HomeMy WebLinkAboutMiscellaneous - 661 OSGOOD STREET 4/30/2018 (2) I
� �
®. � _-
I
��
I
w0RTFj
N 9
��'a•.,.o•••'�� BOARD OF HEALTH ;, t F..• (r_ I
Ss�cwusE NORTH ANDOVER, MASS.
APPLICATION FOR WELL AND PUMP PERMIT Q
Permit # Date
A permit is requested to: drill a well install a pump
LOCATION: Lot #
Owner-A60. Address Tel I-9/2U! 77y /OD-57-6
Well Contrctr r,"- yDv h 6 V"ttAdd. 2& P�lk,-4) Tel
Pump Contrctr _ 47-C Add. Tel
k�e�r* k�tlekk�ek* t*�rk**9rkk9ct�c�e*ale*�eie�e�ck�r�rk�e*4rlr�e*ieIe�e�r9e�e*�ek4ek�e�c�eie�ekalr�r�e�e*9eicoF�e�c�e
WELLS (To be completed at time of pump test. )
Ii
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