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Home My WebLink AboutDomestic Well Permit - Permits - 1985 SALEM STREET 9/25/2019 ' NUMBER COMMONWEALTH OF MASSACHUSETTS BHP-2018-0254 North Andover FEE $135.00 BOARD OF HEALTH George W. Rollins NAME 1985 SALEM STREET ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Well Construction lot 2 Salem Street This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires _ _ November 21, 2018 unless sooner suspended or revoked. --------------------------------------------- August 21, 2018 BOARD OF ------ HEALTH ----------------F_ILE----COPY----- - -- - _ - ---------------------- OF HEALTH CHAIRMAN •' TH OF MASSACHUSETTS NUMBER COMMONWEAL BHP-2018-0254 North Andover FEE BOARD OF HEALTH $135.00 George W. Rollins NAME 1985 SALEM STREET �o --- - - ------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Well Construction lot 2 Salem Street This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires November 21, 2018 unless sooner suspended or revoked. August 21, 2018 - - ------- ---- -------- BOARD OF ----- - ..... -------- HEALTH -------------------------------- BOARD OF HEALTH CHAIRMAN x TOWN OF NORTH ANDOVER • Community& Economic Development HEALTH DEPARTMENT 120 Main Street NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540-Phone health ept@n-FAX healthdept@northandoverma.gov www.northandoverrna.gov Well and/or Pump Application (Please print) DATE: LOCATION to Drill Well or install a pump:Licensed Well Contractor Name and Company Nam Uj• Pzot_Lt+j�5 CA/ta'-g Vim, +.c tt�S Co . 11c oz � 7- Contact Phone Numbers: e�_ �? -3? - -&5-Y 7 Homeowner: CC P• 6,R)PlA, Address: `8• 1%y' Contact Phone Numbers: T)8 -6((0 WELLS(to be completed at time of pump test) Type of well: V" 1� Use: Diameter of well: Size of Casing: 4 Depth of bedrock: Depth of casing into bedrock: Seal been tested? Yes( ) No( ) Date of test: Depth of well: Water-bearing rock: Depth of water: Delivers: GPM for: (how ng) Drawdown: feet after pumping: hours at: Date of Completion: Signature of I 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? Yes No Type of well seal: Date: Signature of Pump Installer Date water analysis report submitted to Health Department: Plumbing Wiring Inspector Health Department Representative S:\Health\Permit Applications\Well\Well and or Pump Application.doc r 15 xA" liaAQ��•BTEVEN C.t`•.NY m.rr, N"k•Wr�ne its/ NAP Iefw LOTx �1 �u u.V, ecoN S•il•AOEm 5 � -.._'��1�,�� .w. NM\ F`,FI1j I r�W Y GEJAI MAP INA LOT 1)) IOTi 4,p W MY'1lfYW e001<SB96 PAGE •�\N11 MA! `NN'NDYW IOTf �\ '�%�t�.N� Na!�Y'N Ylrl'W CelN W W IN" C� oFM '� FRANK V.ROE oo�oK lobe wr s)e nNs,.l Nay�W PnOE a1a wx..<AAovn •a, 'mod °0q'1""r"��L 3. . `�+ nacxAEL G.NEWNAN LOCUS MAP �• �!•E N�y.W MM IMA LOT ttB NO SCALE BOp(—EAGEfs Cif Na,AW NiF 6 la.� Eowulo L WOLEE W wP 1a.a LOT ua Na,. Booty sBTB PAcc x 3 1 AA.P w p L _:!!�IFERENNCE PLANS xanl Lw N"'v. Van W `BN"eaiO1fex w"o`N�:Y x Na"\ti ZONING DISTRICT R2 M®a MIV01HB.ITM.NMxd1R1 a "A' 1"`"'FS ""V' W u MMMUM AREA-43SBS.F. MMMUMFRL111TAG 1301EE7 .N]ATT< a M inbfrFAceunrurdrtan TAY—rnFnu NMMu1FRONTSETBACK-30RET edRx ereAAedenYM Mew, "' »Ba w MWMUMMEMETBACK—EET �' NMMAUM AFAR S KN FEET dFe: LOT 2 ETJALOT 3 I Mxd1 v •�.»,�„� rro.m«. aawesAieeinw"iaN \,,AL' drAYFATwNnw APPROVAL UM"THE JUBDIVIJION y OENpELJTABLELMNO TRUST MAP IMA LOT 1f1 CONTROL lAW NOT 11EOUlm ED eDp()if2 PAGE 1B5 ucTrHv1A,.[c.«r REFERENCE DEED i. rNwaMAr vudPnla::Yise'is nm neix ��`'' —I/—M—�� , rB<rNYMMen easN aNeinaeNarelrrrANc¢. NFIWBr.<.1NtlNro /Lvy/`'IA--wMY111<l imN�I3fie:.`acTF:x Nr•W"w � 6 w � I NOTES L.�.) Nt\AccEseaunLflY i. ae NrIxINlAee!/ pxLonreA Taaa•M EASEMENT s E xawx � fr�W i 1 MORM dMN1AOd<TONw MWtNn ere NAe�«). \ �.� N.wan,wuNMauivr .mr LOT 1 PLAN OF LAND g NICNAELLACIMPELLE " 7 10e.8 LOT 1. .A R SOON 9F1i PAGE 1>B F NORTH ANDOVER MA. E LOTS R.Ne�dNG Lel1 Lme ,.,, i LACHAPELLE: 1+•N,, EI LIVINGSTONE ' r ...�• L �• DEVELOPMENT CORE-.r w<Iw. eNsa1 Iti .if'N IY NT�B.,b'A•a0.ea' .. '-� SALEM DETAILA DETAIL B •M•L1p ST �in1�.E iMr mw.d Y.N.N. T `T�"�'TM ��®NIOFlMIpNIL ENdMEER6lLAN❑SIITIEVOx6 NArlae A us mtix l wCl TG1NSEN6 SERG1,INC. ' eoaNur rneE of fT•rcS N»wNSE.RGI,I n 1MW{�M[dI T¢»a1i>ata .,.»zaro t DVOSAM 15047ADLM ypp 3 '10R 7N V 1 , 2 OL Town of North Andover HEALTH DEPARTMENT ,SSACM�SES CHECK#: DATE: LOCATION: H/O NAME: CONTRACTOR NAME: C� } Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DW[) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ Other:(Indicate) Hea th Agent Initia White-Applicant Yellow-Health Pink-Treasure Massachusetts Department of Environmental Protection Bureau of Resource Protection Lil. Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 1985 SALEM STREET Please specify well type: Building Lot#: Assessor's Map#: Domestic _- 2 Assessor's Lot#: ZIP Code: Number Of Wells: 01845 City/rown: Well Location NORTH ANDOVER In public right-of-way: GPS 1^Yes C'No I North: West: __J 42.63750 71.05156 SubdivisiontProperty/Description: Mailing Address: I"click here rf same as well location add res Property Owner: Street Number: Street Name: LIVINGSTONE DEVELOPMENT CORP. PO BOX 50 City/Town: State: Engineering Firm: WILMINGTON MASSACHUSETTS ZIP Code: 01876 Board of health permit obtained: `re Yes f Not Required y Permit Number: Date Issued: BHP 2018 0254 j0&12 1/2018 RECEIVED SEP 17 2018 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Air Hammer Hamner WELL LOG OVERBURDEN LITHOLOGY I I Drop in dr M Extra fast or skow Loss or addition From(ft) To(fl) i Code Color Comment stem drip rate of fluid ��8.5 Send And Gravel� �Brown Fast r Slow =Add-b- WELL YES NO LOG BEDROCK LITHOLOGY Drop In Extra fast or Loss or Visible Rust Extra From(ft) To(ft) Code Comment drill stem slow drill rate addition of Large fluid StainingChips 8.5 100 Granite --� YES NO Fast Slow Loss Addition 100 (zoo_ Granite -- r- --- r rIFr- r F r�__ �'"YeYES NO Fast Slow oss Addition r r. [Fast r r r Granke YES NO Slow Loss Addition -- -- t r r r r r r C� Granite— R e YES NJ Fast Slow Loss Additijl� ADDITIONAL WELL INFORMATION Developed r Yes r No Disinfected ii r-Yes r No L Total Well Depth 380 Depth to Bedrock 8.5 Surface Seal Type --~—_ Fracture Enhancement IrYe re�3 CASING Is Casing above ground?! ��From ''�� To��''�� Type Thickness es _Diameter_ Driveshoe_ Y SCREEN Iry No Scree [From To Type Slot Size Diameter L —Choose Screen Type— WATER BEAtiMti ZONES r DRY WELL, �T�o�--� Yield(gpm) !382_J L e PERMANENT PUMP QF AVAILABLE) variable r Speed �1 Pump Description Suomersloie Horsepower 12 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Pump Intake Depth(ft) 200 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Botches Method Of ' (pal) (count) Placement Material- e—j atedal� Gravity Fe—.n�xnile chips/Pellets 3 F -^1 I choose INsterfal j Gravity WELL TEST DATA Data Method y ) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) ow (HH:MM) 08/23@018 j�r a- - ��128 02:00 � WATER LEVEL - -- -, __---i-- -- Date Measured Static Depth BGS(ft) Flowing Rate(gpm) i 08/27/2018 13 -----� --� 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. ROLLINS, JEFF Monitoring[Ml Supervising Driller Signature GEORGE, DrillerROLLINS 307 Registration# 305 W CHARLES M. Date Job Complete Firm ROLLINS CO.,INC. Rig Permit# 0208 O8JZ3/2018 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Nashoba Analytical, LLC Tel:978-3914428 Fax:978-3914643 LabNumber: 193852 3I A Willow Road.Aver MA 01432 Website:http:Uwww.NashobaAnalytical.com Use this number with al I correspondence Client: Charles M.Rollins Co.,Inc. ReportDate: 8/31/2018 126 Depot Road Boxford,MA 01921 Certificate of Analysis 1985 Salem Street(Lot 2), North Andover MA Parameter Method Result iNICL MRL Date of Analysis Analyst -Well Head Sampled:812912018 3:00:00 PM by CMR Staff Total Coliform Bacteria,/100ml ENZ.SUB.SM9223 Absent Absent Absent 8/30/2018 11:00:00 AM M-MA1118 Arsenic,Total,MGlL SM 3113B ND 0.01 0.001 8/31/2018 M-MA1118 Calcium,MG/L EPA 200.7 40.5 Not Spec 0.2 8/31/2018 M-MA1118 Copper,MG/L EPA 200.7 ND 1.3 0.004 8/31/2018 M-MA1118 Iron,MG/L EPA 200.7 # 0.599 0.3 0.004 8/31/2018 M-MA1118 Lead,MG/L SM 3113E ND 0.015 0.001 8/31/2018 M-MA1118 Magnesium,MG/L EPA 200.7 6.7 Not Spec 0.1 8/31/2018 M-MA1118 Manganese,MG/L EPA 200.7 # 0.075 0.05 0.004 8/31/2018 M-MA1118 Potassium,MG/L EPA 200.7 0.6 Not Spec 0.1 8/31/2018 M-MA1118 Sodium,MG/L EPA 200.7 12.4 See Note 0.2 8/31/2018 M-MA1118 Alkalinity,MGIL SM 2320B 137 Not Spec 1 8/30/2018 M-MA1118 Ammonia as N,MG/L SM 4500-NH3 ND Not Spec 0.1 8/31/2018 M-MA1118 Chloride,MG/L EPA 300.0 2.6 250 1 8/30/2018 M-MA1118 Chlorine,Free Residual,MG/L SM 4500-CL-G 0.07 4.0 0.02 8/30/2018 M-MA1118 Color Apparent,CU SM 2120E 15 15 0 8/30/2018 M-MA1118 Conductivity,UMHOS/CM SM 2510B 293 Not Spec 1 8/30/2018 M-MA1118 Fluoride,MG/L EPA 300.0 0.6 4 0.1 8/30/2018 M-MA1118 Hardness,Total,MG/L SM 23406 129 Not Spec 1 8/31/2018 M-MA1118 Nitrate as N,MG/L EPA 300.0 ND 10 0.05 8/30/2018 M-MA1118 Nitrite as N,MG/L EPA 300.0 ND 1 0.02 8/30/2018 M-MA1118 Odor,TON SM 2150B 2 3 0 8/30/2018 DPR pH,PH AT 25C SM 4500-H-B 7.3 6.5-8.5 NA 8/30/2018 M-MA1118 Sediment,pos/neg ----- NEG -- NEG 8/30/2018 DPR Sulfate,MG/L EPA 300.0 9.9 250 1 8/30/2018 M-MA1118 Turbidity,NTU EPA 180.1 8 Not Spec 0.1 8/30/2018 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 9