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HomeMy WebLinkAboutWell and or Pump Application 1995 Salem St lot 1 formally known as 1975 Salem St - Permits - 1995 SALEM STREET 8/2/2019 i ®� TOWN OF NORTH ANDOVER Community& Economic Developments : • HEALTH DEPARTMENT ,U�© �,PNd��1� 120 Main Street pF�Q QpEz NORTH ANDOVER,MASSAGHUSETTS 01845 (O�gv 978.688.9540—Phone 978.688.9542—FAX healthdcpt@tiortliandoverina.gov northandoverma.gov www.northandoverma.gov k Well and/or Pump Application (Please print) DATE: 08/20/2018 i LOCATION to Drill Well or install a pump:1995 SALEM STREET(LOT 1) Licensed Well Contractor Name and Company Name:GEORGE W. ROLLINS CHARLES M ROLLINS CO., INC. Contact Phone Numbers: 978-887-2320 4rr 1 Homeowner:LIVINGSTONE DEVELOPMENT CORP. Address:P.O. BOX 50,TEWKSBURY, MA 01876 Contact Phone Numbers: '7 7 Y Lt ? WELLS(to be completed at time of pump test) Type of well: BEDROCK use: DOMESTIC Diameter of well: 611 Size of casing: 61' Depth of bedrock: 15' Depth of casing into bedrock: 40' Seal been tested? Yes(?e) No( ) Date of test: Depth of well: q.)o Water-bearing rock: 3 S`f oZ r f Depth of water: Delivers: 11.5 GPAI for: Z AS (holy long) Drawdown: Y D feet after pumping: 2.- hours at: lr ✓� GPi11 „ - j Date of Completion: 06/25/2019 Signature o 'ell Contractor w PUMPS(To be filled in before installation) Name&e size of Pump: ��p5 tl2 Type: d Fn Sizc of Tank: Pump delivers: / GPM 1 Pipe used in well: Cast.tron Galvanized Plastic K. -L( J I St '- Sleeve used to protect pipe? Yes No Type of hell seal: Date: 'Z — t`� ��-�'-rJ • Signture of � ter Installer r 3 .Dale water analysis report submitted to Health Department: -7 / V�17 Z V-5-:7 y C) .1(o Plumbic 97S Wiring inspector r I ea �De rf e11t itepresenta' c S:\Health\Permit Applications\Well\Well and or Pump Application.doc Massachusetts Department of Environmental Protection LF-,�— Bureau of Resource Protection Well Completion Reports 4 _ s Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 1995 SALEM STREET Please specify well type: _ Building Lot#: Assessor's Map#: IDo estic Assessor's Lot#: ZIP Code: Number Of Wells: 01845 City/Town: Well Location NORTH ANDOVER In public right-of-way: GPS f Yes FN.] North: West: 42.63780 71.05095 SubdivisiontProperty/Description: Mailing Address: IF click here if same as well location address Property Owner: Street Number: Street Name: LIVINGSTON DEVELOPMENT CORP PO BOX 50 City/rown: State: Engineering Firm: TEWKSBURY MASSACHUSETTS ZIP Code: 01876 Board of health permit obtained: is Yes C'Not Required Permit Number: Date Issued: BHP 2018 0253 �08/2112018 I Massachusetts Department of Environmental Protection T Bureau of Resource Protection-Well Driller Program Well Completion Reports(General) I I Well Driller - General Well Form DRILLING METHOD Overburden Bedrock �rHammer PrHammer WELL LOG OVERBURDEN LITHOLOGY From{ft) Top) Code Color Comment Drop in drill Extra fast or slow F-f-flluid s or addition stem drill rate —� E�1 15 — � �1 Brown JI i r t Fast Slow —� YES ND =Addffion WELL LOG BEDROCK LITHOLOGY _Loss or �— Extra From(ft) To(ft) Code Comment Drop in Extra fast or addition of Visible Rust Large drill stem slow drill rate fluid Staining Chips P 15 100 Granite — L YES ND Fast Slow Loss Addition Yes r Ye 100 200 GranRe� —� �� r =r. (, Yesi rYeJ YES ND Loss Addition ' — 200 300 Granite YES NO N Fast Slow Loss Addition 300 400 Granite- y-� F7r � r Ye 1rYes Fast Loss Ad 400 420_j Grranite t" �[y�S ND Fast Slow tion ADDrWNAL WELL INFORMATION III Developed r Yes (?W Disinfected Total Well Depth 420 Depth to Bedrock 15 Surface Seal Type None ---}.racture Enhancement CASING r is Casing above ground? From_ To - Type Thickness Diameter Driveshoe C Steel -- 17# �i i✓Ye SCREEN V No Screen TO Type -- - �_'— - Slot Size - '- Diameter—� —Choose Screen Type— WATER-SEARING ZONES DRY WELL FFrom To Yield(gpm)—� 354 355 402— �403 ------' 7.5 —_�---- Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program L7,1, Well Completion Reports(General) PERMANENT PUMP(IF AVAILABLE) t3 Pump Description Wire Variable Speed 1� ! Horsepower iSubmersible 112 Pump Intake Depth(ft) 300 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement r0 �l 15 INative Material -I (Choose Material c G�ravi�t L�.1 — I l E�..�� L_—_—I L_ y 15 40 LBentonite Chips/Pellets I — Choose Material .� 4___� Gravity Li WELL TEST DATA Date Methodv Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) _ BGS) (HH:MM) BGS) 06/2512019 Air Blow With Drill Stem 11.5 —� 02:00 ago WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured I 06126/2019 28 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. �� Supervising Driller ROLLINS, Monitoring[M] Signature GEORGE, DrillerROLLiNS Registration# 305 g W CHARLES M. Firm ROLLINS CO.,INC. Rig Permit# 0208 Date Job Complete o6/25/2019 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Nashoba Analytical, LLC Tel:978-391-4428 Fax:978-391-4643 LabNumber: 203737 31A Willow Road,Ayer MA 01432 Website:http://www.NashobaAnalytical.com Use this number with all correspondence Client: Charles M. Rollins Co., Inc. ReportDate: 7/3/2019 126 Depot Road Boxford, MA 01921 I Certificate of Analysis 1995 Salem St. (Lot#1), North Andover, MA Parameter Method Result MCL MRL Date of Analysis Analyst -Well Head Sampled:6/27/2019 1:30:00 PM by CMR Staff Total Coliform Bacteria,/100ml ENZ.SUB.SM9223 Absent Absent Absent 6/28/2019 10:00:00 AM M-MA1118 Arsenic,MG/L EPA 200.9 ND 0.01 0.001 7/1/2019 M-MA1118 Calcium,MG/L EPA 200.7 23.3 Not Spec 0.2 7/1/2019 M- A1118 Copper,MG/L EPA 200.7 ND 1.3 0.004 7/l/2019 M-MA1118 Iron,MG/L EPA 200.7 0.146 0.3 0.004 7/1/2019 M-MA1118 Lead,MG/L EPA 200.9 ND 0.015 0.001 7/2/2019 M-MA1118 Magnesium,MG/L EPA 200.7 3.3 Not Spec 0.1 7/1/2019 M-MA1118 Manganese,MG/L EPA 200.7 0.018 0.05 0.004 7/1/2019 M-MA1118 Potassium,MG/L EPA 200.7 0.5 Not Spec 0.1 7/1/2019 M-MA1118 Sodium,MG/L EPA 200.7 27.7 See Note 0.2 7/1/2019 M-MA1118 Alkalinity,MG/L SM 2320B 116 Not Spec 1 6/28/2019 M-MA1118 Ammonia as N,MG/L SM 4500-NH3 ND Not Spec 0.1 6/28/2019 M-MA1118 Chloride,MG/L EPA 300.0 2.4 250 1 6/28/2019 M-MA1118 Chlorine,Free Residual,MG/L SM 4500-CL-G 0.56 4.0 0.02 6/28/2019 M-I All 18 Color Apparent,CU SM 2120B 5 15 0 6/28/2019 M-I A1118 Conductivity,UMHOS/CM SM 2510B 257 Not Spec 1 6/28/2019 M-MA1118 Fluoride,MG/L EPA 300.0 1.1 4 0.1 6/28/2019 M-MA1118 Hardness,Total,MG/L SM 2340B 72 Not Spec 1 7/1/2019 M-MA1118 Nitrate as N,MG/L EPA 300.0 ND 10 0.05 6/28/2019 M-MA1118 Nitrite as N,MG/L EPA 300.0 ND 1 0.02 6/28/2019 M-MA1118 Odor,TON SM 2150B 1 3 0 6/28/2019 I KW pH,PH AT 25C SM 4500-H-B 7.7 6.5-8.5 NA 6/28/2019 M-MA1118 Sediment,pos/neg ----- NEG -- NEG 6/28/2019 LKW Sulfate,MG/L EPA 300.0 6.7 250 1 6/28/2019 M-MA1118 Turbidity,NTU EPA 180.1 1.8 Not Spec 0.1 6/28/2019 M-MA1118 MCL=Maximum Contaminant Level(EPA Limit),MRL=Minimum Reporting Level Sodium Guidelines-Mass 20,EPA 250, #=Result Exceeds Limit or Guideline ND=None Detected(<MRL), `=Background Bacteria Noted,J=Estimated Value Analysis performed according to 310CMR42.00 David L.Knowlton Massachusetts Certified Page 1 of 1 Laboratory#M-MA1118 Laboratory Director