HomeMy WebLinkAboutWest Church St. #50 - 5/11/2021Massachusetts Department of Environmental Protection
LL7] Bureau of Resource Protection
Well Completion Reports
Well Driller
Please specify work performed:
Address at well location:
New Well
Street Number: Street Name:
WESTCHURCH
50
STREET
Please specify well type:
Building Lot#: Assessor's Map M
Monitoring
Assessor's Lot#: ZIP Code:
Number Of Wells:
1
Cityrrown:
Well Location
MANSFIELD
In public right-of-way:
GPS (GPS for the deepest well)
r Yes R No
North: West:
42.02870 71.22209
Subdivision/Property/Description:
"
Mailing Address:
IF click here if same as well location address
Prc party Owner:
Street Number: Street Name:
2269 MASSAVENUE
City/Town: State:
Engineering Firm:
CAMBRIDGE MASSACHUSETTS
MCPHAIL ASSOCIATES
ZIP Code:
02140
Board of health permit obtained:
(' Yes t: Not Required
Permit Number: Date Issued:
0
101 Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
Well Completion Reports(Moniforing)
Well Driller - Monitoring Form
DRILLING METHOD
Overburden uger edrock -Choose Bedrock --
WELL LOG OVERBURDEN LITHOLOGY
From(ft)
To(ft)
Code
Color
Comment
Drop In drill
stem
Extra fast or
slow drill rate
Loss or addition
of Fluid
0�
�
r r
YES NO
r r
Fast Slow
r r
Loss Addition
5�
UNan Fiii �
Brown �
r r
YES NO
f Sl
Fast Slow
r r
loss Addition
70
Coarse Sand
Brown .J
r r
YES t�
IF, Sl
Fast Slow
r r
Loss Addition
70
75
Boulders ®
Brown s l
PERMIT INFORMATION
DEP 21 E RTN # DEP Groundwater Discharge #
ADDITIONAL WELL INFORMATION
beveloped r Yes (•' No Are these wells nested? r Yes r No
Surface Seal Type ement rem of group (sq. ft)
Total Well Depth 15 Depth to Bedrock
CASING
From
To
Type
Thickness
Diameter
Polyvinyl Chloride J
Schedule 40 .I
22
SCREEN No Screen
From">
To
Type
Slot Size
Diameter
15
Slotted PVC ,J
i
WATER -BEARING ZONES
From To Yfeld (gpm)
0
ANNULAR SEAL/ FILTER PACK
From
0
0
0
r Is
Casing
above
ground?
To
Material 1">
Weight
Material
Weight
Water
(gal)
Batches
Method Of Placement
Native Maledal
---Choose Material--- ,•
Gravity J
Gravity J
eentonite Chips/Pellets
---Choose Material---
15
Sand
---Choose Material--- J
rGravily J
Ll
WATER LEVEL
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
Well Completion Reports(Monitoring)
Date Measured
Static Depth BGS (a)
Flowing Rate (gpm)
OS/11/2021
0
0
COMMENTS
_3 WELLS INSTALLED
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.
Monitoring [MI Supervising Driller Signature NEWSHAM,
DrillerGARY CAOUETTE Registration # 606 PETER, W
TECHNICAL
DRILLING Date Job Complete
Firm SERVICES, INC. Rig Permit # 67 05/11/2021
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.