HomeMy WebLinkAboutCarriage House Ln. #12 - 3/4/1997MAR-24-97 11:47 PM
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Nama
Address
Location
Inataller
LISCO—IRRIGATION 1 508 761 5950 P.01
Cc> 4 Cooyz� 54-
4�4Le(C-IG VYA ?,
TOWN OF V(.A;45F FTTS
sowes,�reSM ,li
stetid,Ma020 S
APPLICATION FOR PERMIT TO DRILL WELL
Address p U v
tC1
'TYPE OF WELL:
�t
Domestic Potable
� 0,,eetic Auxiliary
1Uf A8ricultural
untended use:
77
Tnduseriai./commercial Patst>Ie
Ifldustrial/CawnelcialAuxiliary
Local. WxCer SUPPIV
Date:_ T�6^ g --✓
PERMIT TO INSTALL WELT -
Tile above above application hay been approved and Pcsmi""on is granted
to instal] a�
well for the purpose
of Ck z%t til._1��u�h1 Gt4�nL_ at._GAl�Srug
I Date:— Approved by�
�j £u he rioard of xea,teh
NOTE: Electrical permit required; underground eabin tranch muse he inspected.
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Department of Environmental Management/Division or Water Resources
1
WELL COMPLETION REPORT
WELL LOCA ION
Address �T/_/�'/�� GEOGRAPHIC DESCRIPTION
)S E W o
City/Town 1
P
Well owner
i Addressess /�/� /road/ "
n1 7� G,� m mmna/ N S E W o l
Board of Health permit obtained. - EE tm/a/
,..Yes Q no ❑ infersect. w/ T n;
WELL USE - '- 1 , road/ /
WELL PAT
-
- Domestic �"Ffubllc El Industrial Total well depth
--fps.-L__ ' Monitoring.❑ .Other - ft. y
Depth to bedrock _ ft.
Method drilled Water -beating rock/unconsolidated � material•
DateAS riller! Description_q
CASING Water -bearing z�on(�e,
TYpe 1) From---C�-t_To
Lengthy/t,pia(LD.) 21 From
--sin. -92�To_ Length into bedrock . 3) From.�� To
Protective well sea,, Gravel pack well:
dia.
a_
Grout-� Dthe' - Screen; -
- dia.
:.Slot✓
STATIC WATER LEVEL (all well
- length fro
Static water _level below land surface -
i WELL TEST �--ft. Date q
(Production. wells' .;
Drawdow,
/l. after p u -
P mpin9__,_hr.�(` at
_min. How measured 1,--)gpin '
RecoveryQ_It. alterlljfit. ;a
' L00 of FORMA TIONS COMMENTS 0
MelePlelf From ToDrills
a
I °a
I Firm� '.
Address & VV_A ITESIAN WELL CO,
City/ro
Superv'sin Driller Reg,q
P/vas Pdnfl/im/Y -Sl nafWe o/eiyeiv/tM9 Gfan '