HomeMy WebLinkAboutMiscellaneous - 411 PLEASANT STREET 4/30/2018 (2) - �//� ,vo
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BOARD OF HEALTH 7
s,cHue ORT ANDOVER, MASS. S
APPLICATION FOR WELL AND PUMP PERMIT
Permit # Date d
A permit is requested to: drill a well install a pump
LOCATION: �! Lot #
Owner Address Tel
Well Contrctr �'�. / a ' G &j Add. co Tele SZ1 I
Pump Contrctr Add. Tel
7k�e�ctr*�e�elr� kk�e�e*ielek�e4rkt�elr9r�eIrIeik�e�e�e�eIr�e�r�eieleIrfrte�rieF*�rkkkk�etr4ekifrleilrk�r�e4ek4ek4r�r**�c�e
WELLS (To be completed at time of pump test. )
Type of well Use
Diameter of well Size of casing
Depth of bed rock Depth casing into bedrock
Seal been tested? Yes (_) No (�) Date of test
Depth of well Water-bearing rock
Depth to 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? Yves (_) No (_) Type well seal
Date
Signature of pump installer
Date water analysis report submitted to Board of Health
Plumbing inspector Wiring inspector
Board of Health
/&'40r/1A(tJ
NUMBER FEE
THE COMMONWEALTH OF MASSACHUSETTS �a
of �� �.�. T•
at.'
This is to Certify that ..._.. ............
........ ... .E...................... .....................•..._....._......_.............
ADDRESS
IS HEREBY GRANTED A LICENSE
For ..... ...............--.........................................................
`- � / .•--- �c sJ...................•..._...........
------------------------•.--------•-•....---•...._._.........----------••----•-•--•-...---------------••--•-•--•----•••---••••-•---•------•---•--••---•---•------•-•--•----
This license is granted in conformity with the Statutes and ordinances relating thereto, and
expires...... Q`....................................unless sooner suspendedor revoked.
.......................... . .....
--------------- °- -- - ---
----- -- -- ---• •-•-• 1
FORM 499 H&W HOBBSB WARRENTM
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WETLANDS DELINEATION BY;
/ WETLANDS PRESERVATION, INC.
�aT 5 47 NEWTON ROAD, PLA I TOW, N. H.
TEL, NO, 603-382-3435
CL. NO. 2461 O'F 8/16/1999
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63030 SCS. FT, +/— y y W
F .. I . 45 ACRES 4
3 ,0t R= 380, 63'
L= 251. 44'
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'1 _ '! r L= 53, 02'
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t : TOP OF FOUNDATION: 162, 5' ��5�?'551 /E KIS �RED�E
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FOUNDATION LOCATION
} IN
NORTH ANDOVER, MA .
PREPARED FOR
` SCOTT &• PATRICIA MASSA Y
NOTES:
ZOt4 I NG4 'ES. 3 SEE: N, A, TAX MAP 95, LST 69
FY-30' SY=20' , RY=30'
SEE ECNFD .BK, 1494, PG. 15. __ _
PLAN 8454, LOT 6. SCALE: I = 40 DECEMBER 05, 2000
PLAISTO o' 40` so' Izo'
CONSULTANTS
LSC. LAND SURVEYORS
- 22 SMITH CORNER ROAD �- OF
W, }: PLAISTO , 1 • .4Z a 03865 DAMEL y�
TEL/FAX 03-382- 7320 7320 " i0mS