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Home My WebLink AboutCompleted Well Permit w/ documents - Permits - 10/9/2019 RECEIVED TOWN Or NORTH ANDOVER RE Community & Economic Development HEALTH DEPARTMENT 120 Main Street j0VM0THpEpAR MFN\T R NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540-Phone 978.688.9542-FAX heal th dept@northandoverma.gov www.northandoverma.gov Well and/or Pump Application � (Please print) DATE: { LOCATION to Drill Well or install a pump: YA01-Ay- eka wl. 31b S- pFcp--o 8T tit•4'j0 - j i Licensed Well Contractor Name and Company Name: LL_1 4 ,✓f Contact Phone Numbers: - 2- 18 7 -12`2 Ceti_ 9— 37-5 �S3�t 7 Homeowner: /�'11k�- �+^�d c-A K- C�'/ Address:36 Q2 AD �/Lo s T-. t✓Dov� - r�l�, T D �� Contact Phone Numbers: T7 - 00 e 19 /9 WELLS(to be completed at time of pump test) �F� R Q Type ol,well: J A�� F� Use: Diameter of well: Size of Casing: CO ('� ' Depth of bedrock: Depth of casing into bedrock: Je C) Seal been tested? Yes Qe No( ) Date of test: ,?—6 " 11�1� 'Depth ofivell: CSC oo ' ?Water-bearing rock: L-AA i`1 tT`� Dcpthofwater• � � Delivers: 3 V-4� GPM for: 3 1'1 A- (how long) Drnwdown: ��J c feet after pumping: 3 hours Rt- C GPM Date of Completion: Signatur o Vell Contractor PUMPS(To be filled in before installation) / Name&size of Pump:01-i -DS S 14 • Type: V F S�IB:Lte f�sl '01 Size of Tank: � �L '^''+t — €' Pump delivers: Z c� GPM Pipe used in well: Cast Iron_ GnlvanizedL< Plastic �J Sleeve used to protect pipe? Yes No X Type Qf well seal: Date: k1j ~-t'- Signature of P Installer Date water analysis report submitted to Health Department: ;�1614 Plumbing Wiring Inspector it ith DTpartmeniRepresentative S:\Health\Permit Applications\Well\Well and or Pump Application.doc Nashoba Analytical, L.L,C Tel:978-391-4429 Fax:978-391-4643 LabNumber: 207321 31A Willow Road,Ayer MA 01432 Website:http://www.NasliobaAnalytical.com Use this number with all correspondence Client: Charles M. Rollins Co., Inc. ReportDate: 9/24/2019 126 Depot Road Boxford, MA 01921 Certificate of Analysis Smolak Farms, 315 South Bradford St, North Andover, MA Parameter Method Result MCL MRL Date of Analysis Analyst -Well Head Sampled:9/19/2019 12:40:00 PM by CMR Staff Total Coliform Bacteria,/100ml ENZ.SUB.SM9223 Absent Absent Absent 9/20/2019 11:00:00 AM M-MA1118 Arsenic,MG/L EPA 200.5 0.01 0.01 0.001 9/23/2019 M-MA1118 Calcium,MG/L EPA 200.7 33.9 Not Spec 0.2 9/23/2019 M-MA1118 Copper,MG/L EPA 200.7 ND 1.3 0.004 9/23/2019 M-MA1118 Iron,MG/L EPA 200.7 # 1.71 0.3 0.004 9/23/2019 M-MA1118 Lead, MG/L EPA 200.5 ND 0.015 0.001 9/23/2019 M-MA1118 Magnesium,MG/L EPA 200.7 8.4 Not Spec 0.1 9/23/2019 M-MA1118 Manganese, MG/L EPA 200.7 # 0.173 0.05 0.004 9/23/2019 M-MA1118 Potassium,MG/L EPA 200.7 2.2 Not Spec 0.1 9/23/2019 M-MA1118 Sodium,MG/L EPA 200.7 11.2 See Note 0.2 9/23/2019 M-MA1118 Alkalinity,MG/L SM 2320E 79 Not Spec 1 9/20/2019 M-MA1118 Ammonia as N,MG/L SM 4500-NH3 ND Not Spec 0.1 9/20/2019 M-MA1118 Chloride,MG/L EPA 300.0 16.1 250 1 9/20/2019 M-MA1118 Chlorine, Free Residual,MG/L SM 4500-CL-G ND 4.0 0.02 9/20/2019 M-MA1118 Color Apparent,CU SM 2120B # 35 15 1 9/20/2019 M-MA1118 Conductivity,UMHOS/CM SM 2510B 312 Not Spec 1 9/20/2019 M-MA1118 Fluoride, MG/L EPA 300.0 0.1 4 0.1 9/20/2019 M-MA1118 Hardness,Total,MG/L SM 2340B 119 Not Spec 1 9/23/2019 M-MA1118 Nitrate as N,MG/L EPA 300.0 ND 10 0.05 9/20/2019 M-MA1118 Nitrite as N,MG/L EPA 300.0 ND 1 0.02 9/20/2019 M-MA1118 Odor,TON SM 2150B 0 3 0 9/20/2019 DLK pH,PH AT 25C SM 4500-H-B 7.1 6.5-8.5 NA 9/20/2019 M-MA1118 Sediment,pos/neg -------------- NEG ------ NEG 9/20/2019 DLK Sulfate, MG/L EPA 300.0 39 250 1 9/20/2019 M-MA1118 Turbidity,NTU EPA 180.1 7 Not Spec 0.1 9/20/2019 M-MA1118 MCL=Maximum Contaminant Level(EPA Limit),MRL=Minimum Reporting Level Sodium Guidelines-Mass 20,EPA 250, #=Result Exceeds Limit or Guideline e f ND=None Detected(<MRL), *=Background Bacteria Noted,J=Estimated Value / Analysis performed according to 310CMR42.00 1 David L. Knowlton Massachusetts Certified Page 1 of 1 Laboratory#M-MA1118 Laboratory Director Massachusetts Department of Environmental Protection �. Bureau of Resource Protection ' Well Completion Reports Well Driller Please specify work performed: Address at well location: �lew Well Street Number: Street Name: SOUTH BRADFORD 315 STREET Please specify well type: Building Lot#: Assessor's Map#: ILmgation -- Assessor's Lot#: ZIP Code: Number Of Wells: 01845 Cityrrown: Well Location NORTH ANDOVER In public right-of-way: GPS Yes r No ! North: West: 42.68933 71.07321 Subdivision/Property/Description: SMOLAK FARMS Mailing Address: click here if same as well location addres Property Owner: Street Number: TStreet Name: MICHAEL SMOLAK 315 SOUTH BRADFORD STREET CitylTown: State: Engineering Firm: NORTH ANDOVERMASSACHUSETTS ZIP Code: 01845 Board of health permit obtained: Yes C Not Required Permit Number: Date Issued: BHP 2019 0003 1, IM9/201� Massachusetts Department of Environmental Protection Bureau of Resource Protection-Well Driller Program ELIVJI Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Flarrrner Air Hemmer WELL LOG OVERBURDEN L ITHOLOGiY _ From(tt) To(R) Code Colo► Comment Drop in drill Extra fast or slow Loss or addition stem drill rate ofUWd YES L ,0-1 Gravel Brown _- �T1 r� t:Fast t`Slow [Los. ta`� Additon WELL LAG BEDROCK Lrn*XDW From(ft) To(R) Code I Comment Drop In Extra fast or addition of Visible Rust Large drill stem slow drill rate fluid staining Chips 120 u t00 '-- �� YES Iq Feat Slaw Loss Addition L— Ye r: r� r" r' C r' Fri Y—asI 100 (irsrike t YES NO Fast Slow Loss Addition r Y� L--� _ if r: r r r ��,,,,�, a n L Yes Yes '� ll YES tJJ Fest Slow � Loss Addition --� ---� r a ' ®® GrariO� YES NO Fast Slow Loss Addition lr:: :7, � ®®I Grenite i' r r. Sl Lo r Ye !F Ye YES NO Fast Slow Lass Addition -- ,500-�©(Granite r (' r. r r r Ye rJ Yes YES NO Fast Slow Loss Addition ADDITIONAL WELL INFORMATION Developed ' r Yes r No Disinfected r Yes r'No Total Well Depth 600' Depth to Bedrock 20' Surk"Seal Type one Fracture Enhancement I r Yes re No CASH R Is Casing above ground — From: t Tot 0 From To Type Thickness Diameter DAveehoe ro—1 ®— Es=bw BCREBi R No Screen From To TIITYM slot Size Diameter —1�--Choose Screen Type wATERaEARtN zONES r DRY WELL From Tb YNkt(gpm) Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program r' Well Completion Reports(General) 181 55 - ---� 213 1b 13.5 PERMANENT PUMP(IF AVAILABLE) 3 Wire Variable Speed Pump Description Submersible Horsepower Pump Intake Depth(ft) 400 Nominal Pump Capacity(gpm) 25 ANNULAR SEAL FILTER PACK _ -- From To Material 1 Weight Material 2 Weight Water Batches Method Of (gaq (count) Placement.__ --- 02101M� CNative Nlatenal_ L � Choose 20- 40 �ntonfte ChipslPeNets-�i �� I Choose Material WELL TEST DATA Date Method --— yield(yam) Time Pumped Pumping Level(ft Time To Recover Recovery(n (HH:MM) Bt3S) (NwMM) B" 08/0812018 LAir Blow With Drlt Stem !30.6 IXi 00 ® 0028 31 WATERLEVEL Date Static Depth BGS(Ft) Flowing Rate(gpm) Measured 08/09/2018 1131 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, AMOS Monitoring[M] Signature GEORGE, DrillerROLLINS Registration# 305 W CHARLES M. Date Job Complete -- -- Firm ROLLINS CO.,INC. Rig Permit# 0208 A8/0812 0 1 9 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.