HomeMy WebLinkAboutMiscellaneous - 197 INGALLS STREET 8/24/2015 Town of North Andover, Massachusetts Form No. 1
G NORTH BOARD OF HEALTH
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,� APPLICATION FOR SITE TESTING/INSPECTION
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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
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APPLICATION FOR SITE TESTING/INSPECTION
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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
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APPLICATION FOR SITE TESTING/INSPECTION
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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.
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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.#
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Signature of supery sing registered well driller
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Please print lirmly
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BOARD OF HEALTH COPY
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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.
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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
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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
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YOUNG'S WATER ANALYSIS
DRINKING WATER CERTIFIED
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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
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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
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��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
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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,
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DATA OF PUMPING:
QUANTITY PUMPED GALLONS
CESSPOOL:OOL: NO YES SEPTIC TANK: NO YES .a,. � +�
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