HomeMy WebLinkAboutPratt St. #203 - 8/19/1999APPLICATION FOR PERMIT TO DRILL WELL
Location {WA7T S }' 14oc�k.,r s Rec. ARF-g
Registered
Well Driller R i W l�9el� Sri ��e�2S
Address �511\\ TkA F1 g Lp 01,
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:
_Domestic $ 10.00
00
—Industrial/Commercial $ 100.Q
NIC� Agricultural
Date:
8-i1'9Y
Applicant Signature: 91'1 "�-r
,�x
l� l—
PERMIT TO DRILL A WELL
The above applicatioph�,as ^been approve and permission is pMe_d to drill a well for the
following use at C �8 d C� S i }t`if-C j\1 S ►G2t /12 ��
--Dgmestic Potable (for household use)
i Ommestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
—Industrial/Commercial Auxiliary (for manufacturin etc.)
_Agricultural (for irrigation of land in the busi s o griculture)
Date:— Approved by:
Fo Board of Health 2L 11_�' I
NOTE: Electrical permit required; underground cable trench must be inspected
Upon installation of well, call Department of Public Works office at
261-7331 to be added to well list
01
Department of Environmental Management/Division of Water. Resources
s WELL COMPLETION REPORT
;t WL L LOCATION i GEOGRAPHIC "DESCRIPTION
Addfi§sw J _VJr <fiti R f .S E W of
toG N
�)LA, 5T iZ ,T'r • jj F l �� 0 F _ 0 (feet) �� (circle)
s l City/Town �`Y1Ya�F_ E t,t�
C e.Ld)
Wetl owner '1-i�CF Wl Y-�1J,`jFl i_,4U. (goad) ,�
Address � i l_! y� 57K �C_ o i N S tt / W of
r, • _ (mi. in tenths) clef
T-- ntersect. w/
3oard of Health permit obtained: yes ❑ no ❑ (road)
WELL USE WELL DATA
m DoesTio ❑ Public ❑ industrial ❑ Total well depth ft.
Monitoring 0 Other 1 � : Depth to bedrock j ft.
Water -bearing rock/unconsolidated material:
Method drilled K %Tn j
Description c�✓Gl, h 1�
Date drilled Water -bearing zones:
CASING_ 1) From I I Y To {�
Type 2) From D To 1`{'S__
Length,.'�ft. ,Dia(LD) in. 3) From �l J To �1. J
'Length rnto bedrock ). ft. Gravel pack well: dia.
Protective well seal dia.
Screen:
Grout ❑ Other_ t{n
L)t_ /Kl't- Slot# length from —to —
STATIC': WATER LEVEL (all wells)
Static water level below land surface ft. Date
WELL TEST (productionwells)
6.rawdown�*. after pumping hr._'�'_Q min. at 1' 1ro gpm
How, measured F j)Recovery S� ft. after_ hr.�`-_min.
LOCy pf`FORMA%TIONS :' COMMENTS
Materials From To"
�I l7 Driller(
Firm " A & W ARTESIAN WELL (2e.
P.O. Box 568
Address
e , H1 02895
City/Town
Supervising Driller Reg.# {