HomeMy WebLinkAboutOld Stable Dr. #29 - 7/15/1997APPLICATION FOR PERNi01T TO DRILL WELL
Name REGIRALD B. WOODY
Address 29 OLD STABLE DRIVE MANSFIELD MA
Location 29 OLD STABLE DRIVE MANSFIELD MA
,,,'Installer
A&W ARTESIAN WELL CO
PO BOX 568 POC: RICHARD FAELLA
Address WOONSOCKET RI PH/FAX: 401-762-1649 FAX: 401-766-0958
TYPE OF WELL:
Domestic Potable (for household use)
(�U,6omestic Auxiliary (for watering, pools,, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
_Industrial/Commercial Auxiliary (for manufactudn etc.)
_Agricultural (for irri ation of land in the bus' ess ofI
Fee.' _Dome c $ 10,0 Industrial/Co ercial /C Agricultural
Date: Applicant Signature.
PERMIT TO
The above application has been approved and permission is granted to drill a well for the
following use at � G} OL.4 ST Ae Lr— Il t_,
Domestic Potable (for househc'.: use) 11
FXD— omestic Auxiliary (for watering, pools, etc.) It
_Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for m arwfacturuig, etc.) - — -
_Agricultural (for irrigation of land in the business, a f agriculture) -
Date: 2` / J -51 Approved by: 3 ao tf- Uc-4e o� �
For the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected
Department of Environmental Management/Division of Water Resources
3
q5 WELL COMPLETION REPORT
H o
WELL LGCATION GEOGRAPHIC DESCRIPTION
0 i `��VYa/
Address '2 ^ ,5y N S E )— of
(feet) (clrcre
City/Town
(road)
Well owner
S EW of
Address (ma. itenths)
0.7
intersect. w/
Board of Health I ermi[ obtained: yes 10'' no ❑
(r'
WELL USE WELL DATA
Domestic El Public El ❑ Total well depth '�'� — ft.
Monitoring ❑ Other Depth to bedrock ft.
Water -bearing rock/unconsolidated material:
Method drilled Description _�
Date drilled I Water -bearing zones:
CASING �p /� 1) From 0 To ' 02
l4 Y 4 2) From � 1 Q
Type To Length Q-_fL Dia(LD.) 69 in.
3) From To
Length into bedrock it. Gravel pack well: dia.
Protective well seal: dia.
Screen:
Grout ❑ Other Slot# length —from —to
STATIC WATER LEVEL (all wells)
Static water level below land surfaced ft. Date 11�j
WELL TEST (production wells)
1,5
Drawdown �� ft. after pumping _ hr.-s � � min. at �� ��^^
How measured Q Recovery ft. after_ hr.__ .
LOG of FORMATIONS
Materials From To
t ®� Driller
Firm A R W ARTESIAN WELL C®,
Address PO COX 600
city/Town WOONSOCKET, RI 02695
�7
Supervising Driller Reg.#
Please pant nrmry -
I
BOARD OF HEALTH COPY