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HomeMy WebLinkAboutLorraine Way #11 - 8/30/2018Commonwealth ofMassachusetts Town of Mansfield Mansfield 8 Park Row Town of f Mansfield, MA 02048 Board of Health Application for Permit to Drill Well NAME OF OWN,EpR:I!/AGS/it %j/QOT/}a REGISTERED Phu GBriS' O0/-(,Q � V- cc WELL DRILLER; ;4& ee_ Oa lI es ADDRESS OF OWNER: r/ 'i'4lY (L LV 4`� 1'y MA LIC #: TOWN / STATE / ZIP:A'00A0L.6- IZI A 4,;b eI TELEPHONE No: ,�d 3- 4� 6W- '?y qzl BUSINESS /4)0 j3aX IP A45 ADDRESS:,�7d—,q�rv/'G4C /�Y ao.Q %.d-l/ LS tvifl7u�'/✓uo��'S � Co 5l. ii i� 'i 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: El Domestic $75.00 H Industrial/Commercial $75.00 El Agricultural $75.00 DATE: APPLICANT SIGNATURE Permit to Drill Well The above application has been approved and permission is granted to drill a well for the following use l] Domestic Potable (for household use) ["omestic Auxiliary (for watering, pools, etc.) Industrial/Commercial Potable (for human consumption, including food processing ) 11 Industrial/Commercial Auxiliary (for manufacturing, etc.) C] Agricultural (for irrigation of land in the business of agriculture) DATE: ' "N `�j APPROVED 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. PREPARED FOR WALSH BROTHERS BUILDING, CO. 11 SADDLE WAY WALPOLE,, MA 02081 508. 666 J434 LOT 2 32,826± sf N42': ',s Boy Colony Group, Inc.) " Professional Civil Engineers & Professional Land Surveyors R=30.00' 1=47.12', A=9000"00'� �0 10.00' �15 C 5C LOT 3 127,640±sf FOUNDA TION AS—BUIL T PLAN OF LAND FOR #11 LORRAINE WAY(LOT 3) MANSFIELD, MA a MAss4` JULY 78, 2018 SCALE.7" - 40' aice o N BAY COLONY GROUP, INC. s .PROFESSIONAL CINL ENGINEERS & LAND SURVEYORS • FOUR SCHOOL STREET, P.O. BOX 9136 q t a' FOXBOROUGH, MA 02035 ^�' Ull (SOB) 54J-J9J9 If � iG l hereby c,fit, fo the Monsf/eld ©analog Cammissiener that to the best of my p,atessionai knowledge, information, and better that the dwe/ling is located on the ground as shown hereon and that if comp//es with the setback requirements of the Zoning By Loss of the lawn of Monsh'eid. 1 J-0173F-AsAs-Buiits� Massachusetts Department of Environmental Protection Bureau Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: ,New Well Street Number: Street Name: 11 LORRAINE WAY, Please specify well type: Building Lot#: Assessor's Map M [Imgahon.___ 3 ___ ___._� Assessor's Lot#: ZIP Code: Number Of Wells: 02048 City?own: Well Location MANSFIELD In public right-of-way; GPS yes No North: West: 42.01569 71.22251 Subdivision/Property/Description: Mailing Address: IF click here if same as well location addfessi Property Owner: Street Number: Street Name: WALSH BROTHERS 11 SADDLE WAY Cityffown: Stale: Engineering Firm: WALPOLE MASSACHUSETTS ZIP Code: 02081 Board of health permit obtained: R. Yes (" Not Required,. Permit Number: Date Issued: AUG282018 (OS/28am __. _,j Massachusetts Department of Environmental Protection Bureau of Resource Protection — Well Driller Program j Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Puger. _ - Choose Bedrock - WELL LOG OVERBURDEN LITHOLOGY WELL LOG BEDROCK LITHOLOGY i From(ft) TOM Code Comment Drop in Extra fast or drill stem slow drill rate choesa code J 'I r r r I YES 1J9 Fesl Slow oss or (Visible Rust (Extra ddRlon of I IStalning (Large uid Chips p Loss Addition �r Yes; [r Yea! -- ADDITIONAL WELL INFORMATION Developed r Yes r No Disinfected I G Yes r No-.) Total Well Depth 18 Depth to Bedrock Surface Seal Type (None —Jraclure Enhancement r Yes G W CASING [r is Casing above ground7� _. [From JTo Type _ Thickness _ ..._. 1Palyvinyl ChlontleZ If Schedule 40 Diameter 1 Driveshoe From To 1Type Islotsize I Diameter [Stainless Steel Vee Wire WATER -BEARING ZONES jr DRY WELL 111 From CTo _ Yield (gpm) IS ._ J 1I18_ PERMANENT PUMP (IF AVAILABLE) Wire Constant Speed Pump Description Horsepower �- Submersible Pump Intake Depth (it) 18 Nominal Pump Capacity (gpm) 10 ANNULAR SEAL I FILTER PACK From To Materlat 1 Material 2 Water IBatches IMethod Of (gal) (count) Placement Massachusetts Department of Environmental Protection Bureau of Resource Protection — Well Driller Program Well Completion Reports(General) F_-'�18�� �� LNaGve Material �Chaose Metadal- WELL TEST DATA WATER LEVEL -.1. Static Depth SGS (a) Flowing Rate (gpm) Measured COMMENTS 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. JASON Monitoring [M] Supervising Driller EMMONS, OrlllerEMMONS Registration # 788 Signature PAUL, PAULS WATER Dale Job Complete 0a((/28/2018 Firm WORKS, INC. Rig Permit# 220 L ____ _._ NOTE: Well Completion Reports must be filed 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: 1051160 Document: Well Driller Size of File: 359.97K Status of Transaction: In Process Date and Time Created: 912612918:5:08:26 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.