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HomeMy WebLinkAboutMiscellaneous - 197 INGALLS STREET 8/24/2015 Town of North Andover, Massachusetts Form No. 1 G NORTH BOARD OF HEALTH V 3�0 6 S"D 646 OL 1 9 O Vi F- 7` k. A ,� APPLICATION FOR SITE TESTING/INSPECTION 7 ORATED PPP 9SSACHUS Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee "' Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 3��y E� 6°���L 1 9 o m APPLICATION FOR SITE TESTING/INSPECTION SA SS Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts F N°ED �6 A Q BOARD OF HEALTH Form No. 1 �O�S.I. �.Y 3 0 1 7 APPLICATION FOR SITE TESTING/INSPECTION ��SSgcHUS���y Applicant NAME ADDRESS A TELEPHONE Site Location /V Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test N o. S.S. Permit No.�l D.W.C. No.. C.C. Date P 44*4 N o. / �° Department of Environmental Management/Division of Water Resources s5 WELL COMPLETION REPORT WELL LOCATION GEOGRAPHIC DESCRIPTION Address i N S E_>W of J r City/Town (feet) (circle) Well owner (road) Address - N IS E W of (m.in tenths') (Circle) Board of Health permit obtained:J yes ❑ no El intersect WELL USE (road) WELL DATA _ Domestic IIJ Public❑ Industrial ❑ Total well depth ft. Monitoring Other__ Depth to bedrock ------- ft. Method drille Water-bearing rock/unconsolidated material: d =;'' 1 19 Date drilled {, .�� Description ati�l / � j Water-bearing zones: CASING r° 1) From � _To Type ,7 2) From To__— Length ' ft. Dia(I.D.) <- in. 3) From To Length into bedrock f.r� ft. Gravel pack well: dia. Protective well seal 1 Grout 1 ; JI' ;l Screen: dia. ❑ Other Slot# length from_to a STATIC WATER LEVEL (all wells) Static water level below land surface ft. Date- WELL TEST(production wells) / Drawdown . ft. after pumping hr min. at _gpm How measured ) i �' `� ` �` Recovery ft after_° `'` hr, � min. i LOG of FORMATIONS COMMENTS Materials From To o i Driller t'PP-7 k coo /,`5' Firm Address r City/Town 'f Supervin� Driller Reg.# r Signature of supery sing registered well driller t Please print lirmly i' BOARD OF HEALTH COPY i I 11 ott50 iyg110 ' to 4 X ^ A P r e 1 4�'a"°»„„��•�cti BOARD OF HEALTH 7 r-,!. ,S '; SS CHU98 NORTH ANDOVER, MASS . a t P,t S APPLICATION FOR WELL AND PUMP PERMIT 1 Permit # Dater',... .., �•. A permit is requested to: drill a well w install a pump C".,. ..q . LOCATION: Lot # Owner,f '�. �� ���� �� ;'�: ....� .. ,rJ Address A���� � � �� �•.��,���.,��,���, (114 14 Tel "17 Well Contrctr ., � t..:� °�> (..1 , Add. r 9 lvi ( , Tel �' °�� ' ° ., Pump Contrctr Add. Tel WELLS (To be completed at time of pump test. ) Type of well �. �, , _�'u •. Use Diameter of well � Size of casing Depth of bed rock :> ;x Depth casing into bedrock Seal been tested? Yes ( ) No (_) Date of test ° Depth of well ' ° Water-bearing rock ( �` Depth to water C Delivers , , - GPM for ' ..� (how long?) Drawdown feet after pumping hours-at GPM 9 Date of completion Signature of ell contractor i PUMPS (To be filled in before installation. ) Name & size of pump Type ) wk-109 ie Size of tank -ap Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic Sleeve used to protect pipe? Yves (_) No ( ) Type well seal LJ Date Signatu of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health CHARLES M. ROLLINS CO. 9788879491 P. 02 12/13/2000 07:40 9786920023 THORSTENSEN LAS PACE 01 66 LITfLETON ROAD,WESTFORD,flA�a 019®6 � (978)992°8395 SAX(97A)692.0023 1-900-649-TES'T Report Number 52401 Report Date: 12/12/00 Client: Sample Information: C.M.Rollim Jim Hartigan 129 Depot Road 197 Ingalls St. Boxford MA 01921 N.Andover,MA Sampled by: Client Date Deceived: 12/6/00 Tate Sampled: 12/6/00 C-ertificate of Analma Test Parameter BEA L' esuits Units Total Colifomt(P) 0 0 perl00ml Fecal Coliform/E.cob(P) 0 0 peri00mi Calcium No Limit 7.0 mg/L Copper(S) 1.3 <0.02 mg/L Iron(S) 03 # 0,94 mg/L Magaesluni No Limit 0.8 mgt% ManganesES('S) 0.05 <0.01 mg/L Potassium No Limit 0.4 mg/L Sodium Sze Note 61.2 mg/1" Alkalinity(S) No Limit 1 t 8 mg/L Ammonia-N No Limit <0.03 tng/L Chloride(S) 250 16.9 mg/L Chlorine No Limit 213 tug/), Color(S) 15 # 25 CPU Conductivity No Limit 336 wnhostcm Hardness No Limit 21 mg/L Nitrate-N(P) 10 0.26 W/L Nitrite•N(P) 1 <0.01 mg/L Odor 3 # 4 TON pH(S) 6.5.8.5 8.5 SU Sulphate(S) 250 15.5 mg/L Turbidity Not Spec, 3.7 NTU Sediment pos/neg Pos. Legends: (P)=Primary EPA Standard,(S)=Secondary EPA Standard,#--Exceeds EPA Limit, TNTC=Too Numerous to Count,*=Background Bacteria Noted,'=Exceeds Advisory Limit Sodium Advisory Limits,Mass.=20,NK-250. Thi$water sample as submitted is considered SAFE to drink according to EPA guidelines_ However,one or more parameters exceeds secondary lisnits as denoted by the#sip, Massachusetts Certification#MA048 r ael P,C rlson,for New Hampshire Certification 9 2734 Thorstensen"boratory Inc. z z ... y CD co E m Z o z o 0 o Z m N CD y � I • a c t to ' p ,•, ... ,: «.i'.r., r,. a u a.,.t., .r..,~<..+. :.`l yy,,.r`.... � 9 w 1 ,..... r :.;t,*.4 k sa.. �r w ;ar.r.. fit,• �x. ��.✓r ro„ ,'"'ry, ���r� , e,..-rEi;� �, ' L f. ark., �4 �„ � ,k.�'�:+ 1 f 'S',,�J�}h?4Y;, �il,w,�",�{$;f�$,yy,,''yy� '.� �k:{,:q.,� '�; a ��d ,t.�.Y v 1.'ro t�"�"�r r b• n ��. '' ,:t 5��,. � r.' .:�a •�i dr. w�Y�F�'i d£�N ys'.;, �.�y 4 �• '..t...5 tY�.Y� .,A. ��}��1���P� ., ,�i't�l/tap Yr �#�` 4 dr I k�(.Y✓��•i}..� '.o-F' �f.' ,4 "N� �T <! f� Zr i� 5, g���"r,,tSNY� 'trk.., [ 4"a�y ,1�t'"t } J,, 1�"�� •.. l�; rr.R,r�+ »..Ytr�: � `y 55'f� . .�,��+ . :. ,�Y ,.J p r 5� Ir" .� .a� t : N �ro{�k ����1�'r ' .`! ��<�";,, �� ,„, rr�. �' 7 YO't��fr«ak 7"� .xu r�'r+��", ,rq ,a 1�,� .^ra�.aa' ?re, r"1""5 �ti'S'r „ai '? l�,, ," •� '' ,q �iY�� .: 1� ,a ..'� �` ���'. x'K k• li�`d'.L f, •?s4� ,,7'. �.a"". r �`� (� !„�' ,�.�+'E.� '1� 7v0.r ri"�.' y':}�'.y�,r�' "M1'(p, T�"n 1 � �4 �, v f,,•✓f ±��. e^t� � v� pr,��n�fx=i' �`}� 1� ,r��°� � b k"'s na,k'ffS d,.1 •a o�" � � .ry, r�� 'i :Y" l t•gfE�.w°ia v,r Y�'p ;�i'i8 �, t,x ,. �t� ,r «• 1��'f ���'"�t�l r t,{d '�,�. 'r;d.., t�a tpy ,a3 �p�pf ..i ro f' FTI O m O ty LD , 3 (7 >F 3HnZZ :r-, UI m hdn00 * r * r',4 -< r,+: �-OWMHH3O 'Y' Cm0Qa N C N ', '1 -. zr Lnx GEC X Z 0 C1-3H3a .'T1 ` C �JO >F t71 N H n" T-6 -u �(7 az05d �d0H a � 0tzl �J n � N � z � T MH3 � •O :r- HZC' Zr "rdH .`d HG) � OOIH () >aw - 0 H � Z t� HU' tmm ;r, 3 U)!4 HH G � Z C CIT.1 `z �° � z+ Ciz0 Q tri Ul m Ul H H H •• m ^ •.d m m •• tt�, w N O0 S 0 7 3 w trJ H FC H :d td FC Z Ul - cn ' rJ _j U) 10 xH H � a � H-� ° ) F3 H H � � 0 �+ y O � CrJxUl b mz X to td H � FC - :x--, lD H v m r- L1. H H a , 7, 40, (!l C71 3 O 01 tri O O Z C7 I Ui U7 Z ° > s Ul H J U) H y r a 3 Ul H e HO, y, U) 3 'TJWli.� H o Nnnor-+ 3FCF- F- W rT1 H Ul ,r�o C • • UI O O U7 O N N CO ZW HH0) F- . . aP • atbrnorr • Z y W z 3 M W Ul O Ii tri • Ul tTj r H H N Q Fd n 0 .. C o 033 0w3333333JQ33 xJG) G� Z G� G} G] G� G7G� Glm � G) G� H zC � H\\ 1 H -.`, C 0 a) • CC H ;dr'' C" Vt-' t'" C'' C^' F'- M r r H W - a O Ul a L co Z a) � o Q r 2 � a LO * H2 xH C H a a Z • to O G) -41, Z 3 a o ul :t:o •• H - u o l[l Hp Z x � CD Z o CD G� o 0 o Ul lT] F✓ o •• o G) o Ul th N Ul W O `' Ul to o C o U) o0 rd o C O o H �+ f C H t7i Z 0 td ;d G2 UI Ln F I w m x Z p u NN a N4, w W W '� Pri W 00 OoUIUIUI ra O l.- CD m C7 0 0 O G J Ui W G1 a Z r W W rA 0 L0 J J J W W W W �+ F� o O H + O ko "R 6Ry 1 qb I YOUNG'S WATER ANALYSIS DRINKING LABORATORY c . CERTIFIED Quick Results, Sample i k- Pelham, d. ( 03) 898-2504 F11030` 3) -132 Laboratory Numb r: 4031A Sarnple Cate: 12-F-90 Submitted y: Mr. James Hartigan Sample Source:�_ Ingall Road. North Andover, MA Analysis: According to the � EPA results Your results Total Coliform . . . . . . . . . . . op x?er . 100 mcr/1. . . o per 100 ml 250 mg/l Chlorides . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . ® . . . 121 mg/l.. 6. 5 to 8 . 5 mg/1 lll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 49 Hardness . . . . . . . . . . . . . . . 150 mg/1. . . . . . . . . . . 108 mg/L Manganese . . . . . . . . . . . . . ..•.05 . . . . . . . . . . . 0. 10 mg/L ** Sodium . . . . . . . . . . . . . . . . . . . . mg/1. . . . . . . . . . . 38 mg/ ** 0. mg/1 Iran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0. 9 mg/L. 10 mg/l Nitr to . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . 1. 0 mg/L 10 mg/1 Nitrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 mg/L Arsenic . . . . . . . . . . . . . . . . . .05mcr. . . . . . . . . . . . . . ® . 0. 01 Comment: * The tested parameters meet current primary standards for drinking water, but exceed somesecondary parameter standards . ** Denotes parameters that exceed. secondary standards An iron and manganese filter is recommended.. ki alyst Vv C nartment of Environmental Management/Division of Water curces - WATER WELL COMPLETION REPORT WELL-LOCATION Address City/Town f ' G.S.Quadrangle Map Grid Location Owner Address WELL USE CONSOLIDATED WELL Domestic❑' Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones 1) From To Method Drilled 2) From To Date Drilled 3) From To 4) From To CASING Depth to Bedrock Length Diameter Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fine❑ medium❑ coarse❑ Date measured Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot` length from to Yes ❑ No ❑ Split Screen (or 2nd screen) WATER QUALITY TESTS MADE,, Slot# length from to Chemical ❑ Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. , How measured Recovery feet after. hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 lb DRILLER m o Firm � Address City Registration No. Operator's Signature !ase print rrmly RO RD Or HEA —1-H GbPY 2559.10.85.807101 i YOUNG'S WATER ANALYSIS DRINKING WATER CERTIFIED ,-f 1 Quick Results, Sample Pick-Up Pelham, Rd, ( 3) ®2504 Salem, NH 03079 ( 3) 898-132 Laboratory Number: 5075 Sample Cate: 12-3-90 Submitted Fly: Dir. James Hartigan Sample Source: new well / lot#4 Ingalls Road N. Andover, MA Analysis: According to ,Standard t Methods t r Wastewater Analysis, 15TH fd, - _ FPA standards your results Total Coliform . . . . . . . . . Q. pier .19on mg/1 . . . . . 0 per 100 ml Chlorides . n . . . . . . . . . . . 25.0. .mq/? . . . . . . . . . . . . . 46 mg/L 6 P . . . . . . . . . . . . . . . . . . 5 to I . . . . . . . . . . . . '. 9 Hardness . . . A . . . . . . . . . 7.5. .to 150 ma/l . . . . . . 123 m /L Manganese „ , . . . . , . , . . o..05 .ma/.l . . . . . . . . . . . 0. 07 rng/L Sodium . . . . . . . . . . . . . . . .2,0. to, 250. mg/l. . . . . . 12. 0 mg/L 0. 3 ma/1 Iran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0. 5o m /L Nitrate . . . . . . . . . . . . . . . . 10g/ . .. m . . . . .. . . . . . . . . 1. 0 rn /L Nitrate . . . . . . . . . . . . . . . . .10 mg/1 . . . . . . . . . . . . 0. 05 m0/L Arsenic . . . . . . . . . . . . . . . ...05 mg/.1 . . 0. 02 Comment: The tested parameters meet current primary standards for drinking water, but some secondary parameters exceed sta.ndard.s . * denotes parameters that exceed secondary standards , DOES NOT FAIL TEST Arialyst I RCH ASSOCIATES f ENVIRONMENTAL CONSULTING, PLANNING, & WATER ANALYSIS 26 FENNO DRIVE ROWLEY, MASSACHUSETTS 01969 (508) 948-2449 DATE : 9/7/90 INVOICE NUMBER: 1983 PO ri 014 Jim Hartigan to Appaloosa Lane Hamilton, Ma. 01936 WATER CLASSIFICATION : XXX THIS SAMPLE, FOR THE PARAMETERS TESTED , IS DRINKABLE ACCORDI=NC; TO STATE AND FEDERAL PRIMARY CRITERIA FOR DRINK.I_NG . SAMPLE INFORMATION : sample taken by above. (late : __9/4/90_ sample type : well faucet_x_municipal rnew sell swimming pool _raw surface other__ SITE INFORMATION : Lot `4 197 Ingalls No . Andover , Ma. BACTERIAL TEST INFORMATIONN : a.l_iquot tota.l,k ml co1.iforill bacterial results - stated as 50 0 number / 100 rill *Standard - 1/100 ml - Water quality may change quickly . If you notice an odor or staining , do riot hesitate to call us . Mass . Certification nHA096 # rx r ,.,,, .r a ' � �,r y"' ✓ r r' ,c�. 5� � -z'r.;Y"� �'°€ wry :�,Xg�i�s ��.;.. .�. � rK- .: ^? � n f r � �: .� .r` r � z y,s'✓ e .r t` ,�"�,'' mss; �' ; ��'�..-'s �k' �j � � x r � � srm�� -4.?r r ,� h fin• � „�,� ,5,"fk. �F.;� �,.��a``#s��'�'G ��'�,,� �``tf"k1x,3'"q,-�° �a.-„ s" r. 'T.�' ""x'r,�r^✓�- .� a 1f =y .�, "," 3�� �sr'"�..ru'�'.�� f'Y-§'' s a� �r. e = m , M { m n O � n �E � Hnzz � Ul �' pyFilnyO �F C � s ,,. G] C x zGC �3F3 � CJ 'z1 � r z 0 x [TJ x H `H CD0CD0 zn clzoinao0H h � om � n z x1N � :U m� x � ® � C�7H :C1 � Hz � zr x1 H �d yG) OCSIyn >� W — L7 - H � [TJ C7 CrJ [rJ ,n U) HH Q :o t4 r r 171 z x 9Z O � `I O O �s U) H y y •• t=] xJ m to •• 'w °' 0 0 = CrJ y Fl, H xJ tr] FC z N a� � z cn — 0 g� F4 z :U FU z x [n o -1 z -n r+ [T] n C O G O Cn D x1 > x � n m o C� T, 20 H y C1 z H ? � -i C, 9 z z CTJ '� o -vP m �! !.co C UNiO 0 < ytyT1 = D � � F-3 'Y x 0 :ro H 0 3 � CrJ x (n N >> x (!l Cr] rT] :o FC � Ln m � H y y u H �o H D o H X •I Lo m z n ° A r! w y > P° (n3 Ul � n �J W oNnnor+ 3FC --1 W m ' H - Ul ,ty r • UI O O Ul 0 N N • • _ CO Z W • H H 0) • • • C7 U7 M C) F- • z y W z3mW LnCD C17 • VI r H H N x Z y > Q ro n0 � r ° 033 0z :KXX3333 z33 z zG) Q z 0 0 G) 0 a 0Q0'') :r Q y zr � y�� (A H���-1��'-, I y�,�- C O O � • r r H o r r r r r r r - M r r y x [T1 z 0 O H z x H G Fl H C7 z 0 z 3 d o • z x O� z o C Q 0 0 o Lrl C� F1 0 •• 0 G� o y F� v ; O Ut y o �• z o 0 0 1 131 • o \� o� C Ut [r� N Ul W O O l0 r Ul to o r 0 U CD r� 0 r O o H E (A C H � z o Ul m � n U7 H tD N N C) N A W W W Ry 'T] W 00 00UlUlU7 ,o O rONO W o 00 O o � LiLiCD U1 of LOLOiP- 0 w Z J v J W W N W y k F•1 ° C) y a) off + 0 z 0 i. r x: HORTN O t FO p I ��s''+,,,o.�•'`h+ BOARD OF HEALTH '7 -7 G►-3 r 1�s S�. ,SS^CHUS�S NORTH ANDOVER, MASS . o I pti S y APPLICATION FOR WELL AND PUMP PERMIT Permit # Date / 2 o A permit is requested to: drill a well install a pump LOCATION: l �"r�✓�, { �"r° Lot # Y � pp " Owner` ^ S i4t- Aq0LT-\ry q YJ Address `� ! VV( 14 Tel (17F - -?7 Well Contrctr C: 0. 00 C` , Add. l3`1 I�VT ��� . Vv(yi, Tel 7 1 S"O-Z`3? Pump Contrctr (A U4rt'e_ Add. Tel WELLS (To be completed at time of pump test. ) Type of well Use Diameter of well Size of casing Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well Water-bearing rock Depth to water Delivers GPM for (how long?) Drawdown feet after pumping hours t GPM .1 r Date of completion ���`' _ C"� �- Signature o 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 well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health W ^ V. I NO _f 4 . I , , � � I ., ^mac r > 17 k w 'j)� 'r' f v ` r' 3 - U { E Q f 319 t ' i 4 } :: y a' I o ..d ,8.1►?'=. /z/-o 7 �1L�A�F /N ,t�lf�/t � � F/N�S6j E )i F f i ! i l i { .L U i �� �► ry n s 1 i r'V � �'•����a @� y+.'.'�SC.'A 4n.°*,t Via'.'? Fo RL5i SIt:&F"F' i- a .:.x....vd•�.u•.w+a..avmv..a.cu,mw+w�rv�wx�v®r--..wvsa�r:+wW+�w YUi.vsas"'awaY� PV' Wdi�"""w'W'v�A �• v,.�wJFti^"" � -�•.ua+w •.,Jx•� ,y ... awl ,•., . f 1 I slvj,eq` i i It r v� I oX /A/ _ lI _ ��c;� ?� � t.-�. ./_. / 1.! . � U •', (z f, ��- ��X6.1 ' � { r TOWN OF NORTH ANDOVER. SYSTEM PUMPING RECORD s� ^� DATE; M !„� nth el�t}�.d�d ,• SYSTEM OWNER&ADDRESS SYSTEM LOCATION (example: left front of house) 44, , a� DATA OF PUMPING: QUANTITY PUMPED GALLONS CESSPOOL:OOL: NO YES SEPTIC TANK: NO YES .a,. � +� iI I If'j6 Ir�,Mti 1�Fi �'',1� A 1 I .. I r, - ,... �, �. ✓ NATURE OF SERVICE: ROUTINE. EMERGENCY f � 1 I �$SEItVATIONS. ” `!"GOOD CONDITION FULL TO COVER F � HEAVY GREASE BAFFLES IN PLACE ROOTS ' LEACHFIELD RUNBACK I EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) YSTEM PUMPED BY: C/f av I A t !QMMENTS• � s 6 R�m,✓,� �,...� �� JIEJ'f to p q 1 r, 11F d r Mi ;� , R�4�ITSFER.RD TO: j ,�: A ,f , Aa-,� � h I 11�a '