HomeMy WebLinkAboutMarie Dr. #6 - 9/18/2017MANSFIELD BOARD OF HEAL
APPLICATION FOR PERMIT TO DRILL WEB SEP 18 2017
Name �oivt�lj df c c-lf�
Address: Telephone
Location:
Registered
Well Driller: r,y L .w� � u �� 5� MA Lic # ;2?Y
Address:
TYPE OF WELL: oCy�•_ %�� c v C�k
Domestic Potable (for household use)
&-% Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
__j4dustrial/Commercial Auxiliary (for manufacturing, etc.)
Agricultural (for irrigation of land in the business of agriculture)
Fee: Domestic $75.00
Date:
Industrial/Commercial $75.00 Agricultural $75.00
Applicant Signature:
PERMIT TO DRILL WELL
The above application has been approved
following use at C, YYIo",z �2 �k
Domestic Potable (for household use)
l permission is granted to drill a well for the
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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 pf agriculture)
Date:u. G'f'! 7 Approved by.
F the Board
NOTE. Electrical permit required, underground cable trench must be inspected.
Upon Installation of well, call Department of Public Works office at
261-7330 to be added to well list.
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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: 971602
Document: Well Driller
Size of File: 360.06K
Status of Transaction: in Process
Date and Time Created: 11/1512017:7:38:07 AM
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.
Well Completion Reports
M1111RIM
Please specify work performed:
New Well _.. _..�
Please specify well type:
Ir9—
n anon
Number Of Wells:
Well Location
In public right-of-way:
t` Yes r No]
Subdivision/Property/Description:
Property Owner:
TOM VERROCHI
Engineering Finn:
NONE
Address at well location:
Street Number: Street Name:
6 MARIE RD
Building Lot#: Assessor's Map #:
Assessor's Lot#: ZIP Code:
02048
Cityrrown:
MANSFIELD
GPS
North: West:
42.01069 71.13418
Mailing Address:
click here if same as well location address
Street Number: Street Name:
6 MARIE RD
CitytTown: State:
MANSFIELD MASSACHUSETTS
ZIP Code:
02048
Board of health permit obtained:
f: Yes (i` Not Requiredry
Permit Number: Date Issued:
6MARIE PT29M7
Ll
Bureau of Resource Protection — Well Driller Program
Well Completion Reports(General)
Well Driller - General Well Form
DRILLING METHOD
Overburden Bedrock
(Auger _.. F Choose Bedrock
WELL LOG OVERBURDEN LITHOLOGY
WELL LOG BEDROCK LITHOLOGY
Loss or
Extra
Drop in
Extra fast or
Visible Rust
EroryFrom(ft)
To(ft)
Code
Comment
addition of
LargeP
drill stem
slow drill rate
Staining
fluid
Chips
I. i
(..._
—
hoose Code._. J�
Lo
�Yes]
iYes
_.�
t YE
Loss Addition )
ADDITIONAL WELL INFORMATION
Developed ( C. Yes r No , Disinfected �- r Yes r No,
Total Well Depth 30 Depth to Bedrock
i
Surface Seal Type (None _ _�racture Enhancement
CASING L Is Casing above ground?
From To Type Thickness
-- --
10 �26 l Galvanized Pipe _ _ _ ,�� Schedule 8o
SCREEN f No Scr ee ni
I�Diameter Driveshoe
77
I Fir— Yes7
From
To
Type
Slot Srze
Diameter
126 _-�
I30 _ �
Stainless Steel Well Point �)
10.12
�i 25
WATER -BEARING ZONES r DRY WEL,1I
From To Yield (gpm)
�13 t10.^ _.'._..�
PERMANENT PUMP (IF AVAILABLE)
Pump Description (JelHorsepower
Pump Intake Depth (it) Nominal Pump Capacity (gpm)
H
ANNULAR SEAL I FILTER PACK _
From To Material 1 Weight Material 2 Weight Water Batches Method Of
(gal) (count) Placement
�► ivaaa.rcuuacua Lc(iat uupn vi i llv it vn111auuA 1 A vtwtivu
Bureau of Resource Protection — Well Driller Program
Well Completion Reports(General)
10 jjlj3Native Material Choose Material
,� ., _�I _�_ Gravity
:- J - --_ - --
WELL TEST DATA
Time Pumped Pumping Level (ft Time To Recover Recovery (tt
[Date Method Yield (gpm)
(HH:MM) BGS) (HH:MM) BGS)
�9/25/17 _.� ( Constant Rate Pump ,� 10 I I0300 �14
WATER LEVEL
Date Static Depth BGS (ft) Flowing Rate (gpm)
Measured
109/25/17 _.� I13 _. _._Ii10 ..... ..�
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,
DrillerEMMONS Registration #
788 Signature PAUL,
PAULS WATER
Date Job Complete
9/25/17
Firm WORKS, INC. Rig Permit #
139
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.