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HomeMy WebLinkAboutWell - Permits - 2017 SALEM STREET 11/20/2019 COMMONWEALTH OF MASSACHUSETTS NUMBER st . BHP-2019-0139 North Andover FEE BOARD OF HEALTH $135.00 Derek Skillings NAME 2017 SALEM STREET ADDRESS IS HEREBY GRANTED A PERMIT Well Permit This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires September 03, 2019 unless sooner suspended or revoked. June 03, 2019 BOARD OF HEALTH BOARD OF HEALTH CHAIRMAN NUMBER •' COMMONWEALTH OF MASSACHUSETTS BHP-2019-0116 North Andover FEE $135.00 BOARD OF HEALTH SKILLINGS & SONS, INC. NAME 7 1 SALEM STREET aY C n' ADDRESSIwo ADDRESS IS HEREBY GRANTED A PERMIT Well Construction new well construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires -__ August 13, 2019_- unless sooner suspended or revoked. May 13, 2019 !m-!"-'--- ----------------- ----------------- BOARD OF ---- ------ ----- ----- HEALTH -------------------------- - ----- -- - --- BOARD OF HEALTH CHAIRMAN COMMONWEALTH OF MASSACHUSETTS NUMBER • BHP-2019-0116 North Andover FEE BOARD OF HEALTH $135.00 SKILLINGS & SONS, INC. NAME f� )2 <1 SALEM STREET lJ _ ADDRESS IS HEREBY GRANTED A PERMIT Well Construction new well construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires _ August 13, 2019 unless sooner suspended or revoked. •---------- --- --------------- ------ -- May 13, 2019 --� - BOARD OF HEALTH ------------ ------------------- BOARD OF HEALTH CHAIRMAN NUMBER yt�rcFb,�s COMMONWEALTH OF MASSACHUSETTS BHP-2019-0116 . North Andover FEE $135.00 BOARD OF HEALTH SKILLINGS & SONS, INC. NAME - 2051 SALEM STREET ADDRESS IS HEREBY GRANTED A PERMIT new well construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires - August 13, 2019 unless sooner suspended or revoked. May 13, 2019 BOARD OF - HEALTH BOARD OF HEALTH CHAIRMAN �rr.Eo, COMMONWEALTH OF MASSACHUSETTS NUMBER yw BHP-2019-0116 North Andover FEE i BOARD OF HEALTH $135.00 SKILLINGS & SONS, INC. NAME 2051 SALEM STREET ADDRESS IS HEREBY GRANTED A PERMIT new well construction This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires August 13, 2019 unless sooner suspended or revoked. May 13, 2019 BOARD OF - - HEALTH BOARD OF HEALTH CHAIRMAN - - i Town of North Andover RE: Applications for a permit to drill a well: Before a permit can be issued, you must have your contractor submit the following: �2,0 I -1 (D Submit to the Health Department a sittp� plan showing tq house and or lot footprint 0Sin9 SyliG 4104 r�- 5;9 /eo-j Sf Vf',- Indicate any wetlands within 200 feet of the proposed well location V,3' Indicate any septic systems within 200 feet of the proposed well location Indicate the proposed well location Submit a check for $13 5.00 with the application Note: All submittals must be drawn to scale. Please note that you may also be required to file with the Conservation Commission if wetlands are near to the proposed well, and to the Planning Board if you are located in the Watershed District. NOR'!H ANppVER 100 N pEPApweAl TOWN OF NORTH ANDOVER • Community&Economic Development HEALTH DEPARTMENT 120 Main Street NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone 978.688.9542—FAX healthdept@northandoverma.gov www.northandoverma.gov Well and/or Pump Application (Please print) .G I'1 DATE: 5 I 9/11 LOCATION to Drill Well or install a pump: / SG 1*1 S�ree� Licensed Well Contractor Name and Company Name: �Pi✓p�c SK �� �� S — SJ� �� �c s Sa�S �Kc. q* qY3 Contact Phone Numbers: Homeowner: pave (AID S l 611 ' lit-Gv� (rjnSl/C/ G►�� Address: kA17 ao 5�� 0" C Contact Phone Numbers: 5,06— 1-40\13- 583s- Lai✓�c-�_ WELLS(to be completed at time of pump test) Type of well: �aLoN tj(� Use: A'M"J ) Diameter of well: (00 Size of Casing: 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: Signature of Well 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 86-► 6 Ot NORT1 1y Town of North Andover HEALTH DEPARTMENT ,SSAC MUSS CHECK#: I7�93 DATE: `S" 9 9 Rc�i7 LOCATION: H/O NAME: '4011 CONTRACTOR NAME: &4 o a r Sons 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 PWell Construction SEPTIC S sy tems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ H Agent Initials White-Applicant Yellow-Health Pink-Treasurer Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: SKILLINGSWELL Transaction ID: 1117511 Document: Well Driller Size of File: 381.68K Status of Transaction: In Process Date and Time Created: 6/26/2019:11:19:00 AM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Lill i Well Driller Please specify work performed: Address at well location: iNew Well - Street Number: Street Name: 2017 SALEM STREET Please specify well type: Building Lot#: Assessor's Map#: Domestic Assessor's Lot#: ZIP Code: Number Of Wells: 01845 City/Town: Well Location NORTH ANDOVER In public right-of-way: GPS f Yes r No North: West: 42.63755 71.04865 Subdivision/Property/Description: Mailing Address: j r click here if same as well location address Property Owner: Street Number: Street Name: DAVE INNIS 475 BOSTON ROAD City/Town: State: Engineering Firm: BILLERICA MASSACHUSETTS ZIP Code: 01821 Board of health permit obtained: f Yes Not Required Permit Number: Date Issued: BHP 2019 0139 F06iO3/2019 — ---1 Massachusetts Department of Environmental Protection Bureau of Resource Protection-Well Driller Program Well Completion Reports(General) Ll j Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Air Hammer Air Hammer WELL LOG OVERBURDEN LITHOLOGY [Fro-(ft) To(ft) Code Color Comment Drop In drill Extra fast or slow Loss or addition stem drill rate of fluid Gravel Brown YES Ip {'Fast r Slow Loss Addition WELL LOG BEDROCK LITHOLOGY Loss or Extra From(ft) To(ft) Code Comment Drop in Extra fast or Visible Rust addition of Large drill stem slow drill rate fluid Staining Chips P 0 100 Granite (: r r rYes ryes YES NO Fast Slow Loss Addition 100 200 Granite r Yes r Yes YES NO Fast ;-low:] Loss Addition 200 300 Granite Tsr Yesr YesYES NO Fast Slow Ldition r r r t^ t~ 1, 300 400 Granite r Yes r Yes YES NO Fast Slow Loss Addition 400 500 mite t: (' f r r Yes YES NO Fast Slow Loss Addition Yes� r7 5lXl 600 Granite � r (` r r t' r �� YES NO Fast Slow Loss Addition ryes ryes ADDITIONAL WELL INFORMATION Developed Yes r No Disinfected �Yes(-No Total Well Depth 600 Depth to Bedrock 4 Surface Seal Type mentlBentonite �racture Enhancement 'Yes t^ No CASING R Is Casing above grou-� From: 1.5 Ta 0 From To Type Thickness Diameter Driveshoe 0 38.5 Steel Schedule 40 © Ye SCREEN R No Screen From To Type Slot Size Diameter —Choose Screen Type— WATER-BEARING ZONES r DRY WELL From To _Yield(gpm) Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) t ` 210 1215 _1 10.5 PERMANENT PUMP(IF AVAILABLE) Wire Constant Speed Pump Description Horsepower ubmersible 1 Pump Intake Depth(ft) 500 Nominal Pump Capacity(gpm) 5 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of F (gal) (count) Placement OF 38.5 Bentonite Grout Choose Material Other WELL TEST DATA Time Pumped-Pumping Level(ft Time To Recover Recovery(ft Date Method Yield(gpm) (HH:MM) BGS) (HH:MM) BGS) O6/12/2019 Air Blow With Drill Stem 0.5 00:30 C� O 06/21/2019 Constant Rate Pump _._J1 7.5 04:00 49.1 00:10 9.7 WATER LEVEL [Date Measured Static Depth BGS(ft) I Flowing Rate(gpm) i O6/12/2019 80 —� 0 06/21/2019 128.1 lu 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. BILL Supervising Driller SKILLINGS, DrillerCONAWAY Registration# 546 Monitoring[MJ Signature ROGER,B SKILLINGS AND Firm SONS,INC. Rig Permit# 537 Date Job Complete 06/21/2019 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.