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HomeMy WebLinkAboutWell - Permits - 808 GREAT POND ROAD 10/30/2019 NUMBER COMMONWEALTH OF MASSACHUSETTS BHP-2019-0233 North Andover FEE $135.00 BOARD OF HEALTH George W. Rollins NAME 808 GREAT POND ROAD ADDRESS IS HEREBY GRANTED A PERMIT Irrigation Well Construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires - - January 23, 2020 unless sooner suspended or revoked. ---- --- a ---- BOARD OF October 23, 2019 , � ----- ---- HEALTH -------- ----- --------------------- ----------------------------------------- --- BOARD OF HEALTH CHAIRMAN t�,FD, COMMONWEALTH OF MASSACHUSETTS NUMBER BHP-2019-0233 North Andover FEE BOARD OF HEALTH $135.00 George W. Rollins - NAME 808 GREAT POND ROAD ADDRESS IS HEREBY GRANTED A PERMIT Irrigation Well Construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires January 23, 2020 - unless sooner suspended or revoked. October 23, 2019 BOARD OF - HEALTH BOARD OF HEALTH CHAIRMAN NUMBER y t�TL"J) COMMONWEALTH OF MASSACHUSETTS BHP-2019-0233 North Andover FEE $135.00 BOARD OF HEALTH George W. Rollins — - - NAME 808 GREAT POND ROAD - - --------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Irrigation Well Construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires ..........January_23, 2020_- unless sooner suspended or revoked. October 23, 2019 BOARD OF HEALTH BOARD OF HEALTH CHAIRMAN COMMONWEALTH OF MASSACHUSETTS NUMBER >t � BHP-2019-0233 North Andover FEE BOARD OF HEALTH $135.00 George W. Rollins NAME 808 GREAT POND ROAD ------------------------ ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Irrigation Well Construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires January 23,_2020 unless sooner suspended or revoked. October 23, 2019 BOARD OF HEALTH BOARD OF HEALTH CHAIRMAN TOWN OF NORTH ANDOVER •- �� �® Community & Economic Development •" HEALTH DEPARTMENT 120 Main Street '�z N� NORTH ANDOVER, MASSACHUSETTS 01845 Q 978.688.9540—Phone 978.688.9542—FAX healthdept@northandoverma.gov www.northandovenna.gov Well and/or Pump Application C (Please print) DATE: 2— LOCATION to Drill Well or install a pump: $Og G(L A,- Pa.'D f Licensed Well Contractor Name and Company Name: �12-4e 'i• i W S to 0 • /�t0 L L ;' J S C o - a__ We, Contact Phone Numbers:OFF<G e 7-7 8 —8.Y 7 — Z 3 Z 0 r.a — Qj 7 3-7 S— S3 7 Homeowner: f;/z,'"j l� s 1' aAP'Ww Address: 30 8 67(1 'r powo Contact Phone Numbers: 56 Q ` 6 4 Z WELLS(to be completed at time of pump test) Type of well O•e—D G/L Use: Diameter of well: l© " Size of Casing: (0 s 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 long) Drawdown: feet after pumping: hours at: GPM Date of Completion: —L ' Signature ell 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 PLAN OF LAND IN NORTH ANDOVER, MA SHOWING PROPOSED DECK /_r #808 GREAT POND ROAD CIO, SGIE,•_40' � Ml[OCTDYR I6.2019 x NOTES.. ` C- T PERMETER,NUUSE A..-WATER WRx lAwLpN FAOY'PUN x OF UND'IN NORM ANDWER,W BY MDOmEl GONSULTANR DATED \ ` Wv 28.i98:.PUN RECORDED AT MSEx NORM REfATRv OF DEEDS. M 087Y9. C LOT D OCATEDDD Ip wATEro PRO�CW(xl NSA TABLE 2.LOTc ry / 3.PARCEL ID 1I0/i0J0-0011-00000 1WP 10J LOT 2 EDGE OF BNY FROY WSSGIS 1 2 b BLWII• + \ WATER PROTECMN DMERICT: TABLE 2. LOTS CREATED ON OR PRIOR TO OCTOBER 24,1294. \ ,,/�``�~W>! / ♦� 1\ xoN-nannlY.Ws rnx-oL�Aarr W¢mWbiEWKATER W.m 23O fEEf 3u PEEE \ FWO4 FDOE Of ALL WEMNO RESOURSS 1.FEET 325 FEET f..�'" \`'j�/ \ AY •�✓! � b '` AIffAS A'R11N 111E wAlfRL1ED D51NCF .iT F°Np�.MWe um \ LEGEND aw GEsrYsnw: L i —EDGE OF G.M 25 NO S.A.ZONE i 50'NO BUILD ZONE • `\1 1 I "__' 00'wETUNO BUFFER / \\\ t E� I ; �VIG:m.1K1lWIOL(APPROIL) --A E N NN�CNEWILN l atl ,I 1 Axrv7Al NIGNiSDATER WTj i LOCUS #808 a IQ,� \\ •\ / PARCEL 8 1 }1 \ /f ///yyy���...""" 5.30 ACRESt I t \ PK.O () • PROPOSED DBCK ` \ \---------------- ' M O ES NINGL RIDENTIAL 1 1T\ RU. .iG 5075E FEET y \ Au LOi—TA GE 5 i£ET =W FROM"ARD:10 FEET /' f+ v u� 1 \ uINIMUu Df tAFD.]0 FE R ET UR vA D JJ FEET S 53'OB'33"W 2A8.08 �O GREAT POND ROAD Fp i'J C LS m uik 1p N Y PRoQe�Lr! sEFtvl«fl 8`r' SE�.L.r�Q 87 `' 4 • - ,� � Town of North Andover �+�'•,.,,o:: HEALTH DEPARTMENT �ss�cNust� CHECK #: 7I r~ DATE: LOCATION: H/O NAME: l L r I)I 1�/ CONTRACTOR NAME: 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 $ ❑ Tras4lSolid 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 $ 01 Other. (Indicate) $; Health Agent Initials White-Applicant Yellow-Health in -Treasurer