HomeMy WebLinkAboutMiscellaneous - Lot 1 Ingalls StreetY w
o"� "•e`'�a BOARD OF HEALTH
' .SACM1JSEt NORTH ANDOVER, MASS.
APPLICATION FOR WELL AND PUMP PERMIT
Permit # Date
A permit is requested to: drill a wellinstal a pump
LOCATION• & Lot #
Owner t" I -1 a -e— Address/6 �� Tel
W_11 Co^.trctr Add. �.-LG( Tel
Pump Contrctr Add. �j' - Tel
WELLS (To be completed at time of pump test.)
Type of well Use
Diameter of well Size of casing 57 "O�
Depth of bedrock Depth casing into bedrock
No Date of test
�a
Seal been test�:d? Yes ( ) (—)
Depth of well s _ Water. -bearing rock
31 Delivers GPM for
,Depth to water -
(how long?)
Drawdown 03 - feet after pumping hours at e GPM
Date of completion
Signatu of ell contractor
PUMPS (T^ be filled in before instal -l.- do
Name & size of pump %� JType
d o Pum
Size of tank oRP delivers GPM
Pipe used in well: Cast iron (—) Galvanized (—) Plastic
(V)
seal
Sleeve used to protect pipe? Yes
Date -lam
(—) No (A) Type well
A
Sign ure ift pump installer
Date water analysis ort submitted to Board of Health C>12-�.3
y . repo
Plumbing inspector Wiring inspector
Board of Health