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HomeMy WebLinkAboutOld North Tr. #41 - 10/10/1997APPLICATION FOR PERMIT TO DRILL WELL Name C gn-t Lie i ou C ST ru e i i d Address �-I� n�� ��a�1-t 12Ai Location 5A,v, 7�L TYPE OF WELL: mestic Potable (for household use) Domestic Auxiliary (for watering, pools, etc.) _Industrial/Commercial Potable (for human consumption, including food processing) TlndustriaUrf Commercial Auxiliary (for mamacturing, etc,) —A:.cui (for irrigation of land in the business of agriculture) Fee: Domestic $ 10.00 Industrial/Commercial $ 100.00 N/C Agricultural Date: /o - /o T 9 7 Applicant The above application following use at I PERMIT TO DRILL A WELL and permission is granted to drill a well for the omestic Potable (for household use) omesticAuxili forr.;a, az'Y ( �tering, pools, ett;. j _IndustHU-SCommercial Potable (for human consumption, i-.hiding food processing) —Indu i.al/Commercial Auxiliary (for manta& tieing, etc.) _Agricultural (for irrigation of land in the business of agriculture) Date: �n (� - c/7 Approved by: For the Board of Heal h NOTE: Electrical permit required, underground cable trench must be inspected 3J' �' Department of Environmental Management/Division of Water Resources ,{ I WELL COMPLETION REPORT 11 1 1 GEOGRAPHIC DESCRIPTION WELL LOCATION N SCE W of - Address (e rtle/ r L'1�,11 ii' - t PIT Ilseer, City/Town .I Well owner t nm4 (l lli if nl l lt�, ��1— N S E W of C" Address�i—.---ter— (mL In lenthel O(drele, ��t I��Kitin t n ��l1lk nrog- Anrrnlz Board ofHealth permit obtamed: ;yes vedl WELL USE WELL DATA W Il Total we depth «m ft. Domestic Public ❑ Industrial ❑ -0lher__------ Depth to bedrock—L3'--ft. I Monitoring ❑ - Wafer -bearing rockhmcunsolidated material Methoddrllled Description Date drilled Water-bearing e..4; zones: a i_-- n --- CASING. 1) From Type 21 From To Length-—iL DIa1L D.1—y;--in g) From Tom----- Length into bedrock i L_-- j----1t•. Gravel pack well: dla•-------- jl Protective well sea]: Screen: , dla._------ 7 -Slot ✓_— length _.(rom ! to Grout.[] Other - STATIC WATER LEVEL (all wells).' rl Static water level below land surface_ 2f) ft• Dale I. WELL TEST (production Drawdown R, after pumping — How C .min. at LI �' 9Pin 0 2--ha ----min. How measured--�--Racovery..�--- it. aller: i, LOG of FORMATIONS CCOyM�MEyNTSLI,) LI. My2iDY, d ePm11 36pM a ! Mauriels From To .b ILO% ACC � D� I I to Driller 1T O N SFl 22I n t1 FirmA & V!I ARTESIAN WELL C©> Address G lVbl.vc�.L f , Gu City/Town 'I Supervising Driller RegA 7•2 I r ary a nr ervia n re➢IIlerod well driller FI..r Ydnt r,rmly LTH BOARD OF HEACOPY