HomeMy WebLinkAboutSpring St. #225 - 11/6/2017Commonwealth of Massachusetts
Town of Mansfield
Board of Health
Town of Mansfield
6 Park Row
Mansfield, MA 02048
Application for Permit to Drill Well x
NOV 0 3 2017
NAME OF OWNER:
ADDRESS OF OWNER:
Sim
TOWN I STATE I ZIP:
TELEPHONENo:
TYPE OF WELL:
FEE:
REGISTERED
WELL DRILLER:
MA LIC #:�
BUSINESS �arulS ✓67 G G%7/r'S .,
ADDRESS: /d � k
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[D' 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.)
gricultural (for irrigation of land in the business of agriculture)
❑ Domestic $75.00 ❑ Industrial/Commercial $75.00 F Agricultural $75.00
DATE:/�.� % APPLICANT SIGNATURE
Permit to Drill Well
The above application has been approved and permission is granted to drill a well for the following use
❑ 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)
DATE: } APPROVED BY
t For the Board of Health
NOTE: Electrical permit required; underground cable trench must be inspected.
Upon installation of well, call Department of Public Works at
508-261-7330 to be added to well list.
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I certify that the house is located
as shown hereon, and that it meets
the applicable setback requirements
and the zoning bylaw of:the Town of
Mansfield, and that it does not lie
within the HUD Flood Hazard Zones A
or B as defined on the latest Flood
In u• ante Rate Map.
AN, IJT-,�
C JAMES M. DUNN, R.L.S. #27877
I certify that the septic system is
constructed substantially in
act ance�withh the approved plans.
U 4�"v-1-,..
�AitES M. DUN , P E #23538 ''�
CERTIFIED PLOT PLAN OF LOT B
Spring Street
•.Mansfield, Massachusetts
August 16, 1984
SCALE 1" = 40'
DUNN ENGINEERING CO., INC.
21 COCASSET STREET
FOXBOROUGH, MASSACHUSETTS 02035
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Massachusetts Department of Environmental Protection
L\
eDEP Transaction Copy
Here is the file you requested for your records.
To retain a copy of this file you must save and/or print.
Username: PAULSWATERWORKS
Transaction ID: 985728
Document: Well Driller
Size of File: 359.73K
Status of Transaction: In Process
Date and Time Created: 1/18/2018:5:14:00 PM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.
Massachusetts Department of Environmental Protection
Bureau of Resource Protection
Well Compl6tion Reports
Well Driller
Please specify work performed:
Address at well location:
Chew Well
Street Number: Street Name:
__
225 SPRING ST
Please specify well type:
Building Lot#: Assessor's Map #:
Irrigation
Assessor's Lot#: ZIP Code:
Number Of Wells:
02048
City/rown:
Well Location
MANSFIELD
In public right-of-way:
GPS
Yes r
North: West:
42.01850 71.22470
Subdivision/Property/Description:
Mailing Address:
�_
�. cli ck here if same as well location addres�
Property Owner:
Street Number: Street Name:
TODD JOHNSTON
225 SPRING ST
City/rown: State:
Engineering Firm:
MANSFIELD MASSACHUSETTS
NA
ZIP Code:
02048
Board of health permit obtained:
G Yes (`.. Not Required
Permit Number Date Issued:
225SPRING 11103/2017
Massachusetts Department of Environmental Protection
,)4' Bureau of Resource Protection — Well Driller Program
' 0 Well Completion Reports(General)
Well Driller - General Well Form
DRILLING METHOD
Overburden Bedrock
r
tiger ChoaseBedrock—
WELL LOG OVERBURDEN LITHOLOGY
From(k)
To(it)
Code
an FIII _ +�
Color
[ Brown
Comment
Drop in drill
stem
(
YES NO ,
Extrafastorslow
drill rate
Lossoraddition
of fluid
I
Loss Addition
_ r Fast r Slow !
t..__.—
6 .. .._
II18 --Il
L_ _.,.._.1
((Sand And Gravel
L.__ .__�
Reddish Brown •
I_
r r i
i YES
I r Fast i Stow
L_`�
=Adlh..
WELL LOG BEDROCK LITHOLOGY
[F:1.1(ft)
Drop in Extra fast or Loss or�
To(ft) Code Comment addition of
stem slow drill rate
fluidgLoss
VisibleRust
Staining
Extra
Large
Chips
�18 ��—_7
(drill
LChoose Cotle-`--_� YES NO� Fest low W�
AddrGan
�Ves
�e�
ADDITIONAL WELL INFORMATION
Developed r Yes r No,
Disinfected
Yes r No
Total Well Depth 18
Depth to Bedrock
Surface Seal Type None
racture Enhancement
r Yes (•" No
CASING
From._._.__._..
Is Casing above ground
To
Type
Thickness
Diameter
Driveshoe
[Galvanized Pipe J1
iSchedule 4g
_. _
1.25
FY7
SCREEN No Scream
From
15
To 1 Type
Sta 18 ( inless Steel Well,Poin[ .�
ZSlot size
2
Diameter
WATER-4BEARING ZONES r DRY WELL
From To Yield (gpm)
PERMANENT PUMP (IF AVAILABLE)
Pump Description Choose Pump Horsepower
Description —
Pump Intake Depth (it)
ANNULAR SEAL I FILTER PACK
Nominal Pump Capacity (gpm)
Material (Weight iMaterial2
Choose
Horsepower
Batches I Method Of
(count) Placement
Massachusetts Department of Environmental Protection
Bureau of esource Protection — Well Driller Program
Well Completion Reports(General)
L\-
r Choose Malenal �� ' Choose Material �hoose One-
1 ---� _ -1 ] L -__ -� E 1,
WELL TEST DATA
Date Method Yield (gpm) Time Pumped Pumping Level (ft Time To Recover Recovery (ft
(HH:MM) BGS) (HH:MM) BGS)
--------- .-.-_._ Ip _____ _ ._..-_.... .-__.
(2/16/2017 I C Constant Rale Pump _ (03 00 C12 J '00.00 C2
WATER LEVEL
Static Depth BGS (ft) I Flowing Rate (gpm)
COMMENTS
WELL DRILLERS STATEMENT
This well was drilled or altered under my direct supervision, according to the applicable rules and regulations, and this report is complete
and accurate to the best of my knowledge.
JASON
Supervising Driller EMMONS,
DrillerEMMONS Registration #
Monitoring [Mj
788 Signature PAUL,
PALLS WATER
Firm WORKS, INC. Rig Permit#
Date Job Complete
139 (12/15/20171
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.