HomeMy WebLinkAboutPlantation Rd. #23 - 5/17/2000APPLICATION FOR PERMIT TO DRILL WELL
Name 22 N l e. C- 4-_ 2 t1 4 T 14
Address 016 P LAAj7—A} 1D1(-1 46)A-L
Location LLLL OF l 0-(U L.LLLt � —
Registered
Well Driller AV t LV /u o 60 Li h� U�r
Address l i (P l-iA V L vt S 'T - IC-� A� (/J C F _A & C) 1 f)
TYPE OF WELL:
_Domestic Potable (for household use)
omestic 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: td Domestic $ 10.00 —Industrial/Commercial $ 100.00 N/C Agricultural
Date: - 1-4 - U 0 Applicant Signature:
PERMIT TO DRILL A WELL
The above application has been approved and permission
following use at dB e 18 X.) TY4 !' (G 10 l
to drill a well for the
_Domestic Potable (for household use)
v omestic Auxiliary (for watering, pools, etc.)
—Industrial/Commercial Potable (for human consumption, including food processing)
—Agricultural
Auxiliary (for manufacttrri�," c.)
_Agricultural (for irrigation of land in the business o a riculture)
Date: /) -o6 Approved by:
For a,jioard of Health
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
AVELLINO WELL & PRIMP, INC.
244A Haven Street Reading, MA 01867 781-944-5454 or Fax 781-944-6625
PROPERTY PLAN TO ACCOMPANY
APPLICATION FOR WATER WELL PERMIT
TOWN:__r�1,Srt
PROPERTY/ADDRESS: 23
HOMEOWNER'SNAME: Mk., QMiE�- H-(kVA-rW-
9
RA
PROPPLANPERMIT
Department of Environmental ManagemenUDivision of Water Resources
- WELL COMPLETION REPORT
WELL LOC TI N,-p �[. / / / GEOGRAPHIC DESCRIPTION
Address l �Q i'1 I Q 7—/ O M J 1CI A)O
N S 4E M/ of
City/Town
� GtgI'e— � n /t/u� Gf7 G f0/l
Well owner 2 % lmadJ '
Address 3 t U t S W of
(mi.. In len(hs) (arcl i
_ft.
Board
intersect. ""'�G G/ej
of Health permit obtained: yes no ❑
wN
oadJ
WELL USE
WELL DATA
Domestic ElPublic ❑ Indpstri@L❑
Total well depth� 9 / v— ft.
Monitoring ❑ 'Dther�Crf �7/Qh
Depth to bedroclkft.
Method dulled o G i
Water -bearing rock/unconsolidated material:
-'
Description 4LI/ae-
.. Q
Date drilled
Water -bearing zone
6
-
CASING P.e /
Type
y) From Tc
2) From .0
Length Dia(I D) in
3) From _ To
Length into bedrock— ft.
Gravel pack well:
dia.
'
Protective well seal:
dia.
Screen:
Grout ❑ Other/�
Slot#
length
— from _ to _
STATIC WATER LEVEL (all wells)
a
Static
water level below land surface ft.
Date
WELL TEST (production wells)
Drawdown ft. after pumping far.
/0 min. at
How measured Recovery
ft. after_
}Oj''��gpm
hr..�min.'
' -LOG of FORMATIONS COMMENTS --
i
Materials From To
qq
riller Q ! h
Fir A INO L P MP
Add 244A Haven Street
City Readinc fNA 0 867
Supervising Driller Reg.#
j signature o/supervising registered well do/ter
i P/ease print firmly -
� BOARD OF HEALTH COPY