HomeMy WebLinkAboutPilgrim Rd. #8 - 9/9/1997Name 1 /' ('�
Address. l 1 l (
Location
Installer AW-111— tea y7
Address �)y /
TYPE OF WELL:
DiSmestic Potable (for household use)
_Domestic Auxiliary (for watering, pools, etc.)
_Industrial/Commercial Potable (for human consumption, including food processing)
_Industrial/Co xiliary (for manufacturing, etc.)
or i n o d in the business of agriculture)
Fee: Domestic $ 10.00
-industnaKommercial $ 100.00 N/C Agricultural
Applicant Signature: &V YJA�6Aair
PERMIT TO DRILL A WELL
The above application has been rqy ed and permiss}orris granted to drill a well for the
following use at I ,c.X C, r/ vt' i de /
=� estic Potable (for household use) -
omestic Auxiliary (I -watering, pools, e[e .)'
_Industrial/Commercial Potable (for human consumption, including food processing)
_Industrial/Commercial Auxiliary (for manufacturing, etc.)
_Agricultural (f r 'irrigation of land in the business of agriculture)
Date: Approved by: �� r—
For the Board of Health
NOTE: Electrical permit required, underground cable trench must be inspected
Department of Environmental Management/Divislon of Water Resources
WELL COMPLETION REPORT
WELL LOC `nTIOpNGEOGRAPHIC DESCRIPTION
Addreess n (+ hr_�—P'o N S E W of
/IFl•.J S'F'e �� /'I�f (feet) (circle)
Cityfrown
Well owner r✓ 9 OAV" %�r�n (road)
Address PQ ��D• N S E W of
-n yjA (mi. in tenths) (circle)
Board of Health permit obtained: yes 0 no ❑ I
intersect. w/
(road)
WELL USE WELL DATA / -
Domestic CP Public ❑ Industrial ❑ Total well depth b 00 ft.
Monitoring El Depth to bedrock �i ft.
/�j� � pp ��/ Water -bearing rocklunconsolidated material:
Method drilled LiY / Description
Date drilled �—� - i cl Water -bearing zones:
CASING 1 l /' I 1) FromTo�
Type ^' , �7 /�S SAP 2) From 3-0 { - To 4/O
Length 'ZO ft. Dia(I.D.)in. 3) From To
Length into bedrock— ft. Gravel pack well: dia
Protective well seal: �p�psy ' dia. `
// Screen:
Grout ElOther .dam e- Slot# length from _to _r
STATIC WATER LEVEL (all wells)
Static water level below land surfacey.. ft. Date
WELL TEST (production wells) /, r-
DrawdownA_ ft. fter pumping � hr. 1.L_ min. at J gpm
How measured 6-o l Recovery ?n.._ ft. after 0 hr_,/�--min.
LOG of FORMATIONS COMMENTS
0
Materials Froml To I p -
<s i
¢ Driller j (,•
Address 1
City/Town l✓eS itrn „-54/1 MI'
Supervisln O eg.# h 1-9 ,7
�l Sign re of supervising well drillerwell driller
Please print firmly
BOARD OF HEALTH COPY