HomeMy WebLinkAboutEast St. #211 - 8/17/1999APPLICATION FOR PERMIT TO DRILL WELL
Name
Address r� ( ( ( n � i S I rr ('--- F
r e �ur7
Registered ) ��_
Well Driller rA li'liay,\�
Address —P0 604, 6_6 8 (1066rl h r kP r
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (for irrigation of land in the business of agriculture)
Fee: ✓Domestic $ 10.00
Date:
Industrial/Commercial
Applicant
00.00 N/C
6r&)
PERMIT TO DRILL A WELL
The above application has
following use at �2 j
is granted to drill a well for the
Domestic Potable (for household use)
omestic Auxiliary (for watering, pools, etc.)
—Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Ag 'cultural (for irrigation of land in the fn s ' agriculture)
Date: (, Approved by:
F ?e Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected
Upon installation of well, call Department of Public Works office at
261-7331 to be added to well list.
epaOment of Environmental ManagemenVDivision of Water Resources
D
WELL COMPLETION REPORT
WELL LOCATION -.
GEOGRAPHIC DESCRIPTION.
N S �E' W of
City(foet I
y Well owner �T t9H t't < p�! )1'[f(fiUt h1-1�N7-i9
)W,I . (road)
Address �� ��l
imr in tenths) �/ $ (rcleW Of
intersect. w/'_�✓��)� ��'
9
1-:ard of Health permit obtained: yes Q1 no ❑
Be
poad)
WELL USE
WELL DATA
lni
Domestic [I Public El Industrial El
Total well depth ft.
Iclonitoring ❑ Other, " r 4 i^r-Depth
to bedrock r) C) ft.
Water -bearing rock/unconsolidated material:
_
Method drilled-tt �f
Description S)'1Ll�i,
Date drilled ^.3 ` �' 0L)
Water -bearing zones:
1) From I (� To I) O
CASING
-:: S 2' l
2) From I _ `- To U`l7
3)From To
..TYpe..
Length (n� ft Dia(I.D.). (0 in.
Length intobedrock a 5 ft.
Gravel pack well: dia.
Protectivewell seal:
dia.
Screen:
Grout ❑ `. OtherrVl lY lyt ly
Slot# length —from _to
STATIC WATER LEVEL (all wells)
` static water level below land surface—[_�a ft. Date
' W ELL TEST (production wells)
,, prawdowp: (T�; ft. after pumping hr.Xt min. at gpm
Hlw measured n.. --Recovery I C after_ hr.__!r_min.
LOG of FORMATIONS
COMMENTS
0
Materials
From
To-
N l C�IU 1 1 V3ti )Y
Driller
A & W ARTFm�.,.._
Firm
P.O. Box 568 �L�---
Address
nsocket, RI 02895
City/Town
f
Supervising Driller Reg.# I %
i a
y, d
-
� u.re of supers g /egistered ell duller
Signaatt
Please print firmly BOARD OF HEALTH COPY