HomeMy WebLinkAboutMiscellaneous - 16 BERRY STREET 4/30/2018 (5) � Ib BERRy 5T.
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NUMBER
Gr . COMMONWEALTH OF MASSACHUSETTS BHP-2016-0086
North Andover FEE
$135.00
BOARD OF HEALTH
TJ OGDEN WELL & PUMP CO. INC.
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NAME
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1-6-BERRY-STREET
ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
Wella--�
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires ---------- - July-19, 2016------- --------unless sooner suspended or revoked.
- - -
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April 19, 2016 BOARD OF
-- -: ------ - -------- HEALTH
-------- ---------- 7
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BOARD OF HEALTH CHAIRMAN
NUMBER
COMMONWEALTH OF MASSACHUSETTS BHP-2016-0086
North Andover FEE
$135.00
BOARD OF HEALTH
TJ OGDEN WELL & PUMP CO. INC.
---------------------
NAME
16 BERRY STREET
------------------------------------------------------
ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
Well
I
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires Jul-y-19,2016 unless sooner suspended or revoked.
April 19, 2016
-------------------------------------------- - - BOARD OF
-------- /, -
HEALTH
------ -- -- �
-----------------------------------------
BOARD OF HEALTH CHAIRMAN
•" COMMONWEALTH OF MASSACHUSETTS NUMBER
� Pnr�s • BHP-2016-0086
North Andover
FEE
BOARD OF HEALTH $135.00
TJ OGDEN WELL & PUMP CO. INC.
NAME
16 BERRY STREET
--------------------
------------------------------------------------------------
ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
Well
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires ----------------July-1-9, 2016_- _ _ _ ---unless sooner suspended or revoked.
---------------- T_
April 19, 2016. a s `, BOARD OF
-----------------
------------ HEALTH
-----------------------------------------------------------------
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BOARD OF HEALTH CHAIRMAN
--------
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.�RAP6110C
Well and/or Pump Application I
(Please print) DATE:
LOCATION to Drill Well or install a pump: 1]c �w 1 FI A 2 N1 S
L
Licensed Well Contractor Name and Company Name: L-S P n S 0
l"'i Ga 111er-w0A0 r�
64'e G r n1 7 to
Contact Phone Nutt ers: C� -9 -LIS — 7br1'1
Homeowner: i + O i �Cl SiY'ouf i 7 — M Q d do 1
J
Address: e2ll L-4-4G( S 1 ?0 r+S rM t5 01 1 yti l ►�
Contact Phone Numbers: Li D 3 - Lj3 to - 2-S7 )0 _ K-R V'n V't, j�6r
WELLS(to be completed at time of pump test) RECEIVED
Type of well: Use:
APR i 2016
Diameter of well: Size of Casing:
TOWN OF NORTH ANDOVER
Depth of bedrock: Depth of casing into bedrock: HEALTH DEPARTMENT
Seal been tested? Yes( ) No( ) Date of test:
Depth of well: Water-bearing rock:
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)
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 of well seal:
Date:
Signature of Pump Installer
Date water analysis report submitted to Health Department:
Plumbing Wiring Inspector Health Department Representative
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