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Home My WebLink AboutWell Permit and Application - Miscellaneous - 288 STILES STREET 7/10/2020 � xy. • PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division Skillings & Sons, Inc . As of. July 10, 2020 Is hereby granted a: Well Water Permit For 288 Stiles Road Applicant: Derek Skillings License #: 943 Emergency Phone: 603-459-2600 Homeowner: Gale Page Homeowner Phone: 978-290-9513 This permit is granted in conformity with the statutes and ordinances relating thereto. Stephen C ey, Jr. Public Health Inspector 120 Main St.,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov NOR QE Massachu Toni Wolfenden <twolfenden@northandoverma.gov> water well application-288 Stiles St. North Andover, MA 1 message Derek Skillings <dskillings@ski Ili ngsandsons.com> Tue, Jun 23, 2020 at 12:16 PM To: Toni Wolfenden <twolfenden@northandoverma.gov>, Vincent DiPiero <vncent@skillingsandsons.com> Cc: gale page <galeforce63@gmail.com> Hi Tony, Attached is the paperwork for the above address. I will have my office mail a check to your new address at 120 Main Street North Andover, MA 01845. Vin, can you please mail a check to Toni in the amount of$135? The site we are drilling at is 288 Stiles St. The check needs to be mailed to 120 Main Street. Thank you, The health and well-being of our customers, associates, and communities is our top priority. We understand the concern and uncertainty you may be experiencing surrounding the coronavirus (COVID-19) and are committed to being responsive to the needs of our customers and associates as the situation evolves. We request if anyone has an upcoming appointment and someone in your household is showing signs of an illness that includes a fever or a cough, please reschedule your appointment for the safety of our staff and our communities. In addition, we are not allowing the public to enter our facilities during this crisis, please callus or go online for product purchases. We are working to do what is best for everyone and appreciate your patience during this time. Thank you! De4-ek,Sk UVIgk Sales and Project Manager SKILLINGS & SONS, INC. Wells - Pumps - Filters - Geothermal 9 Columbia Drive Amherst, NH 03031 office: 603.459.2600 fax: 603.821.3822 toll free: 800.441.6281 www.skillingsandsons.com 2 attachments .� Page, Gale, 288 Stiles Road, North Andover, MA WELL APPLICATION.pdf 71K "'Q Page, Gale, 288 Stiles Road, North Andover, MA SEPTIC PLAN WITH WELL LOCATION.pdf TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET;SUITE 2035 NORTH ANDOVER, MASSACHUSETTS 01845 10 Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX healthdeptC,townof iorthandover.com www.townofnordiandover.com Well and/or Pump Application (Please print) I).4'rl.:6-23-2020 LOCATION to Drill Well or install a pump:288 Stiles Road Licensed Well Contractor Name and Compan- Name: Sklllings & SOUS, Inc., Derek Skillings License # 943 Contact Phone Numbers: GG GG Homeowner:Gale Page R`C` Address:288 Stiles Road North Andover, MA SUN ? ap R 978 WN pF No -290-6513 d P MEN Contact Phone Numbers: WELLS(to be completed at time of pump test) Type ofwell:bedrock use,domestic Diameter of well:6" 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: 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 X:\O1May2012\HEALTH\WebUpdates\WordForms\Well Application.doc 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: 1. Submit to the Health Department a site plan showing the house and or lot footprint 2. Indicate any wetlands within 200 feet of the proposed location for the well 3. Indicate the well location 4. Submit a check for $135.00 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. RM PIP z 41' � Imigip F , 4 i � � w s \ k r g rn 3S rn N o, # a p gel r � e r E �� ! 3 i!! EYY�� 1 i; y�Ei�i�� e= ��E �� ; �� B �• � ar �� ICE i�9 E!� �• � �� latl�� 1� i!��;!!n i��a��a�I��I�I��E€�� •` �1 tNORTM'ly V V � � w Town of North Andover ��'•�:, o.= HEALTH DEPARTMENT CNUS CHECK #: 7 DATE: 6.30. dW O LOCATION: /Q5` 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 $ ❑ Trasl{lSolid Waste Hauler $ 1 Well Construction — SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health 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: 1213417 Document: Well Driller Size of File: 362.36K Status of Transaction: In Process Date and Time Created: 8/24/2020:3:21:55 PM 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. R�cF/V 2 6 1020 TOWN O,, v Ir' NF LrHO gTH INoOV� TiyENT R Massachusetts Department of Environmental Protection Bureau of Resource Protection " Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 288 STILES 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 (�Yes t- No North: West: 1 42.63840 71.09988 Subdivision/Property/Description: Mailing Address: 117 click here if same as well location addres Property Owner: Street Number: Street Name: GALE PAGE 288 STILES STREET City/Town: State: Engineering Firm: NORTH ANDOVERMASSACHUSETTS ZIP Code: 01845 Board of health permit obtained: G Yes Not Required Permit Number: Date Issued: VERBAL 07/10/2020 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Air Hammer Air Hammer WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid 0 14 Gravel Brawn 1"3" - r Fast r Slow r YES NO �� Loss Addition WELL LOG BEDROCK LITHOLOGY Loss or Extra From(ft) To(ft) Code Comment Drop in Extra fast or addition of Visible Rust Large drill stem slow drill rate Staining fluid Chips 14 100 Schist �� GRAY/WHITE/ > i^ r r G -JI ADMYe rYe YES NO Fast Slow Loss Addition 100 140 Schist IGY/MWHITE I r r G r Yes r Ye YES NO Fast Slow Loss Addition ADDITIONAL WELL INFORMATION Developed G"Yes G:No Disinfected f�Yes G"No Total Well Depth 140 Depth to Bedrock 14 Surface Seal Type CementlBentonfte �racture Enhancement Fr Yes G No CASING Jr.-,Is Casing above ground? From: 1.5 To: 0 From To Type Thickness Diameter Driveshoe 38.5 Steel (Schedule 40 77:i� r'Yes SCREEN No Scree From To Type Slot Size Diameter ---Choose Screen Type--- WATER-BEARING ZONES L DRY WELL From To Yield(gpm) 65 70 110 120 20 PERMANENT PUMP(IF AVAILABLE) Wire Constant Speed Pump Description Horsepower �ubmersible 3/ Pump Intake Depth(ft) 100 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL/FILTER PACK Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement 38.5 Bentonite Grout + Choose Material = = Gravity WELL TEST DATA Time Pumped Pumping Level(ft Time To Recover Recovery(ft Date Method Yield(gpm) (HH:MM) BGS) (HH:MM) BGS) 07114/2020 Air Blow With Drill Stem -ji25 00:30 I 07I20/2020 Constant Rate Pump- WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured 07/14/2020 10 10 07I20/2020 12.8 Iv 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. COREY Monitoring[M] Supervising Driller SKILLINGS, DrillerDICKERSON Registration# 546 Signature ROGER,B SKILLINGS AND Firm SONS,INC. Rig Permit# 557 Date Job Complete 07/30/2020 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.