HomeMy WebLinkAboutLorraine Way #6 - 8/30/2018Commonwealth ofMassachusetts
Town of Mansfield
Town of Mansfield 8 Park Row
Mansfield, MA 02048
Board of Health
Application for Permit to Drill Well
NAME OF OWNER:
Go .
ADDRESS OF OWNER:
TOWN / STATE / ZIP: 4c/49 po ul M%
TELEPHONE No:
TYPE OF WELL:
FEE:
DATE:
.5 -o'q' &ro 3'� Gf
REGISTERED 1.4UZ- C/ktMO/L'5' WELL DRILLER:nA, L� �y� `. V c. p AV -5'
MA LIC #: 79
BUSINESS )%Olo pX
ADDRESS.l—A7e)Qf'tJ� Lam.' �_Oo2g,
I-C�t4 y
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)
O Domestic $75.00 0 Industrial/Commercial $75.00 O Agricultural $75.00
APPLICANT SIGNATURE
Permit to Drill Well
The above application has been approved and permission is granted to drill a well for the following use
El Domestic Potable (for household use)
'Domestic Auxiliary (for watering, pools, etc.)
dustrial/Commercial Potable (for human consumption, including food processing )
C7 Industrial/Commercial Auxiliary (for manufacturing, etc.)
U Agricultural (for irrigation of land in the business of agriculture)
DATE:APPROVED BY
For t e Board of Health
NOTE. Electrical permit required; underground cable trench must be inspected.
Upon installation of well, call Department of Public Works at
508-261-7330 to schedule an inspection.
FOR. WALSH BROTHERS BUILDING, CO.
11 SADDLE WAY
WALPOLE, MA 02081
508.668.3434
LOT 18
24,074± sf
LOT 14
»so. 23,787± sf
9g ssF
rS899
r5JB9
LOT 17
25,871 ± sf
h
2
h CONC. FND Is
TF=143 84'. o
y 2 0'
d 6113Y4"
ry,0
O
tia
32.4'
Bay Colony Group, Inc.
Professional Civil Engineers &
Professional Land Surveyors
a I nT i r,-
32,133± 1
2j", —
LOT 16
W 40,720± sf
h
v�
FOUNDATION AS-BUIL T
PLAN OF LAND FOR
#6(LOT 17) LORRAINE WAY
MANSFIELD, MA
8p`vN ar 94ssgcy i APRIL 20, 2018 SCALE. I" = 30'
RIC6A BAY COLONY GROUP, INC
o .
E iE ZI PROFESSIONAL C1WL ENGINEERS & LAND SURVEYORS
No 38 FOUR SCHOOL STREET, P.O. BOX 91J6
Gill FOXBOROUGH, MA 02035
NQS (90B) 54J-J9J9
I hereby certify to the Mansfield Building Comrnisstaner VI to the best of n v O,of assiono/ knrhd dge,
information, and belief feel the d—fle,, is /acated on the ground he shorn hereon and that it compliG,
with the setback requirements of the Zoning By -Cons of the Town of 41ansh'eld
/I
13-0OJF-As-B01s
Massachusetts Department of Environmental Protection
Bureau of Resource Protection
Well Completion Reports
Well Driller
Please specify work performed:
Address at well location:
New Well
Street Number. Street Name:
_
6 LORRAINEWAY `
Please specify well type:
Building Lot#: Assessor's Map #:
Irrigation „�
17
Assessor's Lot#: ZIP Code:
Number Of Wells:
02048
Citylrown:
Well Location
MANSFIELD
In public right-of-way:
GPS
(' Yes r Pb
North: West:
42.01654 71.22309
Subdivision/Property/Description:
Address:
IMailing
1� cirok here If same as well location address;
Property Owner:
Street Number: Street Name:
WALSH BROTHERS
11 SADDLE WAY
City/Town: Slate:
Engineering Firm:
WALPOLE MASSACHUSETTS
ZIP Code:
02081
Board of health permit obtained:
WY.. ±' Not Required
Permit Number: Date Issued:
AUG282018 08/28/2010
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
Well Completion Reports(General)
Lill I
Well Driller - General Well Form
DRILLING METHOD
Overburden
Bedrock
r
Puger. _
i Choose Bedrock--
WELL LOG OVERBURDEN LDTiOLOGY
From(ft),To(ft)Code
Color
Urban Fill
Sand And Gravel � II I I Reddish Brown
WELL LOG BEDROCK LITHOLOGY
Drop In drill
Extra fast or slow
Loss or addition
Comment
stem
drill rate
of fluid
l:
f"
f
I
i �' Fast G slow
_
( YES NO
—
Loss
Addition
C r
r' Fast G Slow
r
YES NJ
I - 11
Loss
Addition
ADDITIONAL WELL INFORMATION
Developed
R Yes r". No
Disinfected
( R Yes Na 1
Total Well Depth
21
Depth to Bedrock
Surface Seal Type
',None _ _
�racture Enhancement
L f Yes G No
CASINGCasing
above ground?l
From
�10
To
Thlckness
��18
�Type
lPotyvinyl Chbdde
�u
l Schedule 40
_
-
SCREEN (r No Scmenl
i
From To _ Type
121 [ Stainless Steel Vee Wire
WATER -BEARING ZONES I DRY WELL
[From TO Yield (gpm)
L
PERMANENT PUMP (IF AVAILABLE)
Pump Description Wire Constant Speed —
Submersible
Pump Intake Depth (ft) 20
ANNULAR SEAL I FILTER PACK
I From � To I Material I
i
Horsepower
Nominal Pump Capacity (gpm)
Slot Size
Diameter
4
Material (Weight Water I Batches I Method Of
J I (gal) (count) Placement
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
Well Completion Reports(General)
(0 — ! !21 1(� Ne6ve Material J� �l `Choose Material �, —1 Gravity
WELL TEST DATA
Time Pumped
Date Method Yield
(gpm) (HH MM)
109126/2018 Constant Rate Pump �� (10 ] I�Ot 00
WATER LEVEL
Date (Static Depth BGS (ft) I Flowing Rate (gpm)
Measured
COMMENTS
Pumping Level (ft ' Time To Recover
BGS) (HH:MM)
110.5 1100.01 i ..
WELL DRILLERS STATEMENT
This well was drilled or altered under my direct supervision, according to the applicable rules and regulations, and this report Is complete
and accurate to the best of my knowledge.
STEPHEN
Monitoring (M] Supervising Driller EMMONS,
DrillerHAASE Registration #
788 Signature PAUL,
PALLS WATER
Firm WORKS, INC. Rig Permit #
Date Job Complete I
220 109/26/2018_
NOTE: Well Completion Reports must be fled by the registered well driller within 30 days of well completion.
Massachusetts Department of Environmental Protection
eDEP Transaction Copy
Here is the file you requested for your records.
To retain a copy of this file you must save and/or print.
Username: PAULSWATERWORKS
Transaction ID: 1051169
Document: Well Driller
Size of File: 360.41K
Status of Transaction: submitted
Date and Time Created: 9/2612018:5:46:56 PM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.