HomeMy WebLinkAboutPlowshare Ct. #20 - 3/30/2000MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name MAtzxo ?. A-7ArCAcC.Zo IS-<.
ao P4,13wSNIRT{r, C-T-. Sop 339-133
Address_ /-i A Telephone 6/ '1
Registered Well Driller Trr - Ca4. 41 lyct( Or; 1/,:pc, .Uc Number S(,
:3(0q t/e Ten Sired
Address_ k3rJ4jewe; •ier MA OD3ay
TYPE OF WELL:
_Domestic Potable (for human consumption)
✓Domestic Auxiliary (for landscape 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 hidustrial/Commercial $ 100.00 N/C Agricultural
Date: Ncirc. 36,.Aa0� Applicant Signature: �1 w
PERMIT TO DRILL A WELL
The above application h been proved and permission is granted to drill a well for the
following use of 70 011nU,5hQP1_ (�(-
_Domestic Potable (for human consumption)
✓ 1omestic Auxiliary (for landscape 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)
Date: �w - 00 Approved by: J&)�t `-K 14,—
For the Board of Health
Follow-up notes for after the well is drilled.•
1. Electrical permit required, underground cable trench must be inspected
2. Upon installation of well, call Department of Public Works office at 261-7331 to be
added to well list
3. Display "Well Water" sign.
OWNER:
RICC10 MiaR O -T.
h ^AC_^CCTo S2
MI6L8 REETAO P40W.i
HlaaR COL(P-r
MANSFIELD, MASS.
ZONE: AGRICULTURAL
ASSESSORS MAP:37
LOT:
I CERTIFY THAT THE EXISTING DWELLING
CONFORMS TO THE TOWN OF MANSFIELD
ZONING BY-LAWS.
NuT,r� Nu urt", C nN �C3LrT'PlsvG
tpocoPr-ars0-s,,
AWNR
SCACE. GATE.
I" = 40' NOV. ?_8.. 1995 89-056
Hutchins Trowbridge Associates Inc.
CIVX ENGMERS SURVEYORS LAAO PCAAMM
HUTCHINS-TROWBRIDGE ASSOCIATES INC.
200 CHAUNCY STREET MANSFIELD,MASS.
Department of Environmental Management/Division of Water Resources
s _ WELL COMPLETION REPORT
WELL LOCATION
GEOGRAPHIC DESCRIPTION
Address, ® iZil\nG �-'F
t-�
\00 N (DE W of
'
(feet) (circle),
City/Town MA �
'Pt at(_�-�ti-'�_'z C-`x-
••d �
Well owner M
(load)
10 N S E I�V of
Address �?-Q'P1 ` tc,.AA0;-2E
G
(mi.-in tenths) (circle)
Board of Health permit obtained: yes no El
intersect
(road)
WELL USE
WELL DATA
Domestic El Public ❑ Industrial ❑
Total well depth ft.
Monitoring ❑ OtheQTt� TiC1.
Depth to bedrock -4to ft.
Water -bearing rock/utasoNsoGdatcd rnateriak
Method drilled �����%
t
Description!`-x"'S"r'=�4r
Date drilled
Water -bearing zones:
CASING
1) From____A!� To
Type `STE!� \`7
2) From____A`? CJ To
Length-,ab—ft. Dla(I.D.) in.
3) From To
Length into bedrock 1 ft.
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 surface V'e- ft. Date
WELL TESTS� ��(production wells)
Drawdown.N ft. after pumping hr. min. at 4C� gpm
How measured A+1P, L,FTRecovery _ k2 •_ ft. after 2A hr. ""'"' min.
LOG of FORMATIONS COMMENTS
0
Materials From To