HomeMy WebLinkAboutOld Stable Dr. #42 - 5/14/2015MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name c-w7/�/✓piahie l/G AA/.yolCti
Address: %- 6)/' S�� & )de,
Location: Z)
Registered ,/ �-�
'SI iRIa
Well Driller: /`�` C Q c.Jr't ;'vey IN( -
Telephone -5-Oe ate/ a_yz f
MA Lic # 7
Address:y b( /06 �l -SUtW 11 fa
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: JDomestic $75.00 _ Industrial/Commercial $75. _ Agricultural $75.00
Date:- % 15 Applicant Signature:99-
-
PERMIT TO DRILL WELL
The above application s been approved d permission is granted to drill a well for the
following use at l -e (174D 7>:P „ 4;;f
-Homestic Potable (for household use)
t Domestic Auxiliary (for watering, pools, etc.)
Industrial/Commercial Potable (for human consumption, including food processing)
Industrial/Commercial Auxiliary (for manu taring, etc.)
_ Agricultural (for irrigation of land in th Idt'he
s oagriculture)
Date: ` ` Approved by:
Board of Health
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.
r
Massachusetts Department of Environmental Protection
Bureau Resource Protection
14Ye11 Comm pletion Reports
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Well DrillerLAI
Please specify work performed:
Address at well locat"�---.._.,—.,4.„�
'New well
Street Number: Street Name:
42 OLD STABLE DRIVE
Please specify well type:
Building Lot#: Assessor's Map #:
llmgation l
Assessor's Lot#: ZIP Code:
Number Of Wells:
02048
.. __... _.. _.
City/rown:
Well Location
MANSFIELD
In public right-of-way:
GPS
No f Yes C' �
North: West:
42.02015 71.10141
Subdivision/Property/Description:
Mailing Address:
1 17- click here it same as well location address
Property Owner:
Street Number: Street Name:
EDWARD AND STEPHANIE VALANZOLA
42 OLD STABLE DRIVE
City/Town: State:
Engineering Firm:
MANSFIELD MASSACHUSETTS
ZIP Code:
02048
Board of health permit obtained:
to Yes C Not Required
Permit Number: Date Issued:
0 105115/2015 -
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Well Driller Program
Well Completion Reports(General)
Well Driller - General Well Form
DRILLING METHOD
Overburden
Bedrock
Air Hammer
;Air Hammer
WELL LOG OVERBURDEN LITHOLOGY
Drop in drill
Extra fast or Loss or addition
From(ft) To(ft)
Code Color
Comment
stem
slow drill rate fluid
i0 10
Silty Sand And Gr - Brown
E C YES (: ND
r .Fast r Slow; {' Loss
CO Addi.
WELL LOG BEDROCK LITHOLOGY
Drop in drill
Visible
Extra fast or Loss or addition of Rust
Extra
Large
g
From(ft) To(ft)
Code Comment
stem
slow drill rate fluid
Staining
Chips
10 ,110
Granite
r YES
N0,
IC' Past r Slow
t' Loss r Addition r Yes
Ye
110 210
Granite 1
C' YES
(: N0
!, t' Fast C• Slow
Loss l: Addition', r Yet
:rye
210 1310
Granite {
C YES
(i NO
C Fast G Slow 1
C Loss 0 Addition r Yes
�. r Ye.
310 _. 402
I Granite
C YES
B NC
f Fast Slow
Loss C+ Addition) r Yes
r Ye
402 �405 _.
Granite �I
; f: YES
r' NO'
6 Fast r Slow
_.
C' Loss Addition r Yes
i,� Ye
406 600
Granite ,j
YES
NG�
C' Fast t: Slow:
C' Loss B Addition r Yes
r Ye
ADDITIONAL WELL INFORMATION
C Yes r Nol
Disinfected
r: Yes C No:
Developed
Total Well Depth
500
Depth to Bedrock
10
Fracture
Surface Seal Type
None
Enhancement
(0 Yes C' No';
CASING F Is Casing
above ground?
From:
2 To: 0
From To
Type
Thickness Diameter Driveshoe
o _.. 27
Steel._..
�
i6 Yes
SCREEN I. No Screen
From
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Prograin
Well Completion Reports(General)
To
Type
-- Choose Screen Type ---
WATER -BEARING ZONES r DRY WELD
From To Yield(gpm)
1 402 405
PERMANENT PUMP (IF AVAILABLE)
i
- Choose Pump
Pump Description (Description --- i
Pump Intake Depth (ft)
ANNULAR SEAL/ FILTER PACK
Horsepower
Nominal Pump Capacity (gpm)
Slot Size
i --- Choose
Horsepower - - j
Diameter
Water Batches Method Of
From To Material Weight Material Weight (gal) (count) Placement
Choose Material Choose Material', _ -- Choose One --
WELL TEST DATA
Time Pumped Pumping Level (ft Time To Recover Recovery (ft
Date Method Yield (gpm)
(HH:MM) BGS) (HH:MM) BGS)
051815 j Air Blow With Drill Stem 3 0:30 i 500 5:50
052215 Air Blow With Drill Stem 10 ' 0 30 500 j 1 30 !
WATER LEVEL
Date Static Depth BGS (ft) Flowing Rate (gpm)
Measured
051815 120
COMMENTS
HYDROFRACKED WELL MAKES 10 GPM
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
Lill
Well Completion Reports(General)
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.
SILVEIRA,
REINALDO Monitoring [M] Supervising Driller REINALD
Driller SILVEIRA Registration # 736 Signature V
Firm ACE DRILLING, INC. Rig Permit # 0227 Date Job Complete I051815
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.