HomeMy WebLinkAboutWood Ave. #50 - 4/23/2015MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
Name
Address: 5D(j 00 e,. tAOD41�Telephone
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Location: S(4 1nnIL t) S rA-bo t o
Registered
Well Driller: Vt°,wv _E¢.cr. (✓e� � MA Lie% ag
Address:
TYPE OF WELL:
Cato iorct� _ CAL—,,c, fOoP
_ 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)
Fee: _ Domestic $75.00 Industrial/Commuercial $ 5,00 nculhn'al $75,00
Date: _Q4 D•t 120IS Applicant Signature:
PERMIT TO DRILL WELL
The above application has been approved and Permission is granted to drill a well for the
following use at z t% t ``Z ". '
Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.)
_ Industrial/Commercial Potable (for human consumption, including food processing)
_ Industrial/Commercial Auxiliary (for manuf4otTii g, etc.)
Agricultural (for irrigation of land in the �busineysgFfagriculture)
Date: } ,,�,; �'�ApproveFor the Board of Health
NOTE, Electrical permit required; underground cable french must be inspected.
Upon Installation of well, call Department of Public Works office at
26I-7330 to be added to well list.
Scott Leite
From:
Cheung, Eric (DEP) <Eric.Cheung@MassMail.State.MA.US>
Sent:
Thursday, October 22, 2015 1:04 PM
To:
Louise Sanders; reiminc@yahoo.com
Cc:
Cerutti, Joseph (DEP); Scott Leite
Subject:
UIC registration Mansfield_50 Wood Avenue
Hi Louise,
The purpose of this email is to issue you Underground Injection Control (UIC) registration MAS41A167207-5CL for the
installation of 11 closed -loop ground source heat pump (GSHP) wells and system start-up at 50 Wood Avenue, Mansfield,
MA.
The wells will be installed by Gap Mountain Drilling.
This UIC approval is conditional upon meeting all of the requirements provided in the MassDEP Guidelines for Ground
Source Heat Pump Wells. This approval is for the installation of conventional closed -loop wells using high density
polyethylene (HDPE) tubing. If you are proposing the use of Rygan HPGX or Kelix well materials you must inform the
MassDEP UIC program of your intent to do so prior to installing the wells. Since MassDEP has not completed a detailed
review of this proposed installation, you are advised to contact me if you have any questions regarding the requirements
that are detailed in the guidelines. The guidelines may be obtained as the P document in the "Guidance" section on the
following MassDEP UIC web page:
http://www. mass. govieea/agencies/massdeo/water/dri nki ng/u ndergrou nd-i n iection-control. html
If you haven't already done so, a copy of the UIC application must be submitted to the local board of health. Please be
aware that the issuance of the above UIC registration number only indicates that MassDEP's UIC Program has received
the information that we have requested. There may be other local permits, ordinances, or regulations that apply, including
but not limited to board of health permits for well installations and building department regulations regarding trenching
work. The issuance of a UIC registration number by MassDEP does not supersede the requirements of any other state or
local regulatory entity.
A copy of this email has been sent to the local board of health. The board of health should be aware that as of Friday,
February 19, 2010, MassDEP significantly reduced the level of effort that goes into the review of a closed -loop UIC
registration application for a GSHP well. Specifically, MassDEP no longer requires that the applicant submit site plans
and proposed well construction details. Therefore, it is up to the applicant to ensure that all applicable set -back distances
are met per the MassDEP Guidelines for Ground Source Heat Pump Wells (January 2012).
If you have any further questions you can contact Joe Cerutti at Jaseph.Cerutti(c? tate.ma.us, (617)292-5859, or by fax
(617)292-5696.
Eric Cheung
MassDEP
1 Winter Street, 5th Floor
Boston, MA 02108
Eric. Cheu na Ostate. ma. us
ph 617 292-5992
fax 617 292-5696