HomeMy WebLinkAboutMiscellaneous - 15 COLGATE DRIVE 4/30/2018 15 COLGATE DRIVE
2101091.0-0014-0000.0
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Address/S,0,o1,GA.r� Title of File
Page of
Date File Open:
Date file Closed:
Doc Document/Action Title Date of Refer to other Purpose of Documecnt A
action Document/ document/ /Action and notes
Num. Action �'
-Department
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Board of Appeals — Board of HeT aI h Plan niin Board ;
9. Conservatiion Commission - Building Department
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MOIITp I
F p i
BOARD OF HEALTH
�SSACH USEt NORTH ANDOVER, MASS.
APPLICATION FOR WELL AND PUMP PERMIT
Permit # Date
1
A permit is requested to: drill a well � . install a pump
LOCATION: C 0 L G 4-r-C led. Lot #
Owner / a�-�►Y �t
A FF�Y Address 15 Tel I
(2
Well ContrctrM ��ciuS c-Oz, c. Add, 2�. wA.Tel
? 8 & 7-z3zo
PP
um Contrctr S �V0Add. Tel
f+�vSe
WELLS (To be completed at time of pump test. ) a Sz,��v��-�� ey
Type of well
I[-t�e� Use
� I
Diameter of well Size of casing
Depth of bed rock Depth casing into bedrock
F
Seal been tested? Yes (_) No (_) Date of test '
I
Depth of well Water-bearing rock
Depth to water Delivers GPM for
P (how long?)
Drawdown feet after pumping hours at GP
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
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Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_)
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Sleeve used to protect pipe? Yes (_) No (_) Type well seal
Date I
Signature of pump installer
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Date water analysis report submitted to Board of Health l
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Plumbing inspector Wiring inspector
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Board of. Health I
3'£ 44 Department of Environmental Management/Division of Water Resources
WELL COMPLETION REPORT
WELL LOCATION GEOGRAPHIC DESCRIPTION
Ad/elE w or
freer! (circle)
City/Town
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Well owner a (road) EQ
Addres 45— ar t. N S E Q of
64&WeA4"t_ I 19' =.1- 111 tenths)
in (circle))
tersect. W1__e__
Board of permit obtained: yes no
(road)
WELL USE WELL DATA
Domestic ❑ Public[ Industrial Total well depth—ft.
Monitoring❑ Other Depth to bedrock 1 ('.r. ft.
Water-bearing te)ck/unconsolidated material:
q-- '-2-86o Description
Method drilled — J"C'r '�
� A t�Date drilled
V CASIN Water-bearing zo�tes:2
t} From �� YY To
Length ft. Dia(.LD.) , in. 3} From To
Length into bedrock 'Z'" ft.
Gravel pack well: dia.
Protective well seal: Screen: dia.
Grout•❑ Other S Slot+` length —
from-STATIC WATER LEVEL(ail wells)
Static water level below land surface ft. Date—
WELL
ate WELL TEST
�(production wells) �1,
Drawdowi ft. iter pumping lir. O min.at /�O gpm
How measured ' " I � � Recovery—ft.ft. after_li min.
0
LOG of FORMATIONS COMMENTS
c
>a
Materials Front To a
0
MAY I 40v,
filler '
Firm r ) `r� r� c'"
Address ' L 6T
MORTN I
F p
41
- .r•�y BOARD OF HEALTH
13
3
"C"USE1 NORTH ANDOVER, MASS.
APPLICATION FOR WELL AND PUMP PERMIT
Permit # Date
A permit is requested to: drill a well install a pump
LOCATION: C o L(;-,4T-,�! Lot #
'- A fFA-) Address �� C�'��'�'r� �4. Tel i
Owner //�a-rN Y � '
Well. Contrctr �' AA, 90L(-;&J5 03 , Cy✓c. Add.-(2-9, P-R�-r r�Z4 • "14-Tel—
pump
"4'TelPump Contrc
tr
S Add. Tel
WELLS (To be completed at time of pump test. )
rn
Type of well �21c � e� Use -L /L2z G T-I rJ ✓NSe'w 2
Diameter of well Size of casing
L�
Depth th of bed rock P De th casing into bedrock
Date 3
No of test
Seal been tested. Yes O (_)
rockc�`�"'
li Depth of well 3 O 'J Water-bearing
Depth to water ( Delivers /OG GPM for
(how long?)
Drawdown_225-5 feet after pumping 2 hours at 7 GP
Date of com letion
Da P
Signatur
e of well contractor
PUMPS (To be filled in before installation. ) _
Name & size of pump 90-`- -5 Type �%, RM �
Size of tank` �- vz- Pump delivers C 3 GPM
a P
Plastic
well: Cast iron Galvanized (_)
Pipe used in (_) ,
.n,, i
Sleeve used to protect pipe? Yes (_) No ( ) Ty e dwell seal 1-- 6
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Date
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SignatlYre of pump installer
Date water analysis report submitted to Board of Health
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Plumbing inspector Wiring inspector
MAY 1 5
Board of Health
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