The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 303 BERRY STREET 1/4/2016 (5) BOARD OF 1-11-- ALTH Town of ',North Andove r Ha S S L t: r# Dote 19 APPLICATION FOR WELL & 1UHP PERHIT Lcation is hereby made for permit: to drill a well Application is to install (—) a pump, system". :ion : Address /0 y- Lot V)A V ;X Address .a^ � (t(y�) Contrac tor h2w./OA 5"L4r es s r Contractor Address Tel . CONTRACTOR ( To be compleLed at time of pump t:c s t: of Well Well used for -ID e-- !uer of Well Size of C*asl,ilg_ Go �5k i of Bed Rock Depth casing into Bed Rock ;eal Tested? Yes /\/X) No Date of Ter' Ling 9, C? Well Ended in W11;1-t. MaLerial ovl- i to Water Delivers Gals . Per Hin . for 4 hours ]own ?0- feet after pumping hours, at: G PH of' Completion Signature 1• e 0 11 rrl ctor INSTALLER ( To be'- filled i.n- before installation ) Pump Ty 1)e U s e d & Name Pump /V Pump Delivers GPH Size of Tank Material Used in Well : Cast Iron I'lascic Pic or Pitless Adapc6r (,X) leeve used to protect pipe? Yes A NO (— Type or Name Well Seal Z-E e Water analysis repbr-t:. submitted to 1joard of He' altli- release given LD owner of record & Bldg . Insh lleaLth Inspector 1 BNOMENrIne 16 RA$T MAIN STktT, P.O. DOX 1153,GLOUCESTER, MASS,01830 j TSLEPHONE: (60@)281.0222 PAX: (508)283.3374 f Certificate 11 E. Pr"Cou Ca, Inc, iO Sax= Report Nos 24693 DOW, NH OM July 11, loll W®4er Anal al>� Rt1f1�1� ' ,, 1 S��ple o , delivered by the United paroQ) �prvlvo n July 10 199; TOW 04Itform Bacterial Count W, loo rnL MP) p 0 � edltt�i�nt(N'Pt.l) 1 1 Color(AF'H,q Unite) " 1 None detected - Odor , 1& 1 l . . , 1 / , , ; . , 1 1 , , Nor)* dotaat�ad - PH VWuo ' , . ' : 1 7,69 Sliphtiy Alkaline Akbllnhy Gontant (CaC , m8/L) ; . , , . . 80 100 I�Iard ( mil ► . . , 1 1 93,4 Modorate ft m ContarA (111 , ' • 1 1 r r f 1 . fi�.M 160 SO4lum COMM ( L) � � 1 . . 1 aas/A �!y��,,, �y,,`'..y,.yyyy /4� 1 . 1 0 , . 1 1 Y i t� i P"i uumlu t1 Corte ) , , ,• . ♦ 1 1 1 ' Ire tat (mg/L) 1 . 210 0113 0.3 MI�r�Oat:4 Canten4 (m1L} . , . . : : ; 0.15. -Mato Co►�nt (r�L) / 1 . 1: 1 . 1 1 o.o¢ Chlorl+�Go�nt(mfr`} � 17 26a 1 1yygq 111 . ! b • 1 t 1 1 of � 0 �0ll1/ 1 1 . 1 1 . . 1 290 ' Yom Do S*Ilda r illty Infix (gym Cja ` ' 1 1 1 141 boa Y1 Gorda Nitrogen lightly Corr the on Carrt�t (m�/L). . 1 <b,02 0,1 , Mira@ Nit�gen Content (rng//I-1 1 . . ! ! 1 . , 1 "c0.1 10 Nttrltd P b"On CQtttent (mD&) -K0,02 110 Copper C"mt (MAY, i ! . . . 1 <0.02 110 mfr Analym portwmed in'aocordanae with Btandard Methods for the Examinstton of Mater & WmIl water, 17th Edition, ism, "cQuldellnea are baiwd on the rocomrhmndod levels of the US Environmental Ptateotlon Ago6oyle 310 CM R 22.C)Q, "prinkin0 Watar peyulations b TWO mpie W fovn to be free of po11u41orMndioator baatarla; howaver, non- aw"m ao-torla were datocted, If off-odors or off4lAvom dmmlop, chlorination and roteaung Ia rocommonded. Tho elevated Manganese leval detected may be reeponalble for nuleanoe staining. John Mwlolt JMldn Lab Moot or E p pn 1ry � l i'A�Pi 6.ri�f'�ir R^Y!1 RA Itif1 Y^uT lh riw.,n r.IA_- t'A BOARD OF HEALTH Town of North Andaver ,tlass Date i L 1.9� _ APPLICATION FOR WELL & PUHP PERMIT permit to drill a well ( ) . Application i„s PPi� cation :i s hereby made for p — "nade to install. (_) a pump system'. . . Lot .ocation: Address �)w n e r 'L/ A d d r e s s Tel . Contract, icl . ;. G Address m 'J e 11 °°. �"� Pump Contractor Address . X fe1 . I WELL CONTRACTOR ( To be completed at time of pump test ) Well used for , j J""I' e o f Well �� e �µ. ,.�. , f��,.. Y P � Size of Casing ' Diameter of Well ;- ,Depth of Bed Rock Depth casing into Bed Rock Was Seal Tested? Yes (®) No (r) Date. of Testing 'Depth caf �rell — lJell Ended in W11a.t. Material Depth to Water_ Delivers Gals . Per Hin . for 4 hours hours- at GI'M Drawdown feet after pumping -- Date o f• Comp 1 e t i o n — Signa -ure 11e) l ntraccr°W .'. ,�,- :c', r, r, r, r. ., r.:c: :c-�••. ,, n n n n n ,. ..;::. ,, n•�_�,�.��r�-"� -*n•�rf�k PUMP INSTALLER (To be-- filled i.n• before inst �l.lation ) Pump Type Used Size & Name Pump -._.- ------ —_-- Water Pump Delivers _GPM Sire of I'anlc pipe Material Used in Well : Cast Iron ( _) Cnlvr�nized (_) Plastic t _1 Well Pit (_) or Pitless Adapter Was sleeve used to protect pipe? Yes (_) NO( _) Type or Name Well Seal_ Date T ___'-►SfP,ma.(:L1X;C.:.I.'. .(�C �4�rit74'i4�r�'cy'�r4�'��rti4��'r�'r�4�4ti'��4�`��4�4�4ti4�tti4�4�r�'r�rr4�Yti't�'t�r�4�4�'t�4�t�r�t�rti��ri;,;,;•,,,c,f,<tif,., ,c,;,;;c;;�,:: , , ,f Date �-)ater analys 's . r'epor-t 'submitted to Board of of Beal'(" D6 _e release given tD owner of record & Bldg . Insp Ilealth inspector ,in,nun am, qw mmn N NV am bry 9n^mq.f Ol@N mwkpJR' NY ....._ .. s �,.aE r,,,�....v,at .uwa�ow5mvw�,nr✓' sal;mrcGu+m�N�a'.kf+m�"u �+'uar�w�Gw'r�wwv3°�- ' FEE NUMizFr� _2.5_��Q_ l Zj THE COMMONWEALTH OF MAS5ACHU.ETTS — NORTH ANDOVER TOWN ............................... This is to Certify that ............E...M...... Q:L1J;1�J. ....................................... NAME Road, Salem, N.H. 03079 .................... 36 Pelham ............................................. ...................... IS HEREBY GRANTED A LICENSE Permit .............................................................. For ......... ......Pump...........,.............. .........., ................................................... ........................................ This license is granted in conformity with the Statutes and ordinances relating thereto, and 19.9.1..............unless sooner suspended or revoked. expires..,.,�eoemb.e.r...31.,-... D . � /........' .......... .......... ........................... ... . ...... .... 1,r. ...... 1::: � ... .19.9 . . , .. .... ..,......... ............may...3.0......................... ... FORM 433 HOBBS & WARREN, INC. t ^.. - I N�' i1 A7 '.." "RIP, yd FA yrai''� ,. fr�� vf � . i i , 4 ;r ^ � � ,.,,, 1"^nau vn",AN:!!.,:W,aww.t..(o.,:.f,:.✓/e.a°du7 mr<e'd:3'Viarc�W,4wr�;,wmtluw ' v Y PELHAM BANK AN 0 TRUST APANY t PELHAM-WINDHAM-SALEM,N.H. o :00 m x E mm ou m r i ❑ � Z S ❑'�'D •] W a to o mi d3 ru w �I Sri r o N h o FA . � I I, C/) - � .� °nns�nL ns�nU��'-�;is.,:,�T��:usc^�.a:.mim-- ._nacssrcum'�•!,; Commonwealth of Massachusetts W City/Town of North Andover . r System Pumping Record [,AVr, D Form 4 DEP has provided this form for use by local Boards of f rms ma b used, but the 1t a Ar ro information must be substantially the same as that pr � s form, check with your local Board of Health to determine the form they use. �eoo d mus t be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: ," ✓ w , ,., . When filling out System Location: forms on the computer, use only the tab key Address to move your No.Andover ma 01845 cursor-do not City/Town State Zip Code use the return key. 2. System Owner: to Name Address(if different from location) i City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date( Gallons 3. Type of system: ❑ Cesspool(s) peptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 77/'Pumped y w Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewa t' Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 i na re of Hauler Date Signature of eceiving Facility Date r t t5form4.doc•03/06 System Pumping Record•Page 1 of 1 . a Com, monwealth of Massachusetts I City/Town of NORTH ANDOVER, MA H TT ,K", System Pumping Record L,rOWN Form 4 t�NIRTt�t ANt� vER Auaq OSEEART ENT DEP has provided this form for use by local Boards of Health, s em umping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1, System Location: forms on the computer,use only the tab key Address to move your rsor-do no usse the retut u m City/Town State Zip Code key, 2, System Owner: mm Name Address(If different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping F h 2. Quantity Pumped:Date y p Gallons 3, :Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank Other(describe): 4, Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5, Condition of System: t ' w 6. System Pumped By: ame (Z� Vehicle License Number Company 7, Location where contents were disposed: Sig lure auler Date http://wvnv.mass.gov/de ater/approvals/t5forms,htm#inspect t5form4,doc 06!03 System Pumping Record-Page 1 of 1 i Commonwealth of Massachusetts City/Town of No andover System um in g Recor Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location; , • on the computer, �°"�"° -� � • ❑� use only the tab key to move your Address cursor-do not No Andover _ Ma use the return City/Town State Zip Code key. 2. System Owner: V UM Name renm Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: °W' Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4.� Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: i i 6. System Pumped By: Name Vehicle License Number _Stewart's Septic Service Company 7. Location where contents were disposed; Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature f a r Date Signature of i ng Facility Date t5form4.doc-03/06 System Pumping Record•Page 1 of 1 1