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APR-28-2005 11 :41 AM CHARLES M ROLLINS CO . 9:78 t
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66 LITTL TON ROAD, WESTFORD,
666 (07 8)
part Nu 91156 4!21
CRA (,d mmwL14m 2A77 Turnpiko 5t,
20 jeff0mo St.,Suite 105 N.Andover MA
MA 01887
gmplod by: C.M.ROBIN
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1 sA cNU t NORTH ANDOVER I MASS 5
APPLICATION FOR WELL AND PUMP PERT
Permit Date
A permit is requested to : drill a well ins
LOCATION : Lot
owner Address
Well Contrctr ,Add. " Ml
Pump Contrctr � Add.
WELLS (To be completed at time of pump test . )
Type of well Use
Diameter of well Size of casing
Depth of bed rock 1 ZL Depth .casinlg into be:
Seal been tested? Yes ( ) No �) bate of test_
Depth of well '- Water-bearing rack
Depth to water
Delivers GPM f o.
Drawdown feet after pumping Y hours at
Date of completion
Signatu 'ye of
PULPS (To be filled in before installation . )
Name & size o f pump . ;t TYl
Ox P-4
Size of tank 2,5- ) Pump delivers GPM
Pipe used in well : Cast iron ( } Galvanized (�)
Massachusetts Department of Environmental Man
Office of Water Resources
TYPE OR PRINT ONLY Well Completion
..
EL -" At OPS iQPTI7NAL) LAITUD
Address at Well Location: ':-.. 7� :y- � �/ ';� � t Property Owner: `4 .. .._,
Subdivision Name: Mailing Address:
City/Town: %r- ` 1' f�, . � r ..{� �.y J) City/Town:
.
Assessors Map Assessors Lot #: NOTE: Assessors Map and t
Board of Health permit obtained: Yes ( Not Required ❑ Permit Numk
P.W EE . P
-New Well ❑ Abandon E��Domestic ❑ Irrigation
❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal
❑ Replace ❑ Other ❑ Industrial ❑ Other
.!WELL 16.0 Unconsolidated Consolidated 6. SIT
LlJ Permeability
Q
c�
From (ft) To (ft) High Low U "' U) other Rock Type
P j i r,. f
f, L.
WELL CiTtCTtN CtN
Total Depth Drilled ' , `rj._ ,... From (fit) To (ft) Casing Type and Material
Date Drilling Complete C. 310
. n SCREEN
From (ft) To (ft) Slot Size Screen Type and Material
FOR FI TER PACE l GRO.UT l ABANDONMENT::MATERIAL
From (ft) To (ft) Material Description Purpose
e ELL T ` T DATA (PRODUCTION:WELLS) . .
Yield Time Pumped Drawdown to Time Recovery to
Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (Ft, BGS)
08/14/2003 11 : 26 9786920023 THORSTENSEN LAI
66 LITTLETON' ROAa, WESTFORD, MA 01806 (878) 692-8�
Report Number 75761 Report Date; 8�1
Client: Sample lnfonnatior
Joseph Casey Lot 66 Turnpike Rd
65 Fcdcxal St. N. Andover MA
W ilrnington MA 01887
Sampled by; CM Rollins Date Received: 8/12/03 Date Sw
1
Test EEA . ults
Total CoMO= (P) 0 # 10
Fecal ColMMV B,coli (p) Absent # Present
Calcium Not Spec, 115
Copper (S) 1.3 0.03
Iron (S) 0.3 # 1.7
Magnesiurzt Not Spec. 11.7
Manganese (S) 0.05 0,05
Potassium Not Spec, 3,1
Sodium See Note 82.8
Alkalinity (S) Not Spec, 103
Ammonia-N Not Spec, <0.03
Chloride (S) 250 # 358
Chlorine Not Sped. <0102
Color (S) 15 # 150
Conductivity Not Spec. 550
Hardness Not Spec, 335
Nitrate-N (P) 10 0.73
Nitrite-N (P) 1 <0,01
Odor 3 0
pH (S) 6.5-8,5 7,7
Sulphate (S) 250 19.3
Turbidity Not Spec, 37
Sedb)ient pos/ncg neg
08/19/2003 09: 18 9786920023 THORSTENSEN LAB
66 LITTLETON RC)AD, WESTFORO, MA 0188 (978) 692-8395
Report Number 75889 Report Date: 8/18/0
Client: Sample Information:
Joseph Casey Lot 66 Tu mpike Rd
65 Federal St ITT, Andover, MA
W 0111 11gloil. MA 01887
Sampled by; C.M. Rollius Date Receivdd: 8/15/03 Date SamP
Certificate of Azalymi5
Test 177eter -EPA Limit &"kl
Total Cobf0j m (P) 0 0
Fecal Coli:Form (P) Absent Absent
�:.C,0 Absent Absent
This watcr sample as subxrdged, meets all State, Local and Federal (EPA) requitvwen