HomeMy WebLinkAboutWell Permit & Applicaiton - Irrigation - Permits - 1600 OSGOOD STREET 9/30/2019 NUMBER
COMMONWEALTH OF MASSACHUSETTS B1~~IP-2019-0227
North Andover FEE
$1135.00
BOARD OF HEALTH
Ryan Wragg
NAME
16 0 OSGOOD STREET
ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
Drilled Irrigation Well
Thin permit is granted in conformity with the Statutes and ordinances reIating thereto, and
expires December 25, 2019 unless sooner suspended or revoked.
September 25, 2019 BOARD OF
HEALTH
t"; iz"'
'U
BOARD OF HEALTH CHAIRMAN
.. ............
per
COMMONWEALTH OF MASSACHUSETTS NUMBER
BHP-2019-0227
North Andover
FEE
BOARD OF HEALTH $135.00,
Ryan Wragg
NAME
1600 OS GOOD STREET
ADDRESS
IS HEREBY GRANTED A PERMIT
Well Construction
Drilled Irrigation Well
This permit is,granted in conformity with the Statutes and ordinances relating thereto, and
expires December 25, 2019 unless sooner suspended or revoked.
September 25, 2019 BOARD OF
HEALTH
BOARD OF HEALTH CHAIRMAN
............
m
I'OWN OF NORTH ANDOVER
C�tIIIBILInI{}" & ECCII #IIrIC" Development
IJEALTH DEPARTMENT
120 Main Street
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Well and/or,Pum,p Application
(Please print,), DATE:
LOC'A"I'ltJlN to trill Well tat"install a pnttala._� "d ....b,15— '� 1,.
Licensed'4 Well Contractor Name and Company Nanaa:
JX
_ _.__ .__.__...... ..._.. ...._ _ ..._. __ ... __...
r
Contact t hone Numbers:
Address: 530
xq
Contact Phone Numbers:
WELLS(to he completed at tiaawe of pump(est)
Type of wvell'-_ '-;Ile k/ . _7_-,C
Diameter of _._,.-_ ----- Size aaf C:asimg.,...._. ,e
Depth of laedrow is _ ......... _...._ ._._. Depth of easing into beds aacic
Sea]been tested? "tire+q, ) No( ) fate
Depth of wvell. Water-tweariap;roelt.
Depth of ww°etas' _. ._....._..._ t7elivers:_.__.___._......._. GPNI fast......_..............
(how taaap;)
Iarsawdowrat:_..... . ._.._.._... feet after pumping. . hours tit. C VAI
Date taf(.'oawapittwaaau
Signature of 1vell C"ootractor
PUMPS(To be filled in before installation)
Name&size of Pump. Type:_
Sire ofTattict � � � N Pump delivers; --GPM
Pipe asset! in Wei i ......_ .___.., - t;'ast troth Galvanized--,—, Plastic
Sleeve used to protect pipe? Yes— No-_____._Illype of,well seal
Hate:
Signalore of Pomp Itasialler
Date water modysis report submitted to'1�lcalth Ilaparttneaat�., � _
phombing Wiring Inspector 11611th Departauent Representative
&V lealftPe•taait a ppalicut ons\WelMell and or I't rnp Application.cdoc
8 7
Town of North Andover
HEALTH DEPARTMENI
DATE:
LOCATION:
/"6 J
H/O NAME: Zz
CONTRACTOR NAME:
Type of Permit or License:(Check box)
0, Animal
0 Body Art Establishment s-
0 Body Art Practitioner
0 Dumpster
0 Food Service-Type:—,---...-..---
0 Funeral Directors
• Massage E.5tablishment
• Massage Practice
El Offal(Septic),Hauler
• Recreational Camp
• Sun tanning
• Swimming Pool
EJ Tobacco
0 Trash/Solid Waste Hauler
Well Construction
SEP77C Systems.-
0 Septic-Soil Testing
0 Septic-Design Approlva I
Septic Disposal Works Construction(DWC)
* Septic Disposal Works Installers(DWI)
* Title 5 Inspector $
[3 Title 5 Report
Other. (Indicate) $
11ed'lffi'Agent Initial
Whit Applicant yellow-Health fink-Treasurer,,
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