HomeMy WebLinkAboutMiscellaneous - 165 Dale Street A
Map 104 . 0-Block 165 Dale Street
Smolak Property (Christmas Tree
Farm area)
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DALE STREET JS-2006-0587
Proiect Detail Report
Printer!On:Thu Feb 23,2006
Project Name:
GIS#: 9063 Project No: JS-2006-0587 Owner of Record SMOLAK, MARTIN&HELEN R&
xORT' Map: 104.0 Date Submitted: Feb-21-2006 315 SOUTH BRADFORD STREET
_ S °p Block: 01.65 Status: Open NORTH ANDOVER, MA 01845 �..
Lot: Work Category: Work Location: DALE STREET
•€ P {« Zoning: Proposed Use: District: d
t '•_�*••`s«'" land Use: Proposed Use Detail Subdivision
s�e„us
Description well Construction Comments:
of Work:
Department Status
GeoTMS Module: Status File No. Comments: LCDate:
Board of Health GREEN FLAG BFIJ-2006-0006
Permit History
Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work:
Well Construction BFIP-2006-0051 Feb-24-2006 SIGNED OFF JS-2006-0587 Well Construction
GcoTMSO 2006 Des Lauriers Municipal Solutions,Inc. Page 1 of I
y, u`
NUMBER
µOAxar , COMMONWEALTH OF MASSACHUSETTS BHP-2006-0051
North Andover FEE
• � w $135.00
Board of Health
SMOLAK, MARTIN &HELEN R&H MICHAEL SMOLAK
---------------------------------------------------
- - ---------------------------------------------------
NAME
DALE STREET
------------------------------------------------------------------------------------------------------------
ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
This permit is granted in conformity with the Statutes and ordinances relating thereto,and
expires--------- ----August 24,2006 -unless sooner suspended or revoked.
------------------------------a ------------------ of
24,2006 '00, IL Board of
__t
Health
- -
CIT ------------- --------------
---------------------------------------------------------------
NUMBER
MO*TM
COMMONWEALTH OF MASSACHUSETTS BHP-2006-0051
t ? ,.• by i
North Andover FEF
$135.00
Board of Health I
.+'1,r3 !
s$,%CHUSE SMOLAK, MARTIN & HELEN R& H MICHAEL SMOLAK ,
NAME 1
DALE STREET
ADDRESS E
i
IS HEREBY GRANTED A PERMIT
Well Construction
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires August 24, 2006 unless sooner suspended or revoked.
I
� I
February 24,2006 Board of '.
Heath
I
COMMONWEALTH OF MASSACHUSETTS �
�oR�►+ NIIMBP,R
BHP-2006-0051
o North Andover
Board of Health $135.00
sSAC SMOLAK, MARTIN & HELEN R& H MICHAEL SMOLAK
NAME
I �
Map-104 .0:165 DALE STREET
ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
Faxon Artesian Well & Pumps
12 Kline give , Salem, NH 03079
(603) 887 . 8169
i
This permit is granted in Conformity with the Statutes and ordinances relating thereto,and
expires August 24,2006 unless sooner s :nded or revoked.
I
February 24,2006 Board of
Health
i
Town of North Andover e ,
Health Department Date:
Location: Y��-�
(Indicate Address, if Residential,or Name of Business)
Check#:
Type of Permit or License:(Circle)
➢ Animal $
➢ Dumpster $
➢ Food Service-Type: $
Funeral Directors $
➢ Massage Establishment $
➢ Massage Practice $
➢ Offal(Septic)Hauler $
➢ Recreational Camp $
➢` SEPTIC PERMITS:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC)$
❑ Septic Disposal Works Installers(DWI) $
➢ Sun tanning $
➢ Swimming Pool $
4'
➢ Tobacco $
➢ Tra�shlSolid Waste Hauler $
➢Well Construction $1�,.f5�
➢ OTHER(Indicate) ,,
fi Health Agent Initials
136
k° �'t
White-Applicant Yellow-Health Pink-Treasurer
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES a
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER,MASSACHUSETTS 01845
Susan Y.Sawyer,REHS/RS 978.688.9540—Phone
Public Health Director 978.688.8476—FAX
healthde tp_townofnorthandover. om
www.tofnorthandover.com
Well and/or Pump Application , �
(Please print) � ZL
a O�-
LOCATION to Drill Well or install a pump: I�(�T /t'a,. lf)14 I �s.�=�ep'
Licensed Well Contractor Name and Company Name:F/.oy(
ontact Phone Numbers:
Homeowner: /i P 4-, h cd I c��c. L'�•C.
Address: l� �.--
Contact Phone Numbers:
WELLS(to be completed at time of pump test)
Type of well Use:
Diameter of well: 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 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 Re resentative
C:\windows\TEMP\Well Application l.doc
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15 SOUTH BRADFORD ST.
NORTH ANDOVER MA 01845 WP 104C Wr 11"
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