HomeMy WebLinkAboutMiscellaneous - 0 SHARPNERS POND ROAD 4/30/2018 (2) BOARD 01- 1Il_ALTIl
Town of North Andover ,tfass
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D1.1 t e 19 "
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APPLICATION FOR & I'UI•IP I'I:R""'
lication . is hereby made for permit to drill a well (_) . Application I„s
de to install (_) a pump system . j
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. . Lot:
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cation : Address '
L
Address
t )r�-111 Ac1dres It. ----- ---
all Contractor ' � > t
Y ,
Address it )A
ump Contractor lM1Jr>1
' ELL CONTRACTOR ( To be completed at Lillie of test )
;,;;ype of Well
Well used i:or
.
Jiameter of Well Size of Casing
—
Del)of Bed Rock DepLAI casing; into -) -d l:ocic
I: as Seal Tested? Yes (_) No (_) Date of Tc, ti_nL;
epthlJell I;ndcd i_n Wha.t- tf::Ttcri.al
'.a Deli.vcr. s Ga1s . L'er. Hill . for 4 hours
�.,epth to Water_ -- --
feet after pumhours rt C,I't1
pin
>.��rawdown [ [ L� -- --
)ate of Completion ----- - - - - __-- - __ _ ----- -
Sigiiaturc hell Contractor
UMP INSTALLER (To be- filled in before
Pump I`),pe Used
ize & Name Pump - ---- - -- -
.later Pump
Delivers GPM Sire of l anlc _ ----
Material Uses[ in Well : Cast Iron ( ) (;rr1 v;rni zed ( _) Plastic ( _1
.,ipe _
', Jell Pit ( ) or P'itless Adapter ( _)
, Jas sleeve used to protect pipe?
,c or t,:Tm� Uell SO,
'�
:',)a t e ----- --- - - --- --- -- -
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I•later analysi's repor-t •submitted to I;oarcl of Ilcalth_
"Tate release given tD owner of record
—Ilealtlh fns[�ecCor