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Home My WebLink AboutWell - Permits - 1975 SALEM STREET 8/31/2020 NUMBER COMMONWEALTH OF MASSACHUSETTS BHP-2018-0255 North Andover FEE $135.00 BOARD OF HEALTH George W. Rollins NAME 1975 SALEM STREET ---- ----- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction-Lot 3 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 COMMONWEALTH OF MASSACHUSETTS NUMBER 6 . BHP-2018-0255 North Andover FEE BOARD OF HEALTH $135.00 George W. Rollins --NAME _ -- 1975 SALEM STREET �o �= - --------------------------------------------------------------------------- - ADDRESS IS HEREBY GRANTED A PERMIT Well Construction-Lot 3 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 -------5 ------ --------- --- - - ------------ BOARD OF HEALTH CHAIRMAN ' NUMBER COMMONWEALTH OF MASSACHUSETTS BHP-2018-0255 North Andover FEE $135.00 BOARD OF HEALTH George W. Rollins -------- --------------- - - - -- --------------------- NAME 1975 SALEM STREET --- - ---------------------- ---------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Well Construction-Lot 3 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 COMMONWEALTH OF MASSACHUSETTS NUMBER BHP-2018-0255 North Andover FEE BOARD OF HEALTH $135.00 George W. Rollins NAME 1975 SALEM STREET --------------------------------------------------- ADDRESS IS HEREBY GRANTED A PERMIT Well Construction Well Construction-Lot 3 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 S TOWN OF NORTH ANDOVER •- Community&Economic Development • HEALTH DEPARTMENT 120 Main Street NORTH ANDOVER, MASSACHUSETTS 01845 978.688.9540—Phone ` 978.688.9542—FAX 6� . /v — (/ �/ healthdept@northandoverma.gov (91 ! / www.northandoverma.gov Well and/or Pump Application (Please print) DATE: �'�� ' a LOCATION to Drill Well or install a pump: C.mT 3 Skue.a` License Well Contractor Name and Company Name�� Contact Phone Numbers: 8 _ 7—3 Z'o Ce-LL — 4-7 3-7 S—6 5 S 7 Homeowner: C7u 67st41 Address: 1-b• 510 1�a uJKS6 J(Z-/, r*,AA ' Contact Phone Numbers: ?) F —6 0 `T 7 7 —g(S — 8� WELLS(to be com�Itednat time of pump test) Type of well: Use: ��'�' -'rT G Diameter of well: Size of Casing: 6 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: Signa re of 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 16 .r.� ,�Ww r�e!¢IeTlw¢e!¢NLy N3r\♦ N!q/ STEVENM WEY iy� 4Yd}M"� °"`•� .hrrly MAP1KALOTK 1 fA•�5+�' "a woi Wl►AOEK �p ••_O.are "N 4W VRNM YOESU .. R Y •Q.G {'� "h MM 108.E LOT 1I) LGTt �ru W Y9'WM'W 8W1(YY PAGE 24 0 IYNWlN + n d� Wq► xar hi '� 6 w ruF '�° N}}.U\ POOH e30f PAGE 813 wiE y�N/MOMM 4, (mow, rU�W °0°""N°F"eF"' •'A.�}, '�*' MCIUEL O.NEMMAN LOCUS MAP R \•`4. } P} "� .Iy WI M 188E LOT TI} NO SGnIe J aoDN eiK rAGE W rm? EOWMG Lon L.O LUP foi.D io Q, _ N}f 1j\� BOOH 80J0 PAG[20 3� L W O r FEENE {LANS , , N ,w , / .7 .,.W ,• ZONING DISTRICT R2 tT 0i}"Ae r,AIl W.111W. 2n.1.r '"' rt� MMMl1M AI1EA•upK S.F. WONTMONTA0E•180 FCET �"'Ttwy MW W GM FRONT SETEAC—FEET rMWWUMME}ETi -]0 FEET A T1N r�grm� naeW�iem¢r¢lo. LOT ,,.N kJl/ MWIYUTA ITEM SEIMCR-Je FEET No.,3ru. aNA,[e N \ph ceuTGTwwln OENWE L.STAEAE LMNO TRUST AMROVAL UNDER THE*U§DIVItION MAP W.LOT M CONTROL lAW NOT "OIRREO iCG1()t}3 PAGE IG NNWMN wARNT M I REFERENCE DEWED eeoNrzror lx}" •¢e.NrRFrrM,c¢. 71 ArI'IL ANMRr, f wr,G.e}.rAwwM , "MuirfiNF"'1,�°nir wr x,Yw„'w llwipi"}t E�..i. j w NOTES ACCESS t UTILITY i. Ao!„G¢s1,¢NL¢n FFA ry arlt• 4 EASEMENT 1 xoeleNmwA:wx¢ y �.» � pEp z xul,x urr,nAmrN)¢wi.u.zuM w•c Nm ml. \ ..�.W.¢�wNo•Ia°..,�. ""°'NI f 4 I i I LOT .e d ''01W':e.N'e'EW�Y`` o� ?�� PLAN OF LAND � MG1MLTwlle% \ A NF y CY•f.18[•" NKHAEL UCIUPELLF S ^po NORTH ANDOVER,MA. I�q�, 000K8ef2-GE2]Y b .... LOIS R.LACHAPELLE:: I N ,•r.r wwa LIVINGSTONE ': P ....n, wdM lW { pgi'ii U'Me1id}'RM}e."'._ t•}}' / •,U DEVELOPMENT CORP. SALEM t ^ DETAALA DETAIL V , } STREET MP TO{N OTOf NDOV Ge1N �,! ®PW]fE}NOx}1 ENDINEEIIil LW06UrrVETGR6 ER MM LAL11e L (�( l,_.`� CMNR�lA SEN6 SERE GI,JN . saDlLurrmem ��.� ""rz,N,`,., " ','N'o>. DMAD.l&M7AD1.EM 3� I 84 2 Gf NOR7N,y s Town of North Andover `,�•-�:,;e-: ,` HEALTH DEPARTMENT 'ss�cHust� CHECK#: DATE: LOCATION: �, ,'3 Ja J°e H/O NAME: 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 $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(D[NI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ c Other:(Indicate) $ f J Health Agent Initia White-Applicant Yellow-Health Pink-Treasure,