HomeMy WebLinkAboutCopeland Dr. #37 - 7/10/1989{
TOWN OF MANSFIELD, MASSACHUSETTS
50 West Street, Mansfield, MA 02048
APPLICATION FOR PERMIT TO DRILL WELL
.r
Name
Address
Location
Installer
Address
TYPE OF WELL:
Domestic Potable
t ✓ Domestic Auxiliary
Agricultural
Industrial/Commercial Potable
_Industrial/Commercial Auxiliary
Intei],ded use: Cv"�P.-j
Fee:?%°°(yO e�-o Date:_
Local Water Supply
PERMIT TO INSTALL WELL
The above` application has been approved and permission is granted
to install a l ® ) well for the purpose
of at Q�w
Date: n 1I.J9
Approved by:
for YtBo�a�rdof Health
NOTE: Electrical permit required; underground cable trench must be inspected.
Department of Environmental Management/Division of Water Resources
tvrr WATER WELL COMPLETION REPORT
WELL LOCATION - GEOGRAPHIC DESCRIPTION
Address �0I7d Dr
N S E W of
UDQZ 4 C I Ci H E) .rl el
City/Town 1
Well owner t6'.f er--- n C::CQCt (med)
Address N S E W of
(mi.. N tenths) (circle) -
Board of Health permit: yes (ZZJ no ❑ -intersect. w/
WELL USE WELL DATA �V'� ,
Domestic ❑ Public ❑ Industrial E] Total well depth LQ-R ) ft.
Monitoring® Other..1cr- 1 11CX1 Depth to bedrock LOB ft.
Water-beanng rock/unconsolidated material:
Method drilled- rOtCl(-y
Date drilled -7110 )Bq
Description
-
CASING -
Water bearing zones:
Type :StPP `.
1) From n To Ih.
Lengthi�ft. DiaLLD.). (� in..
2) From I h. To LoL40
-
Length into. bedrock �� ft.
3) Fromr To
Gravel pack well: dia.
Protective well seal:
-
_
Screen; dia.
Grout:❑ Other -
Slot""_. length from_ to_
-_
PUMP TEST
i:..
Static water level below land surface
ft. - Date
Drawdown O ft. after pumping
ir. - /5 min. at gpm
How measured )( Recovery
ft. after—hr. min.
s .
LOG of FORMATIONS
COMMENTS
I
•
_
jistrat bn It-2
R109iOT�r1Ann
2 s/D 11
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