with the Statutes and ordinances, relating t
expires. IiE e-mbe X• .. a. hereto, and .
a ��a. r
• ' ' --unless sooner sus
tf P�fdQll ar, evoked.
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