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Miscellaneous - 243 GREAT POND ROAD 4/30/2018 (2)
N O M ~ �. o & f < o o s a A "' ic;ab o 0 o lu o mac, LO 2 00 < W < z 2 L \ 0 c \\\ < // of ( § 0 Q o z kk�) oo§@ 00<< § cg o§000 &� 0 000 2 CL F- A f 0 \ 0 MLL O k §e®� @a$ z 0©$ 0 0 §][)m 2 /3 u)/{/ N z zE n o= w O \ �0 m $ co 2 \ ) 0-0 / C:, 5 o� \/ 0) �_0 ƒ 00 - eCL 2 /\ 2 e S Q_ -i UJ (D ±3%§) CL k �\6LL: U ƒ cIAI //mmo \w �w \e*m a '2 m< /\ ca �� '2`= w )) o f§o ) G R,� eqN §4 W I%xWo &k k o a) .. Q. 2 p ( $ /20 &�3< �3..§ =,oe� a _ =n<= o, �Oƒ\ - t tot om@)u me 2 $ -0 }$fs[wo_ � # \ �e U O m LO 2 00 < W < z 2 L \ 0 c \\\ < // of ( § 0 Q o z kk�) oo§@ 00<< _ § \/o } \ )a 6 0 .. \ / \ 9 <Eo ae=m�- »{2{ )f§7«« o,oo�= k322 Imo<< 2 \\ \\\</k w O j \ k 2.. cu ) ƒ_ k ®<°k §[� e O �LL�/ƒ \)d#37 \ �-0 2 c 2 (D \ 2 2=<=A u»ooIfa u»CO co / Q .. 2 .. z o §§//ƒ##a )/§ J 0 ) < 0MCU o °` LLJ § \3}}]m§7 jj\ CL f§=± j ±c�» & § a & .. f& a±%0. =S« / 0 �\ CL F- //j])) f 0 0 MLL \ e � //Cl) WR Gp 0 9 C, § N zE n o= �0 m co cq 0-0 §� o� \/ �_0 0�� -� u Q\ /\ S Q_ LL \ 2 § Viz= CO 0 2 a m< /\ «� o_ �c �k R §2 w k o, S/ ILW \ c _ me 2 $ -0 « _ § \/o } \ )a 6 0 .. \ / \ 9 <Eo ae=m�- »{2{ )f§7«« o,oo�= k322 Imo<< 2 \\ \\\</k w O j \ k 2.. cu ) ƒ_ k ®<°k §[� e O �LL�/ƒ \)d#37 \ �-0 2 c 2 (D \ 2 2=<=A u»ooIfa u»CO co / Q .. 2 .. z o §§//ƒ##a )/§ J 0 ) < 0MCU o °` LLJ § \3}}]m§7 jj\ CL f§=± j ±c�» O R 0 _ CL Lo & § a & .. f& a±%0. =S« /©/Gf /tea» CL F- //j])) f 0 t MLL O R 0 _ CL Lo ~CO \ /» ® ®U)�/ e //Cl) . 04 m co cq §� o� \/ ~CO \ NUMBER COMMONWEALTH OF MASSACHUSETTS BHP -2017-0483 North Andover FEE $135.00 BOARD OF HEALTH Charles -ri-esM--.Rollins, Inc. ---I- - -------------- NAME 243 GREAT POND ROAD - --------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Irrigation Well This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires ........... September 27, 2017---- ------ unless sooner suspended or revoked. June 27, 2017 BOARD OF --------------- ------------------------------------------- HEALTH P r n- 71? yi -------------- --------------- - --------------- ---------------------------------- BOARD OF HEALTH CHAIRMAN ----------------------------------------------------------------- NUMBER 1 . COMMONWEALTH OF MASSACHUSETTS BHP -2017-0483 North Andover FEE $135.00 BOARD OF HEALTH Charles M. Rollins, Inc. ---------------------------------------------------------------------------------------------------- NAME 243 GREAT POND ROAD --------------------------------------------------------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Irrigation Well This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires September 27, 2017------_- - unless sooner suspended or revoked. June 27, 2017 -------------------------------------------------------------- BOARD OF --------------- HEALTH ----------------------------------------------------------------- ----------------------------------------------------------------- BOARD OF HEALTH CHAIRMAN �! 79'17 Town of North Andover HEALTH DEPARTMENT 34 U CHECK #: Zq! /4/ DATE: 6 LOCATION: 0'-y �1 ea;64 AnG� H/O NAME: She Jl .&(4ko p CONTRACTOR NAME: u 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 $ ❑ Trash/Solid Waste Hauler $ XWell Construction $13.5 -- SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ t ❑ Other: (Indicate) $ ��,tD Heaatt"gent Initials White - Applicant Yellow - Health Pink - Treasurer ' / e TOWN Or NORTH ANDOVER � • tT YLFJ),• ' Community & Economic Development RECEIVE® HEAL TH DEPARTMENT 120 Main Street ,JUN 2 2 2017 NORTH ANDOVER, MASSACHUSE-17FS 01845 TOWN OF NORTH ANDOVER 978.688.9540 - Pllone HEALTH DEPARTMENT 978.688.9542 - FAX hcalthdept iiotiliandoverma.�ov www.noilliandoverma.gov Well and/or Pump Application (Please print) DATE: --.2Z — / -7 LOCATION to Drill Well or install a pump: 243 Great Pond Road, N. Andover Licensed Well Contractor Name and Company Name: George W. Rollins " Cf,f1 9 2 8 -.3 75 - 6 55 7 Charles M. Rollins Co., Inc. G�Ge @ Rtck-,- 1,0sw L� Contact Phone Numbers: 978-887-2320 Ftomeowner: Stephen Boyko Address: 243 Great Pond Road, N. Andover, MA 01845 Contact Phone Numbers: 978-886-4863 WEILLS (to be completed at time of pump test) - Type of wen:_ - 17 t� �t G- tL Use: —L— t2 F -T C I Z'j 1+ Diameter of well: (p Size of Casing: 6 Depth of bedrock: Depth of casing into bedrock: Seal been tested? Yes { ) No ( )Date of test: Depth of well: Watcr-bcaring rock: Depth of water:__ Delivers: Drawdown: Date of Completion:__ GPNI I for: (how long) feet after pumping: hours at: '1E ignatitre Yell Contractor PUMPS (To be filled in before installation) Nanie & size of Pump: Size o1" I'anic Pipe used in well: Cast Iron Sleeve used to protect pipe? Yes Date: Date water analysis report submitted to Health Plumbing Pump delivers: Galvanized Plastic No Type of well seal:_ Wiring Inspector Signature of Pump Instflller GPM 1.1calfh Department RN4j.-s*tativc �SAT-lealth\Permit Appli •ationd or Pump Application.doc �V- f C4'1�4 /ao ' 6 2, Vis"` 1 x✓ �`� .r�""�f �6....• � »3 �_ b \�` ' °n'� i g! , { 5 q { � '� °w `a 1 � i ,; � [_ I , . t � f � Bei, , �; � � ��•__ � � gi ' ' 44 Nt 9 4.1t 39 `—� It Z�� it ; � �FCNL"��_ .t nit -. .�.• 4',.,�e V_ r - --x^F!�. �..�, 1 �, rc r I t 40 � }. �:. � s . t �i i � % ,' � _ ;rtes• " s ' '��. t , _ >w r� - t '� R3 rr i I `�• 1} �! a \' � ;� ��_� "..T�'`';'t _L ' t ✓:,t, �., t1� �\ �¢ G- ` L• �Jt�Fp %+�" •f ( .. � Yr� �._ ♦ 5711 .' ` A. . 9 " 1 V 1 _ U •a j� j i Wy. 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