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HomeMy WebLinkAboutMiscellaneous - 743 FOREST STREET 4/30/2018N ~ ° ' MAP LOT # -.... ` PARCEL ` - _ QONS-TRUCTJ.ON HAS PLAN REVIEW FEE BEEN PAID?NO PLAN APPROVAL: DATE . BY ' - DESIGNER: PLAN DI -1 [E WATER SUPPLY: WELL PERMIT__ WELL- TESTS: TOWN � DR%LLER __-' L, --CHEMICAL DA|E APPRUVED_�����_ BAC3ERIA I DAlE U|�PRUVED BACTERIA %I DAlE APPROVED_____.__ FORM U APPROVAL: APPROVAL TO ISSUE NO DATE ISSUED BY -. CONDITIONS: ... .... ���..... � FINAL APPROVAL: ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL NO SEPTIC SYSTEM CONSTRUCTION APPROVAL CYES-D NO OTHER YES NO ANY VARIANCE NEEDED YES FINAL BOARD OF HEALTH APPROVAL: DAlE: _ BY: ,FINAL CONSTRUCTION APPROVAL: DATE:- -.BY Any appeal shall be filed REO':iYt� ���"'° DANIEL LO'�G within (20) days after the ' �: APOULM :fie TO LRK date of fi ins K' of tliis afte Vit. iaas ,� NORTH ANO OVER in the Office of the T,. ,-n ti .:;;;.'�'* 25 '93 TOWN OF NORTH ANDOVER OCT 2 MASSACHUSETTS BOARD OF APPEALS NOTICE OF DECISION Date . October, 14,,..1993.......... Petition No... 0 4.1.- 9 3 ............. Date of Hearing.. October..12, .1993 Petition of .....John. and .Annet.t.e .Iannarone........................................... . Premises affected ... 7.4.3.. Forest. .Street ............................................... . Referring to the above petition for a variation from the requirements ofd ..S e c t i on. .7....... Paragraph 7.3 and Tab 1e. 2.of. .the.Zoning,Bylaw..................................... so as to permit relief. of ,three, .(3) feet. f.or.the. side.yard..s.etback................... After a public hearing given on the above date, the Board of Appeals voted to .. GRANT .... the variance.... and hereby authorize the Building Inspector to issue a . pelt to John and. Annette Iannarone................................... The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the gratning of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Signed / J� Frank.Serio,..Jr.,.C.TE rman. William Sullivan, Vice-chairman .. ..Walter Soule, -Clerk. Raymond Vivenzio .............................. Board of Appeals Any appeal shall be filed it,IC1 0 ) illi win_ ('cato of .3 0 id WN TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS *************************** * John & Annette Iannarone 743 Forest Street North Andover, MA 01845 * *************************** GAtii� L o.;O TOI��' CL��ZK NORTH AHOVER an 14 2 25 H '33 Petition: #041-93 DECISION The Board of Appeals held a public hearing on Tuesday evening, October 12, 1993 upon the application of John and Annette Iannarone requesting a variation of section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw so as to permit relief of three (3) feet for the side yard setback on the premises located at 743 Forest Street. The following members were present and voting: Frank Serio, Jr., Chairman, William Sullivan, Vice-chairman, Walter Soule, Clerk and Raymond Vivenzio. The hearing was advertised in the Eagle Tribune on September 13 and October 1, 1993 and all abutters were notified by regular mail. Upon a motion by Mr. Vivenzio and seconded by Mr. Soule the Board voted unanimously to GRANT the variance as requested. The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Dated this 14th day of October 1993. BOARD OF APPEALS Frank Serio, 'Jr./?1= Chairman FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: J o k, �a �- r d ^-� Phone (sem �-) c. � I - G 11 C LOCATION: Assessor's Map Number ic;S D Parcel ('11j - Subdivision Lots) ,f Street �oresL- Ste_ St. Number ?`f3 ************************Official Use only************************ RECOMMENDATIONS OF TOWN AGENTS: Ln, Date Approved �Al* Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Food Inspect-o--r--Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved / Date Rejected Received by Building Inspector Date i 107 Forest St. ?AiddIleto , MA 01949 C FORM 4 - SYSTEM PUMPING RECORD Commonwealth of Massachusetts Massachusetts System Pumping Record system u\N System Location ?57 Date of Pumping: �// �� Quantity Pumped: / Soo gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes SystemPumped by: . ................................................................... License #:......................................... _ Contents transferred to: Date Inspector �vbTtt-lG \t5 o0 CA<JG. %VT I L 70\1 Y_ 1 1 ELEVATIONS TAKEN AT TOP OF PIPE DWELLING ELEV.: W/A. TANK IN: 14%.Is 4 TANK OUT: 142 D -BOX IN: 141.°13 D -BOX OUT: 141.'144 (%crr1 Ltwf b END OF DISTRIBUTION LINE -A- c: D: Zt w\ - 14a, Oe 1 � AS—BUILT SEWAGE DISPOSAL SYSTEM PLAN IN AS PREPARED FOR Lx -B B4,S i \� EXtST %AX- LL THIS IS TO CONFIRM THAT I HAVE INSPECTED THE CONSTRUCTION OF THE SAID DISPOSAL SYSTEM OCATED ON LOT 5t5 F-.0 cxST SA THE GRADES ARE AS SPECIFIED IN THE PFL.QN� AND SPECIFICATIONS DATED e)AZ � ` y7BY MAR�'C�H10NDA & ASS0C., INC. ,31 ATI DAT u E1: *' I 1wy t. MARCHIONDA & ASSOC., INC. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE., SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: ��`:2p DATE: M & A FILE No.: :I� f"�Jtr r -y �� '� I '�' i IIe�'-rowsli C \ Lor 413 mil tST ---�. 'G��STttiIG Go N C� SrcC�'1` 1 L i 4 1 r ':tAG R a ELEVATIONS TAKEN AT TOP OF PIPE DWELLING ELEV.: N/p. TANK IN: 14%,SA TANK OUT: l4'L.'3 as D—BOX IN: 141. �3 D—BOX OUT: 141 ,-14- (,bead �It4f b) END OF DISTRIBUTION LINE - - -qB':- . C: vela - 141,'l Z, c"4Q - *'so D: Zc to - 1AtC, 4101 AS -BUILT SEWAGE DISPOSAL SYSTEM PLAN IN AS PREPARED FOR \ t e-YI.5r w:✓LL THIS IS TO CONFIRM THAT I HAVE INSPECTED THE CONSTRUCTION OF THE SAID DISPOSAL SYSTEM_,j_OCATED ON LOT '5?-> 50MC-ST SA THE GRADES ARE AS SPECIFIED IN THE P,4AWS,, AND SPECIFICATIONS DATED 5/ 2 Y. MARCF,i.IONDA & ASSOC., INC. RO'S .,Y j` G CvITZ °M 1,, C11AEi,:, J iOR0SATI DATE MARCHIONDA & ASSOC., INC. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE., SUITE I STONEHAM, MA. 02180 (617) 438-6121 SCALE: ���� DATE: (D'Ipj4-Z„ M & A FILE No.: b5I -r)5 a Department of Environmental ManagemenUDNision of Water Resources A, WATER WELL COMPLETION -REPORT WELL LCAT N GEOGRAPHIC DESCRIPTION d ess ` N S E ®Of– (feet)(crrd I * City/Tow ri 4e Well owne (road) Address 3 / �� N LJ` of T ,�— /ml. in tenths! (drde intersect. w/ (road) Board of Health permit: yes (�. no E WELL USE WELL DATA Domestic g Public ❑ Industrial Total well depth Monitoring ❑ Other Depth to bedrock_� e2__ft. Water -bearing rockiunconsolidat d material: Method drilled Date drilled — Description Water -bearing nes: _ 1) From To CASING Type // — Length It. Dia(.l:'IS:)•___f in. 2) From To Length i tQ bedrock / ft. 3) From To , Gravel pack well: dia. Protective well seal:.,: f Screen: I dia. Grout-[];8ther Slot 0 le�gth from_ to STATIC WATER LEVEL LL Static water level below land surface ft. Date J WELL TEST t Drawdown —4-00f I. aftor pumping hr.-010—min. at gpm How measured Recovary ft. after--7hr. m 0 LOG of F ATIO61t ME NTS 0 Materials From To S - Driller Mass. Reg' r on 7- � r Qo Firm t Address City/T`ow 03 51 Igg A Signature of vififrvisingregistered wejrlfler Please pribe firmly BOARIYOF HEALTH COP Y WA `~ Toy-gin of .North Andover, Mass. :nLt 17 Date .,: 1.9 1 APPLICATION FOR WILL & PUMP PERMIT' ,iLication is hereby made for permit to drill a well (A . Applicatao'h S _ to install a pump Sy Kion:. Address ..Lot!s : �r Addr.c , - �5 Contracto Acicics , �j�vjTe6`� BS. 6r ,n Contractor � _ _Address Tel. CONTRACTOR (To be completed at time of pump Ccst) - of Wcll Wcll used for t " netcr of Well Size of Cass.n .h of Bcd Pock Depth ca.sin� in}Co Ded, �w5 Seal Tes ted? Yes (X) No (_) Da Ce. of Tes'Ca n,g� _ ..__ ���y '4v4rrs.f , C�,. .t3w'#5 �.PSt 1' �� ( Well .Ended in Wha:C Ma'`Jtf-dry I h o f We 7.-1— — �-�-� '* h to Water. j' Delivers Galt Fe-r fin. for 4{�houarse, ------- C� cit i .:down facet after ter um in hours, a,t GP,M -- — i. t. of ComY 7-cLion , i T S1. nat.urc 1,1e ConY.: i ter a.cltvo r , f g h Y A. r INSTALLER ("to bc- fil-led i.n before inst.al.J.ation) & Name Pump ` Pump Type Used r Pump Delivers GPH �' Sizc of Tank MaL'erial Used in Well: CnsL Iron ( ) C.-i)v.nni.7cd ( ) --Plastic i Pit ( ) o;- Pi. L1. est., Aclaptcr (' ) sleeve used Lo protect jai pe? Yes (—) 1NI0(^) 'type or Name Well Seal , ti�4)4l'tN4)r)4iri4i4NY Nri( ti4ir*t4)r%r*ir)rti4)4)Y)'r+rNr:rN4tiYNr,rNrirYrSr,:'::.:::,.,rtir�� .:Sr:��::r::7,:P�) 141 t�l9�fS�f;141�+1%t1�f Water analyJlJ rcporG _;ubmittcd to I?card of ;tfcal'�h release liven UD owner of record & BIcI;. Insp f; Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT :Li L9,�.AT N GEOGRAPHIC DESCRIPTION,", ; � r -� own_ `•!!-feet/ 11 l c. vne 3 �r N D �. i I9 / l 47 _6i I!—n'i-1,-'!ten renihrl- (elre/a , :uu of Health permit: yes a no E]Y in(ersect. w/ _ Li. USE WELL DATA me tic X:Pubtic ❑ Industrial ❑ Total well depth nit .ring ❑. Other Depth to licdrock,r�_ ft Water -bearing rock/tinconsolidat d.mat. r(al: Ill( I drille { e r — filled Description t: Sif G Water -bearing nes: 1) From —To / It. Dia(.I.D.)�In. 2) From To I+. gti 9< VdtQ bedrock 0ft. 3) From To Gravel pack well: dia. ter iAl vewell seal: Screen: dia. 'M ❑ Other Slot A length from—. rl( WATER LEVEL tic vater level below land surface.4ft, Date 13� I_l_ rEST t- r t. ,vd after pumping hr -216 -min. at gpm III asured Recovery-2,6—ft. after_�Trhr. min r i F ATI ENTS o Mai rials From To �- Driller r Mass. Reg 0ion 6d Firm , Address city/Towr1 �( i nature o ru rvrsln re isrored rve rl/er r� Firmly ,I DRILLER COPY ,?v •No-uh Anclover,Mass. Daae:: 1 r �1PPi.ICA7'ION FOR WE :LL & PUMP P;L .M$zT 1 n i.: hc�: cl�v m tdc for. permit to dril.l_• a wcl.]. lcat�.o p ' to i.n5c t1.1 :t Pump �..Cr'nt ', ria; r7- A-t�Xon:Adcli:c Lo !. C o n t r n > COn•trnct-o'" t`�� `�ciclress /Yn.P y R C0NTRi1CTO R ('1'o lac col"pl-c tccl :IL: ti.mc of pump Wc].1 usccl' for of Wc11: �, c,t.c r o -f t c 11 Sizc of Caslrn f3 :h of Bccl iZo(-ltDcp[:}i (�,� - c�atst�rn�r Liit� ' Led Ro )' ,.i.� �rig ' 1 'M,n+•�.IM S•ca1 Tested'? Yc. o (_) *1 I lel Da`sC�cxof��!c 1 Wc1l rn`dc;a.n.WTa� Al": to• lJn to �`_� Dc1.ivcr. s cvoL- Gln�,.M '`y; r down fcc t ,� :: tc�: pL rnping hours at �� ri — 'o.f Comp].ctzon IN STA III- ('1'o },c f•i.1.]:c_d i.n before i.nstal.].,ction) & N trnc i uinr Pump Tyneurs`ed r Pump i)c1..i.v0 t .. ----(.:1'11 Sir.c of Tnnk �Y. tiatc. i.. -r1. li..o d i n (:nlvnni zcd ( ) Phast - -: Pitt ( ) !'i.t:l.c. NO(_) Typc or Nam'c Wic:ll SIc ,Y SP tN �4 lH )'r ;'r l4 ,Y �Y ;4 ,4 )'r %'r i'r yr ;'r •,- Jr +'r N'r +'r N't Vr * :'r 1'r +'r 1'r 14 �Iatcr an1.`;Si:; T.C1�6 L ':ul:mi_Ctccl to 1'oarcl of ;i.rcal•oi r.e.]:easc pj.ven UD o'::ner of t:ccord (!< Bldg. Insp 1•l e al>t h I ri°s4p'etcC°olr ,11ru`riwewev '-'-^'—�-'--''--' ' '''---------~- 802'839S FAX (&00)*N2'0UO3 \ ae u|uoS1 0N noAu ��F0xD �aVloUn �»«» pt,-n(:.jr{. Number x (",lifmot: HTTN� Tmm Dreen W1�m�n�ton Pvmp �upp)y FO N1%ming�nn, MA 018G7 Rep�rt Dzite: May 15,199,� �mmpl� Taken wt: `y F�1nt1ock ltic:. N.Andover�Ma 5ample Teken �y: NpG Staff On: May 14,1992 CEHT]H I1-AlF UP ANALYSI8 `.... .... ..... � �em� �a/ameter: ' ��A M�x HF2sults Units Co1irorm �a�ter`a(�> 0 0 per 100cc 6.n-6.ti 7.3 GU Cu]ur (G> 1� 1D C,PU nm,u/`e�e No L1m1t 100 mg/L mg�� n�nganese L --'�ira6 mg/L Ogor(�) I 0 TON Nit,'ijce avi 01 mg/L Tur�td1ty 5.0 NTU Alkalinity Nut �pec1fj.ed 91.5 mg�L xmmp"i Not �peci/ied <0.0l mg/� 1..3 <0.01 mg/L 8ud1um 20^ 12,0 mg/. Dalcium . No Limit 29.3 mq/L Magnium No Limit 6^4 mg/L Potassr, iufit <B) 4.4) 2.() mg/L 15.6 mg /L su]faLes (S,) 250 21.9 mg/L Ch�orJ.//e 4-.7.7 /n.02 mg/L Cu^`/uc L. J. vi ty No L1m�t. zoV umhos/cm �eui mC;f,'t pos/npg neg �P)- �rtmary parameter <B>-�F,5condary EPA Parameter (may &ffect aeeU��t1c q"u\�tz�� w.g, rnlor,odor und tacste ) N1 = Not-Tes��d #� -EPA Maxi atuin -itandard. advisory limit pno furma1 1.imit Numerous to Count TI`e quality o� u.j.s water �mmple i� accepted as Safe To Drink mccCr* f.:l jg �o EPA etmr��. This water sample , ks t"st(-"d , dues not *e�t eC)mw? of the s as.-, d b 0) s19n. M�.A si r-Iusetts *�e �mrt14zed Michael P. �arlsnn ' fmr [c�s.�tlng #MH04FJ -rhorsten�f4,n Laboratory, Inc, Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 1 �io� k �� 19 \Aon weP ^� APPLICATION FOR SITE TESTING/INSPECTION Applicant 4 UA&LOC.k-.-' JP0 60y, NAME ADDRESS TELEPHONE Site Location l 1�+ -1k Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No. 43 (.- S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 :TH q• BOARD -OF HEALTH _`��/] jq� APPLICATION FOR SITE TESTING/INSPECTION Applicant �LAAAJ LUCK PQ 60"/— S- COE R NAME ADDRESS TELEPHONE Site Location Engineer�`-- NAME ADDRESS TELEPHONE Test/Inspection Date and Time pL Fee l'�b CHAIRMAN, BOARD OF HEALTH Test No q -"N S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. T11N- - T�iE 1 THIS FLAN 15 INTENDED FOR ZONING pUPPOSE.S ONLY, IT WAS COMPILED Mom EXISTING PLANS AND RECORDS WITH BUILDING LOCATIONS CONFIRMED IN TME FIELD. IT SHOULI) NOT BE USED FOR PROPERTY LINE DETERMIN- ATION. ThiE BUILDING 15 NOT LOCATED IN AN ESTABLISHED FLOOD HAZARD AREA. ZONING: %A REQUIRED SETBACKS: FRONT: �10' SIDE: 50' REAR: �. CERTIFIED PLOT PLAN IN %rfh AndoverPQ AS PREPARED FOR Fl W440C-�,,10C V k A FILL- No.: 351.OA5 WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THAT ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED AS SHOWN. ALL BUII_DIPJGS Sf IOWN CONFORM TO THE ZONING LAWS OF THE MUNICIPALITY WHEN CONSTRUCTED. MARCNIONDA & ASSOC., INC, ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALC AVE., SUITE I STONEHAM, MA. 02180 (617) 438--6121 SCALE; I"4/0. _ DATE: -5'V7'R4 Form No. 3 Town of North Andover, Massachusetts BOARD OF HEALT MO oTh � 19 O A H ,- �:_.�.'' DISPOSAL WORKS CONSTRUCTION PERMIT ,SSAGHUSEt Applican Site Loc; Permission is hereby granted to Construct or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAI MAN, BOARD OF HEALTH D.W.C. No. , s Fee FLIMTLUCK, 10 P. oo BOX 53? Nof,,TH ANDOVER MA 01845 (50SI 688-6558 DAVE UNDRID 0006/95 o0a000010 30SO 4775 500.0 T, 4005 DEPTH OF 6" DRILLED WELL ywooFT. 4015 LENGTH OF 6- CASING 1.00EA. 4045 6" DR WE SHOE 1.00 4035 WELL PEWT WELL SYSTEM INFORMATION DEPYX OF 6" DRILLED WELL - 500 FEET LEMOTH OF 0" CASING - 40 FEET DEPTH TO LEDGE - 22 FEET FLOW RATE - 2 GALLONS PER MINUTE STATIC WATER LEVEL - 25 FEET 1ISSITE: LOT 0 05 FOREST ROAD NSRTH ANDOVER. MA COMPLETED 05/05/9-,-' 6,00 aQuy. 5%) 7.20 EEO, ac., 50.00 50. n; 35_D0 5S.§« TOTA'.- 3165. o« Ile DATE_ V`�1,2_1�9_-,7 Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER � n SUBSURFACE DISPOSAL DESIGN REVIEW G FEE � 6 / PERMIT # DATE RECEIVED APPLICANT ADDRESS ENGINEER Z 1114 /Gc rC // 646 ASSESSOR'S MAP PARCEL # LOT # STREET�cs ADDRESS PLAN DATE �/���9v2 REVISION DATE 6-11919 CONDITIONS OF APPROVAL: DISAPPROVED I ADDRESS JZ -5 GENERAL PLAN REVIEW CHECKLIST ENGINEER 3 COPIES STAMP L` � LOCUS t// SCALE 1--' CONTOURS cis PROFILE SECTION BENCHMARK G,� ELEVATIONS ✓ SOIL & PERC INFO ✓ WETS. DISCLAIMER WELLS & WETLANDS WATERSHED DISTRICT W6 DRIVEWAY v' IWATER LINE Z- DRAINS RESERVE AREA ✓ SCH40 c.�' SLOPE /-� SEPTIC TANK MIN 1500G. .17 INVERT DROP 2,s GARB. GRINDE]R�(+200 % EDF) 25' TO CELLAR `� MANHOLE TO GRADE L-- ELEV GW D -BOX # OUTLETS',,9- FIRST 2' LEVEL STATEMENT((/ INLET - OUTLET = (2" OR .17 FT) LEACHING ord C)le 100' TO WETLANDS 1001 TO WELLS4-obe�O 325' TO SURFACE H2O SUPP 35' TO FND & INTRCPTR DRAINS 4' TO S.H.GW &✓" 2% SLOPEc/---- 4' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVER ✓ FILL?a (25' if above natural elevation; 101if below) TRENCHES MIN 660 f� SLOPE (min .005 or 6"/1001) ✓ 3 COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61) ✓ IS RESERVE BETWEEN TRENCHES? ✓ IN FILL? MUST BE 10' MIN. BOT X LDNG 0612 + SIDE X LDNG J = TOT (L x W x #) (G/ft2) (DxLx2x#) i; l •��1,{{� ,,��TT1C1q �r i jail is ,` lr 4f rv}iY}2 ,IiFY f i I , }4 F. Ott , •1 F li 'i��lL'".; �� t,is• t nC t T6 •w , n k , �i y5 I+i1f1 OI'•�IVA'P IY'� .i=Sr �\I i 4A}l f �A �. ' �l `t { • �� \.,• r7V:.,t A r , SSS t +a j;t{�'(t, .�•s1 (} �' i * r yi\YIv= tM, f! 'I. , � .2 1} ,.�� .i y } } \ � ' . . i ' �Y'^3�':��.��1�11�, }�t'! t�, �. to i�t.. ..,..,rt �{i• To OF • NORTH ANDOVER SYSTEM p UM1'ING RECORD X411 -ti� Jj •• _ n snt tt; '/�l; lJ'f,• +. Ty � 4t�. {•. I t. t };FA t � tit+ %5'.q�{t �({�•r Vit} a�' t 1'r! . �' t Yl)�' X •.. . '. : ,SYSTEM O��D tgg ♦♦ R ADD SYSTEM LOCATION t�r}Yj;� • ��upples iRft'iroat of house) t +` •���i „9 �,, .f?ht a.l r il� I i \<1�. X J ,. 7" WI � �y y w , ;�7 {rte ,14F >,tyz,,rt. +a�1. J, --••'. 1X • 4X � fiiM. r. 7• M.�l,�:�7jr t' �i�iit r ... ,..� ... .. aPj3 L .4 t IST y'..4 A '�. ..� I f ;• n 1 '4' f , �� • IVANTITY P � } NS •II* �/ i.. }/�� i'l is "' � �1 t'IP'�' teffµ Sh � . a.. J•': !,�A7, .. F7�ryw-r T f ANK• NO YES t •Y 'yc• - � 5.1.,.,47. yr. 5. Y.. ..i. ,. . n.^ f. .. �,'.. �,,... :4q"r�t�,, �sXti�:�•�h� � f 1i�rE• AOYT� j 'y�X� p0,f7:\nG�M_ammonomm ., .... .' '1IV, r,, rh �jY�",•Nt , i�}I, ,t> „til } •'" •��� T - ,�•�T�011�,7• A. -. 1 '4+ , t v 1�i�`/�t+ .I t .• 2... ,. Cyt h won. CoNDON... BEAVY R T OVER E: "`ROOTS �- BAFFLES IN PLACE LEA MI.P EXCESSIVE SOLIDS FLOODEDRACK so MS CARRYOVER �"'""' O M , , (EXPI,AII� v �•/ 1' .I y , ..T�4,J AY; rt off n, ] l,;y .�/y f ,t� } ,i ,ty`• - E ply, pyl��IF pili [� L 1., 6 r,�'Itil�jAr'' r: } f wj I-•'� r ! -6%4 t'f1.. ;:.'1?,r + �'• a 1.: O• si "a r' 1 ,„.X w ••? FIIZFt,Ia,�',rlr�'�i�:?��1`�� l��V f � WELL DATABASE ADDRESS: 5� .5-8 AGE OF WELL: WELL DRILLER: WELL PERNfIT m: ? WELL LOCATION: U --_WELL PER1lIIT DATE: (� DEPTH OF WELL: TYPE OF WELL:b. DUG C. U TYPE OF WATER BEARINGR�OCK: WATER Ai`iALYSIS DATE. �j ' f 5 _ `� -2 HIG M' ANGA HIGH IRON: YOTHER CON"F ' ANTS: WELL DATABASE ADDRESS: 7� 7 � Sj� AGE OF WELL: WELL DRILLER: WELL PERMIT f: WELL LOCATION: WELL PER DATE: DEPTH OF WELL U titl WN ;SE: Y Y N TYPE OF WELL: a.. DRILLED b. DUG c. UNKNOWN TYPE OF WATER BEARING ROCK: WATER ANALYSIS DATE: HIGH tifANGANESE: HIGH IRON: Y N OTHER CONTAMINANTS: Y LNJ Y N N PER