HomeMy WebLinkAboutChauncy #36 - 5/13/2020Well Driller- Transaction #1199418 https:Hedep.dep.mass.gov/eDEP/WebFonns/WeIlDriller/WeIlDi,ill...
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
Well Completion Reports
Well Driller
Please specify work performed:
Address at well location:
New Weld
Street Number: Street Name:
36 CHAUNCEY
Please specify well type:
Building Lot#: Assessor's Map #:
Monitoring
Assessors Lot#: ZIP Code:
Number Of Wells:
l7
Cityrrown:
Well Location
I MANSFIELD
In public right-o&way:
GPS (GPS for the deepest well)
Yes. i;; No
North: West:
42.01923 _ __ __�71.13095
Subdivision/Property/Description:
Mailing Address:
Tyclick here if same as well location address,
Property Owner:
Street Number: Street Name:
67 _.. HALL ROAD__________
City/Town: State:
Engineering Firm:
STURBRI_OG_E
CMG L-1
_JMASSACHUSETTS
ZIP Code:
01566
Board of health permit obtained:
O Yes -'Not Required
Permit Number: Date Issued:
1 of 1 6/2/2020, 11:41 AM
Well Driller - Monitoring Form- Transaction #1199418
littps://edep.dep.niass.gov/eDEP/WebFoiins/WeIlDriller/WELLD...
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Well Driller Program
Well Completion Reports(Monitoring)
Well Driller - Monitoring Form
DRILLING METHOD
Overburden[Direci Push ',Bedroc --Choosy Betlrock�
WELL LOG OVERBURDEN LITHOLOGY
Fram(ft)
To(ft)
Code
Color
Comment
Drop in drill
stem
Extra fast or
slow drill rate
Loss or addition of
fluid
V J
�J
Brown
`YES NO
[Fast Sfow.
---1
Loss Atldton�Dalale
Urban Fll_ _
3
115
Send And Gravel
� emfvn l
1
YES _ NO (LFast
Slow
L ss Atldpion l
_..
Delete
PERMIT INFORMATION
DEP 2IE RTN#
DEP Groundwater
Discharge#
ADDITIONAL WELL INFORMATION
Developed
'-'Yes•'No
Surface Seal Type
Fcednent
Total Well Depth
Ed
__ _ [
CASING f is Casing above ground?i
From
1
SCREEN I_i No Scree
F�rom�>
Are these wells nested? '>Yes IN.
Area of group(sq. It) L_..
Depth to Bedrock ii
To
Type
Thickness
Diameter
IDelete
��
PalyNnYl Chloride (
Scheduie4a ......._.'
12 ,. _-�
-..
Type
Slot Size �Oiameter��
ITo
L15 _l
Slotted PVC
1 _._1
12
Delete
WATER -BEARING ZONES
ANNULAR SEAL/FILTER PACK
From
To
Material V>
Weight
Weight
Water (gal)
Batches
Method Of Placement
'.�
Native Maleriaf
I�
W
rDelete
3te
ChpslPellets
',�
i
��
I
�-
Gravity
Delete
[Sand _.
�_
r _ ]
—
Gravty I
Delete
WATER LEVEL 1
Dale Measured Static Depth BGS (it)Flowing Rate (gpm)
COMMENTS
Maximum Characters(200)
1 of 2 6/2/202n 1 f •41 AM
Well Driller - Monitoring Form- Transaction #1199418
https://edep.dep.mass.gov/eDEP/WebFotins/WeIlDriller/WELLD...
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.
__
Driller ALFREO gLLEN _ jRegistration N 560 Monitoring (M] _ ;Supervising Driller Signature 1ZORK, MARK(
Firm TECHNICAL ORILORRig Permit# 592 Date Job Complete 05/13l'2U20
NOTE: Well Completion Reports must be fled by the registered well driller within 30 days of well completion.
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