HomeMy WebLinkAboutMiscellaneous - Sullivan Road (Lot 5),
DeF)artmeni.of Environmental Management/Division of Water. Resources
Vli};TER WELL COMPLETION REPORT
WELL'L GEOGRAPHIC DESCRIPTION .
vur
N S E W of
(Icer) arclel
Clty/TOW
Well ow Wa Iroadl
"dress �_ N S E(W)of
(mi. in tenths) � Ic7rcle7�-�'
Board of Health permit: . yes no �❑ intersect.(row � ad)
WELL USE. WELL DATA
Domestic Public ❑ Industrial ❑ Total well depth __,,,pz9, / ft.
C1 �
Monitoring ❑ Other Depth to bedrock ft.
iWaler-bearing rockiunconsQlidal d material:
Method drilled -,
Date Description
Water -bearing nest -^
CASING Q (�
11 From �To
Type yr 2) From To
Length 'x(l ft. Dia(.l'.D.)n. 3) From To
Length 'nto bedrock ft.
Gravel pack well: dia.
Pro iva we I sea :
Screen: dia.
Grout -0 Other Slog length from_ to
STATIC WATER LEVEL
Static water level below land surface ft. Date
WELL TEST Q
Drawdown IP10 It. after pumping �S>hr. min.gqat�gpm
Ho�ea ed , r Recovery ft. after. L4O`hr../min.
0
LOG of FORMATIONS C= N
,Materials From To
a , r
Driller
Mass. Re t'0 w4
Fir
Address
city/Town
'0 30 9
S na ure of supervising reistered drlller
PleasepnntM-ly BOARD W HEALTH COPY -
rld
BOARD OF
-Town of Porth
•
APPLICATION FOR
a t i ob GIIISI hereby made
0 v11"n,,,,sFWa11,- a pump
. = f -� >�
on,
,S
.onv
'ON
)f
e
of
a 1-J
tot
Dwn:
is ;Ysr
INS;
P Lij
a
P i t-;
I e q
w a
i
rel
for permit
system.
A d d r d -S R
r
Address
f
le
In dap etc
),R,(To be completdcl
:
at time of pump
Well used, for
b filled c Ln before
0 1-1
Pump ryl), "U
11L
J'j
Size of Cass j. Thfl:��
Lr
R"Vd k Depth cals k n g.,
D-0-1 j"V c r s GPM
ed? Yes) No
Date. of
-c . n
Well Ended
GSI v--lv1JZc,d,_
al US -ed n
Delivers
after pumping
hours- atfeet
g—
i'ion
In dap etc
b filled c Ln before
0 1-1
Pump ryl), "U
11L
J'j
D-0-1 j"V c r s GPM
S i Z c o f T anlc
i Well: Cast ron
GSI v--lv1JZc,d,_
al US -ed n
x. Pitless Adapt6r
r ;N;a
NO( )c in c
ry I
'dto Pipe? Yes
ai
I I a iu� L ?I C
Anv y s i s repor-t'submitted
to 0 a r cl 6f
Zven D owner of record
&
In dap etc