HomeMy WebLinkAbout- Permits - 480 Boxford Street 7/26/2021 • y`�TI,ED l6y� .
•
•
PUBLIC HEALTH DEPARTMENT
Town of North Andover
Community and Economic Development Division
480 Boxford Street
aka 500 Boxford Street Lot #1
Map 105.0 Lot 42
As of. August 11 , 2020
Is hereby granted a:
Well and/or Pump Permit
To:
George W. Rollins
Charles M. Rollins Co., Inc.
Contact Phone: 978-887-2320
Owner: James Peters - Peters Construction
Contact Phone: 978-479-7845
This permit is granted in conformity with the statutes and ordinances relating thereto and is
restricted to the above address.
Stephen Ca, , Jr.
Public Health Inspector
120 Main St.,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov
TOWN OF NORTH ANDOVER
��wel) Community & Economic Development
RE ,G HEALTH DEPARTMENT
? 2dZ 120 Main Street
�uL tC RNORTH ANDOVER, MASSACHUSETTS 01845
OF NOi�v0
978.688.9540-Phone
978.688.9542-FAX
healthdept@northandovenna.gov
www.northandoverma.gov
Well and/or Pump Application
(Please print) (� DATE:: 07/23/2020
LOCATION to Drill Well or install a pump: GOO `,O �OC U J'��e��' CL 6*#�
Licensed Well Contractor Name and Company Name: r\S
C\00-�C- ke 9Z en c .
Contact Phone Numbers: 9-7'R, g R 7 _ a 35 3 O
Homeowner: VQA Qx S C cir\ ]A-C 0CA koy) - J a yr e S Pe�eC S
Address:-Y. O- g >.x G33 . J-p-wKs6t)ry , MA O I OI G
Contact Phone Numbers:
WELLS(to be completed at time of pump test)
Type of well: '?S edr-C;C K Use:
G1( i/ 6 /
Diameter of well: Size of Casing:____
Depth of bedrock: Depth of casing into bedrock: S
Seal been tested? Yes( ) No( ) Date of test:
Depth of well: Water-bearing rock:
Depth of water: Delivers: GPiYI for:
(how long)
Drawdown: feet after pumping: hours at:
Date of Completion:
Signature o' ell Contract Kr
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
Dale water analysis report submitted to Health Department:
Plumbing Wiring Inspector Health partment pr, entative
S:\Health\Permit Applications\Well\Well and of-Pump Application.doe
O s
Town of North Andover
.. HEALTH DEPARTMENT
,SSACHU`+t<
CHECK #: 2-7�90 DATE:
LOCATION: Y& A:�, .Lrd 24 Ai
H/O NAME: /e / - Cx,0 S�ZuGhO4 .ems
// I 'is
CONTRACTOR NAME:,_,'/lazZe5- /V. �/����Ca„Lr
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 $
O Septic-Design Approval $
❑ Septic Disposal Works Construction(DW0 $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
❑ Other:(Indicate) $
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
•�i !EF .tt+.[ S7 RFSUt.TS '
• s
w
- ` -
,
� rt aa.'t-a. , �•. � -., .. �� � }j LOC(15 AIRfY
r r t
wre.
,
<� 11
S. a LOT
w
Vn '
• IW,iM.L liNdigt
• ~ � �'• .._�___' s ...,�.... _.
.._—_._— ..
PLAN Awu r•,i .. , ... ,
,rew,.rc eet _ ro PLAN SHOWING PROPOSED SJOSURT'ACE
m x;� SEWAGE MPOSAL SYSTEM LOT t
„-��r.Y�x:.;-ca+v:.. �-rea.rwr•,r,aFerw�s :wn ',
)P l H
,n t .ttL , 4 !t..av x.♦ ee S+r c tROb4W_J.�ti�.. ..
11 1 r.
andover a
Fdt>;KIS �IbTATLPti ft}L E ,IFIAII_ ina _.
MY BALE SILTATION BARRIER Pf!A/L RECEIVED
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT