HomeMy WebLinkAboutOld North Tr. #55 - 9/13/2000.06/1,5/1999 08:45 5082617343 PAGE 01
APPLICATION FOR PERMIT TO DRILL WELL
Location
Registered
WBIIDriller American Drilling Services, Inc. #607
AddresS 9 Bathrick Rd. / P.O. Box353 Westminster Ma.
TYPE OF WELL:
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_lndustrral/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: V Domestic $ 10,00 `Industrial/Commercial $ 100.00 N/C Agricultural
Date: cant /`��CG APpli Si r -r /�* 1�
The above application has been approved and permission is granted to drill a well for the
following use at
D nestic Potable (for household use)
estic Auxiliary (for watering, pools, etc.)
_,_.IndustrW/Commercial Potable (for human consumption, including food processing)
Industrial/Commercial Auxiliary (for manufacturing, etc.)
Agricultural (for irrigation of land in the busi/n/yGyss�of agriculture)
�Kl ', /
Date: CI l �' Oy Approved by: Q t� l F`
For the Board -of Health
NOTE' Elec h*al pernrlt requ& e4 underground cable trench must be inspected
Upon ln" 211atfon of well, call Department of Public WOrkY office at
261-733.1 to be added to well list
Department of Environmental Management/Division of Water Resources
s of WELL COMPLETION REPORT
WELL LOCATION
Address GEOGRAPHIC DESCRIPTION
City/Town T > !leap N S E W of
(circleJ
Well owner --./rl �Ji/'o ff
Address (road)
mi. !n tenths) N S E W of
(
'c2G �a (circleJ
Board. of Health permit obtained: yes no
El intersect. w/)_
WELL. USE WELL DATA (road)
Domestic 0 Pubhc ❑ Industrial ❑ Total well depth /, 0 ft
Monitoring ❑ Other; Depth to bedrock /3 _ n
Method drilled c Water -bearing rock/unconsolidated material:
Date dulled Description
CASING Water -bearing zones:
Type r� /� T/� 1)From '/— 5 —To _To
From______________—To_
Length Dia(I D) _fin. - 3) From.To
1 Lengthinto bedrock- .� %
ft. Gravel pack well: dia.�_
Hrotec(ive well seals r , h- i N �D rd _jj Screen: dia.— —
'I Grout ❑ Other T „,w tP
_ Slot# length _from _to
STATIC WATER LEVEL (all wells)'
Stator water level below land surface
�. ,Jr)..ft. Date
WELL TEST (production wells)
D�awdown_ _ fL:. after pumping P— hr,_Q min. at 1S
a HOW measured 9Pm
Recovery 2q ft after
LOG of FORMATIONS COMMENTS
` _ Materials From To o
3 630
Driller -
Firm aL7LP✓ l
!rf t
Address %�� ✓`�/f ; 2c
City/Town
Supervising Driller Reg.#
gnalure supervisin re is�e�
� IPlease prnt Lrmly i9 9 well tlnller
BOARD OF HEALTH COPY