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04/27/2010 09:41 6035779947 NORTHEAST WATER WELL PAGE 01/02
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Lab
Num'ber: 113495
ashobanalyticalT ' r&978-496-3314, Fix;978486-3U1sRCdlunbcr
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29 King Sttrc,.t.J.,itilc4oti MA 01460
Client' Repartl)eite: 5/6/2010
Northeast Water Wells
$0 RivEw Streot
inffr6y,NH 03452 J Z�
Ce_rtif ate of Anal sis
Lot 1 yBeSt, North Andover MA Z
Resialt MCL MRL int.e of Analysis Analyst
)a er met.hod
-Well
S.qMpjt,d:4/29/polo 14-00:00 AM by Client
Total Coliform BaM,MAl 1118
0 O/Absent 0 4/29/2010 1;30-00 PM
n
..terla,lio()ML MP-5M927.2614 0.01 0.002 511/2010 M-MA11 118
Ar-schic,Total,MG/L SM 31138 # 0.9 5/11/20`10 M-MA1118
cAlnlum,MOIL EPA 200.7 $7.3 Not Spec 1 5/112010 M-MA1118
Copper,MGIL EPA 7003 No 1.3 0.01
Iron,MOIL
FPA 700,7 0.22 0.3 0.01 511/2010 M�MA1118
Lead,MG/L SM 31138 NO 0.015 0.002 413012010 M-MA1118
Magnesium,MOIL EPA 200.7 2.2 Not Spec 1 511/201'0 M-MA1 118
Manganese,MG/i- EPA 200,7 0.02 0.05 0.005 5/1/2010 M-MAI 118
ND Not Spec 1 51112010 M-MAI 118
parasSikim,MOIL EPA 200.7 4.4 See Note 1 5/1/2010 WMA1 118
Sgdlum,MOIL EPA 200.7 4130/2010 M-MAl 118
Alk.allnity,MG/L SM 23208 72 Not Spec I M-MA'1118
Ammonia,MOIL SM 4500-NH3-D ND Not Spec 0.1 4130/2010
EPA 300.0 14.2 250 1 4/2912010 M-MA1 118
Chloride,MOIL
4/2912010 M-MA1118
Chlorine,Free Residual,MG/L SM 4500-CL-G ND Not$pcc 0.02
SM 2120 `l 118
Color Apparent,CU 8 5 15 1 4129/2010 M-MA285 NotSPec 1 4/2912010 M-MA1 118
CondudvilY,UMHOS/CM SM 2510B NO 4 0.1 412912010 M-MAI 118
Fluoride,MG/l, EPA 300.0 102 Not 2 51112010 M-MAI 118
Hardness,Total,MG/L SM 2340B tS4129/2010 M-MA1118
Nitrate as N,mG/L EPA 300.0 ND 110 0.05
Nitrite as N,MG/L EPA 300.0 NO 1 0.01 4129/2010 M-MA1 118
Odor,TON SM 21508 1 3 0 4129/2010 PN
SM 4500-H-9 8.1 6.5-8.5 4/29/2010 M-MAI 118
PH,PH AT 25C
NEG 4/2912010 PN
Sediment,pas/neg NEG .1----
Sulfate,MG/1- EPA 300.0 20 250 1 4/2912010 M-MA1 118
134 500
1 51412010 M-MA1 118
Total Dissolved Solids,MGIL SM 2540C
412912010 M-MAI 118
EPA 180.1 2.6 Not.Spec 01
TurblditY,NTLI
MCL=Maxlmurn Contaminant Level(EPA Limit),MRL MinimLl?-n Reporting Level
Sodium Guidelines-Mass PO,EPA 250, #;e Result Exceeds Limit or Guideline
ND=None Detected(<MRL), Background Bacteria Noted
David L Knowltonrertiflad Page 1 of I
1.,q
Massachusetts h orntory#MAI 118 Laboratory Director
04/19/2010 05:22 6035779947 NORTHEAST WATER WELL PAGE 01/04
Office or joater Iteaou,rues
* Well egj2letion Report 23-ApR-10 l.4„50:54
Wj3)aL LOCATION 27555
3PS North: 42 ° 38,1341 GPS W00t: - 7,1.' 4.226,
Addreris: Rerry street Lot: 1N-11 Property Owner/Client: One Hundred. Irourteen ',rrust
Subdivision Name: Mailing Addreos: 51 Mount Joy Drive
Citi./Town:North Andover City/Town, State:Tewkobury MA
kggeasora Map: Assessors Lot #: ZN-A Permit Number:SHP-2010-
Board of Heelth permit obtained: Y bate Issued: 04/06/203,0 0527
Work Performed propoaed use Drilling Method Overburden, Drilling Method Bedrock
Now Well DomeatiC Mud Rotary Air Hammer.
CASING
From (It) To (ft) Type Thickness Diameter
-00 -32.00 Steel 17# 6.00
SCREEN
Prom (ft) To (ft) Type Slot Size Diameter
WELL SEAL / FILTER PACK ABANDONMENT MATERIAL
From (ft) To (ft) Material Description purpose
.00 -32 Nat Svc material Fill
WELL TRST DATA (ALL SECTIONS MANLATORY FOR PRODUCTION WELL§)
Date Method Tiold Time Pumped Pumping Level Time to Recover Recovery
(GPM) (hr s & min) (Ft. HOS) (Hra & Min) (Ft. BGS)
04/19/201.0 Air F3.l,ow with brill Stem ls.0000 002;00 385.0000 001:00 40
STATIC NATER L.9VZL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE)
Date Depth Below Ground PUMP Description-
Mea,sured Surfaco (ft) Type: Intake Depth:
04/1.9/2010 !40 Nominal Pump Capacity: Horsepower:
WELL DRILLER'S STATEMENT
ADDITIONAL WSLL INFORMATION Driller: shaven Mackie
)eveloped: No Tractus., Enbancement:No Supervisor: Joseph Haynes Rig #: 182
)isinfectad: yop Wall Seal Type:Nope Firm: Northeast water Wells, Inc.
,otal Well Depth: 385.000 Depth to Bedrock: 1B.000 Registration #: 762 bate Complete:04/1,9/2010
iamthonts:
oyEADURDEN
From To Description color Comment water Loss/Add Drill Drill
(ft) Zone of Fluid Stem Drop Rate
.00 3.00 A.r-tifici,al, Fi-1.7. Brown No N/A No Normal.
3.00 18.00 Ti11. Yellowish Blown No Loss Normal
04/19/2010 05:22 6035779947 NORTHEAST WATER WELL PAGE 02/04
M��rerr)�g6r.tt.a ofeice Of XQb6s 1.2e801]„rcca
OOeI� rO} Etio; Report 23-APR-10 14:50:54
`- WELL LOCATION 275655
:4P$ NOrtb.: 42 38. 1,341 GPS West: --71 4.226'
Address: 2c.r..ry Street Lot! IN-A Property owner/Client: one Hundred Pourteen Trust
Subdivision Name_ MAiling Address: 51 Mount Joy Drive
City/Town:North Andover. City/Town„ State.-Tewksbury MA
9sonasoto Map: Aseenaors Lot #: 1N-A Permit Number:BRP-201,0-
Soard of Raalth permit obtained: Y Date Issued_ 04/06/2010 0527
$1JDROC�
From To Code Comment hater Drill Extra Drill Rust Loss/ # of
(ft) (ft) Zone stem Large Rate stain Add of Frac
per ft
1.8.00 24,00 Granite Yes No Yes Normal No Loee 7
24.00 75.00 Gabbro 1\10 No No Normal No N/A 1.
75.00 110.00 Amphibolite No Np No Fast No N/.A I
110-00 2.1.0-00 Granite No NO No Norma..l NO N/A 1
210.00 305.00 Granite No No No Normal No N/A 7,
305.00 310.00 Gneir,3 No No NO Fast No N/A 2
370.00 385.00 Amphi.bol.itc Yea No No Fast No Add 3
TOlNN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete 11 items on this page
LOCATIONJ.
� .
PRflPERT OiER -_ S x
t .
not
MAP�lO PARCEL
ZONING DjSTRICT 1- - I�storic33astrict yeso
s•_
Macfai.he Shop Vill'age... yes.:. no
TYPE OF IMPROVEMENT PROPOSED USE
Resid Non- Residential
N�Buildin One familTwo or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
TT
londplair /�tlands Watershed��srac F
DESCRIPTION OF WORK TO BE PERFORMED:
C5I �
Identification Please Type or Print Clearly)
OWNER: Name: [ l `u -�- 0 -C Phone:
Address: 1 (`'l�-, SOL -DC. l C S-� C� lQ4)
OTCTfl1art�e �`
1 I♦ k.
f
, 1 LIfieSS ' ~ s
t� tc
; peT�tsor'sx�r�srrtcnr� er�se
�-
-
rHorramproverrent �cerase - b4
Each .Date a'F 4
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ��. Sr�f,', FEE:
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to th guarantji fund
S, nature of A ent/Owner ,
9 g � Signature,of contractor '
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
'qce or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
e building application
iit Revised 2008
r ` NUMBER
M¢Rto, COMMONWEALTH OF MASSACHUSETTS BHP-2010-0527
North Andover FEE
$135.00
• _; - { Board of Health
Northeast Water Wells
--- ------------------------------- ---- NAME ---------------------------------------- -----
Lot 1 N BerryStreet
------------------------------------------- ---ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
Rotary Domestic Well
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires ----------------July-06-,--20-1-0----------------unless sooner suspended or revoked.
--------------- ------------- ---
April 06, 2010 (( Board of
-------------- L - - -------------- Health
-----------------------------------------------------------------
-----------------------------------------------------------------
Board of Health Chairman
f 'x
A 7
• Town of North Andover
`�'•�;, HEALTH DEPARTMENT
,SSACNustt A /
CHECK#: DATE:
LOCATION:
H/O NAME:
z.,,� 6v
CONTRACTOR NAM .
Type of Permit or License: (Check box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Service-Type: $
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
❑ Sun tanning $
❑ Swimming Pool $
❑ Tobacco $
❑ Tras4lSolid Waste Hauler, r $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
Other:(Indicate) $
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
' TOWN OF NORTH ANDOVER
t Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT :}•'�_ {'
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y.Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.8476—FAX
healthdept@townofnorthandover.com
www.townofnorthandover.com
Well and/or Pump Application
(Please print) DATE• 3 3d
//
LOCATION to Drill Well or install a pump:
Licensed Well Contractor Name and Company Name:
Contact fhone Numbers:
Homeowner: /K S / O/a�I y ,®r 1
Address: a
Contact Phone Numbers: Jao'933 7
WELLS(to be completed at time of pump test)
Type of well:' e/4'�-T/ Use:
Diameter of well: Size of Casing:
Depth of bedrock: Depth of casing into bedrock:
Seal been tested? Yes( ) No( )
Depth of well: f
Depth of water: De (�
v long)
Drawdown: fee — GPM
Date of Completion:
Signature of Well Contractor
PUMPS(To be filled in before installation)
Name&size of Pump: Type: 000
Size of Tank: Pump delivers: GPM
Pipe used in well: Cast Iron_ Galvanized Plastic
l
Sleeve used to protect pipe? Yes No Type of well seal:
Date:
Signature of Pump Installer
Date water analysis report submitted to Health Department:
Plumbing Wiring Inspector Health Department Representative
C:\DOCUMB—l\bcurran\LOCALS—I\Temp\Well Application.doc
TOWN OF NORTH ANDOVER
t Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
a,�cwss
NORTH ANDOVER, MASSACHUSETTS 01845
Susan Y.Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.8476—FAX
healthdept@townofnorthandover.com
,townofnorthandover.com
www.townofnorthandover.com
Well and/or Pump Application
(Please print) DATE• 3 3a
//
LOCATION to Drill Well or install a pump:
Licensed Well Contractor Name and Company Name:
Contact fhone Numbers:
Homeowner: 4"
Address: �p-57
Contact Phone Numbers:
WELLS(to be completed at time of pump test)
Type ofwell: -1 �'Te Use:
oF. f
i,
Diameter of well: /p Size of Casing:
Depth of bedrock: Depth of casing into bedrock:
Seal been tested? Yes( ) No( ) Date of test:
Depth of well: Water-bearing rock:-
Depth
ock:Depth of 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) — J
Name&size of Pump: Type:
Size of Tank: Pump delivers: GPM
Pipe used in well: Cast Iron_ Galvanized Plastic
l
Sleeve used to protect pipe? Yes No Type of well seal:
Date:
Signature of Pump Installer
Date water analysis report submitted to Health Department:
Plumbing Wiring Inspector Health Department Representative
C:\DOCUME—l\bcurran\LOCALS—I\Temp\Well Application.doc
ASSESS. MAP & LOT 0:
106[-75
(� 37.11 9
Tae+ Tmw
Si MOUNT Jay. MA M076 T ` �,`� N� 27 DRIVE 271
RESIDENCE
? 181
WELL
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B
w
LOT 1N — A o 6091
rn N
1 . 900 AC. `' " m m;
co �-
�-` 82,814.20 S.F.
30' REAR SET8K
NOTE
THIS PLM COMPARES THE PROPOSM�DAUMLOT _ 1
FOOTPR§ff As APPROVED BERRY S T R E E T
SY THE CONSERVATION
COWISSM TO 7Flt AC- NORTH ANDOVER, MASS.
TUAL HOUSE FOUNDATIM
THAT 18 PROPOSED TO BE
BUMT ON THIS IAT. PROJECT NO, NAND 07 SCALE, 1'=50`
DRAWN BY, PCG DATE,2111110
CHECKED BY, SC SHT+ I
OF, 1