HomeMy WebLinkAboutMiscellaneous - 460 STEVENS STREET 4/30/2018 (2) JS
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Np Department of Environmental Management/Division of Water Resources
WELL COMPLETION REPORT
WELL LOCATION GEOGRAPHIC DESCRIPTION
Address Y.� ,,N S E W of
a I t) (circle) '
City/Town -F-t'J tr IJS S'r
Well owner (road)
Address /-[�6,1 N S �E W of
�j (mi.in tenths) (circle)
D < firf nr-rt1.�� /�/7 ag7�7" kA
Board of Health permit obtained: yes no E] intersect. w/
(road) v%
WELL USE WELL DATA
Domestic�Public ElIndustrial ElTotal well depth S-G ft.
Monitoring❑ Othe Depth to bedrock �q f f ft.
Water-bearing ro�cnk/unconsolidated material:
Method drilled Description /Y 1-Qy/ 0* 0^
Date drilled �" ~ Water-bearing zones:
CASING 1) From Q '73 To 07 7 Y
Type 2) From To
Length,eft. Dia(I.D.) in. 3) From To
Length into bedrock 202 Z ft. Gravel pack well: dia.
Protective well seal: I I dia.
Screen:
Grout ❑ OtheN S Slot# length from to
STATIC WATER LEVEL(all wells) 1� (I
Static water level below land surfacer ft. Date
WELL TEST(production wells)
Drawdown 355 ftp after pumping 3� hr. 0 min/at gpm
`/ t
How measured LRecovery3V/ after hr. Z 5 min.
LOG of FORMATIONS COMMENTS
Materials From To
L L Q
CSG f S- Driller
e
Firm Z
Address
City/Town
Supe isirj Driller Reg.#
S460 Of supervising registered well driller
Please print firmly
BOARD OF HEALTH COPY
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O�,t` •1�0 GGC
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y'•e.•.,,,.••h BOARD OF HEALTH
'SS'4cMU f. NORTH ANDOVER, MASS.
APPLICATION FOR WELL AND PUMP PERMIT 9
Permit #
Date `�
A permit is requested to: drill a well; install a pump
LOCATION:_� 5,� � Lot
OwnerQ," A �'` � Address ( s St"" Tel�%/1�
�J ,/ -�
C G
Well Contrctr (/ '/� lL/lti�( Add. f Tel L�o ' � 3
Pump Contrctr It Add.
7k 9t*lRYC 7t 7R it 7t 7C i i i }i.1..6. **71tlit�C�C�t�t�t�t7k�C�C7�C7k�t�C�t�t7�t7k7it�c�t7kAC7IC�t�c7IC�t9c�cSIC9rdrdo�c*�**74e�kdo�c�r�t�c
WELLS (To be completed at time of pump test. ) n
'"'� �d�d
Type of well .c.-[-?-•-�> Use �-l�/
vt L
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 L"' 02 X73 Z
GPM for '�`�greD �'o,R. y
Depth to water � � Delivers (how long?)
Drawdown 353' feet after pumping LI hours at M
Date of completion ��- 6� Signatui,e of well contractor
PUMPS (To be filled in before installation. )
�7
Name & size of pump��`�-b5 I •P Type U 6f►'l ei� st �S'��
U� ilk q-4° 1 GPM
Size of tank kAx -Z5� Pump delivers
Pipe used in well: Cast iron (_) Galvanized (�) Plastic ( K�
Sleeve used to protect pipe.� e well seal �f
�)
Date 6 —Ig- 0 Yes No ( k ) Type
SigrUture of pump installer
Date water analysis report submitted to Board of Health
Plumbing inspector Wiring inspector
Board of Health
x' '� ��� ~s MERRIMACK MEDICAL LABORATORY Philip Cammarata, M.T. B.L.M:
200 SUTTON STREET•SUITE 100
Merrimack Medical Laboratory NORTH ANDOVER, MA 01845
TEL:978-686-0089 FAX: 978-691-5982
SPECIMEN DATE 08/06/98 DATE RECEIVED 08/06/98 DATE PRINTED 08/07/98
PATIENT .11211367 CLIENT PHYSICIAN .FOSTER, BRENDAN
460 STEVENS ST PHILC:Att1M�1RATA EtLM
NO ADOVER, MA 01a4-5a
AGE
D.O.B.
SEX PHONE: 680--4727 WELL WATER
WOODY w
MW
/F lArnl1J�rlS f • V j'
WATER TESTING 111ii "
FECAL COLIFORM CT=O
TOTAL. COLIFORM CT=Qt —
BACKROUND CT= 0
MERR I MACK MEDICAL LAB, I N --
WATER CERTIFICATE #M2105
4- -
* FINAL REPORT #�