HomeMy WebLinkAboutPleasant St. #63 - 12/2/1991TOWN OF MANSFIELD, MASSACHUSETTS
50 West Street, Mansfield, MA 02048
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address
Location
Installer lei i —CJ pa--� JI J& C "-3� -)C'
Address
TYPE OF WELL:
Domestic Potable
V Domestic Auxiliary
_Agricultural
Inten)ded use: (,,�, y Q �\ Li`c I
Fee: C �Z Date:
_Industrial/Commercial Potable
Industrial/Commercial Auxiliary
Local Water Supply
PERMIT TO INSTALL WELL
The above applicati n has been approved and permission is granted
to install a VG' it - well for the purpo
of yam/ at '> pLC �S s�itit
Date: /Z _ Approved by: 1/
fo the, oard of Health
NOTE: Electrical permit required; underground cable trench must be inspected
Depa_�Jment of Environmental Management/Division of Water Resources
IfJ la WATER WELL COMPLETION REPORT
WELL RfCATION
GEOGRAPHIC DESCRIPTION
Address
_�' 0 N S EV of
to,(leerl
(circle
`� ! City/Town
I �nrt V
_Vu6. ,tnadl
W�I owner ,
3
Address
Fr N Q E W of.
(nrl. In senshsl lcliclel
infersect w/
road)
+ I nor x] J 1J,
1 JJ a fr ?� �.{?I
t=
Board of Health permit: yes ❑ no Q,
WELL USE
WELL DATA -
Total depth ft.
Domestic ❑ Public ❑ Industrial ❑
well
Monitoring ❑ Other r'tn
Depth to bedrock Z& ft.
Water -bearing rock/unconsolidated material:
//
Method drilled k%d�Ti�lnc!.t_
� 1 - f
1416
Descriptlon
Date drilled Fi
Water•bearingzones;
1) From -:20 To
CASING
Type P
Lengthy 1L DIaI.1.D.►—in.
2) From To
3) From To
Length into bedrock ft.
Gravel pack well: dla.
Protective well seal:
Screen: dia.
Grout.(' Other &_A4 r
Slotr'. 14 length 3C2!fromili,Sf0•n.
STATIC WATER LEVEL
Static water level below land surface— ft. Date_,'
WELL TEST
Drawdown f g ft. after pumping hr. AO min. at 2_ /Q gpm
Howmeasured Zipt Recovery ft. after—hr. /0 min.
0
LOG of FORMATIONS COMMENTS 8
q
Materials From Ton "to lie
b , Driller
Rr� cr^ir
Mass. Registration#.
Firm TM., �� 1 Dt_� i i w� rn 7-
Address d/9fl2 1^. S/N"'' f'
City/Town 45. 61_4n1" Iiemep X. r I')Y'g1q