HomeMy WebLinkAboutMiscellaneous - 187 Ingalls StreetBOARD OF 1-11"ALT11
Town.of North Andovcr,Mass.
....._. Date �d 19'x_
'ermit� w
APPLICATION FOR WELL & I'UMP PERMIT
PP
lication.is hereby made for permit to drill a well (_)• Application i„s
rade to install (_) a pump system.
q I&
..Lot # 'y• ..
Location:. Address �d9 —L,4IS
//�/ "fcl.����,�'G�
wner n AAIZT/ C-s,P9��A Address
c Acldress�_ /�,,� �e� rel
hell Contractor -,C � /orJNC3' U/��G� /-�
?ump Contractor
Address s� �l� Tel.
'aELL CONTRACTOR (To be completed at time of pump test)
t1 -sed for _160i�es/��
Hype of Well -
Diameter of Well Size of Casing
S
/�f Depth casing into Bed Rock
Depth of Bed Rock q
Was Seal Tested? Yes (lei No (_)
Date. of Testing
of GJell — -
Well Ended in What- Material Cel? e.
Depth
Depth to Water_ %
' 1)eIivr'rs Gals.Per Min. for 4 hours
g
feet after pumping hours- at ,�.5 GI'M
(Drawdown P P _ -
(Date of' ,Completion
C —
Si-gnature 11e ontr ctor
PUMP INSTALLER (To b'e'.f.il.led in before tal.].ation) 3 Pump "type Used -9-1,6
(Size & Name Pump /_�/_—_//I
Water Pump ---
Delivers„I GPM Size of Tanlc --
yV —�
'
Pi e Material Used in Well.: C:nst Ton (_
) Cn) v;,rii zcd (_) Plastic
P
Well Pit (_) or Pitless Adapter (�
l Sea
Was sleeve used to protect pipe? Yes (_) N0) 1.yPe or RWelo l
Date /o Y G�
T
D
rtihrr�
�*�t*�F�'r��i�C�4��i4�4�4�4�r�1r�M��C►4�M�4�'c�t�4�t�'r�4�'t�'r��r�M�4�Yiv�4�4�Yti4�'rti'rt'c�'rti'r5`r;;;';'.:.;;:,c,c,c,.,,c•.,:. �,—::
Date Water analysi's.report 'submitted to Board of lleaith
'Date release given tD owner of record & Bldg, Insp
Health Inspector
JAMES HARTIGAN 8i90
i.: 15 APPOLOOSA LN.
1367
e' SOUTH HAMILTON, MA 01982
} >> q 53-7043
2113
PAY TO THE
ORDER OF
s BANK FIVE
i FOR SAVINGS
Arlington, Massachusetts
FOR
. 2 L 1370435. 79 95083 26 Is L367
DOLLARS
_,.NUM2F.R FEE
112 THE COMMONWEALTH OF MASSACHUSETTS $25.00
TOWN of NORTH ANDOVER
------------------------------------------...---- .......
This is to Certify that ..... james_--Hart.gan------------------------------
NAME
15 Appoloosa Ln., So. Hamilton, MA 01982
ADDRESS
IS HEREBY GRANTED A LICENSE
For-----------.Wel..._.Construction___- 187_. Ingalls St. _ -_° .
------------------------------------------------------------- ------------- ........... ...................
-----------------------------------------------------------------------------------------------------------.......................................... ---.....
----------- ---------------------------------------------------------------..................... -............ ---.............. ........... ..................... --.-
This license is granted in conformity with the Statutes and ordinances relating thereto, and
expires... ... September- 17,___1991 Unless sooner suspended or revoked.
--------------------------------------------------------------------------- ---------------
.... Septembe-r...1.7..,...............19..90
------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------
--------------------------------------------------------------------------- ----------------
FORM 433 HOBBS & WARREN, INC.