HomeMy WebLinkAboutCopeland Dr. #70 -12/5/2018Well Driller- Transaction #998489
https://edep.dep,mass.gov/WebForms/WeIlDriller/ WeIlDriller_Select.aspx
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Well Driller Program
Well Completion Reports
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Well Driller
Please specify work performed:
Address at well location:
New Weil
Street Number: Street Name:
70 COPELAND DRIVE
Please specify well type:
Building Lot#: Assessor's Map #:
Monitoring _.
Assessor's Lot#: ZIP Code:
Number Of Wells:
City/Town:
Well Location
I MANSFIELD I
In public right-of-way:
GPS (GPS for the deepest well)
�9 Yes (-) No
North: West:
42.01702 _ 71.13693,.__
Subdivision/Property/Description:
0
Mailing Address:
❑ click here if same as well location add
Property Owner:
Street Number: Street Name:
C_�
2 MERCHANT _)
City/Town: State:
Engineering Firm:
SHARON MASSACHUSETTS_
ENVIROTRAC
ZIP Code:
22067
Board of health permit obtained:
Yes O Not Required
Permit Number: Date Issued:
1 of 1 3/7/2018, 1:47 PM
Well Driller - Monitoring Form- Transaction 4998489
https:Hedep.dep.mass.gov/WebForms/WeIlDriller/WELLDRILLER—...
Massachusetts Department of Environmental Protection
Bureau of Resource Protection— Well Driller Program
Well Completion Reports(Man/lodng)
Well Driller - Monitoring Form
DRILLING METHOD
Overburde Auger Bedrock�_choose Bedrock--
WELL LOG OVERBURDEN LITHOLOGY
From(k)
To(ft)
Code
Color
Comment
Drop in drill
stem
Extra fast or
slow drill rate
Loss or addition of
fluid
10
Boulders
Light Gray
��
YES NO
II
Fast Slow _ _ 1
( Loss Addition J
Delete
10
1 =I
Cobbles
Light Gray
1 yES NO
�ast Slow J
Loss Add
Delete
PERMIT INFORMATION
OFF 21E RTN N DEP Groundwater Discharge H
ADDITIONAL WELL INFORMATION
Developed
'Yes s No_
Surface Seal Type
_.
Cement
Total Well Depth
1�
CASING ❑IS Casingaboveground
From
0
SCREEN ❑No Scree
From">
WATER -BEARING ZONES
Are these wells nested?
Area of group (sq. it) '
Depth to Bedrock
To
Type
Thickness
Diameter
� �
rPolyvinyl Chloride _
Schedule 40
2
Delete
To
Type
Slot Size
Diameter
15
Slotted PVC
�
__Delete
(From ITO IYleld (gpm) I
Delete
ANNULAR SEAL I FILTER PACK
To
Material l">
Weight
Material
Weight
Water (gal)
Batches
Method Of Placement
Native Material
�
—Choose Material---
��
�i
��
,Gravity_ - 1
Delete
®
Senlon to Chips/Pellets
--Choose Mat al __,'i
L__I
L�
Grav ly._�
Delete
i
Choose Material
�
�
__
Gav tY�
Delete
From
10 FT
F
Date Measured Static Depth BGS (ft) Flowing Rate (gpm)
COMMENTS
Maximum Character5(2UB)
I of 2 3/7/2018, 1:47 PM
Well Driller - Monitoring Form- Transaction #998489 https://edep.dep.mass.gov/WebFonns/WeIlDriller/WELLDRILLER—...
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 BRETT DALYKlRegistration# �GOG Monitoring lMl JSupervising Dole, Signature NEWSHAM PETER, Vu
Firm TECHNICAL DRILLING Rig PermitN G9 Date Job Complete tgpryypgip
NOTE: Well Completion Reports must be fled by the registered well driller within 30 days of well completion.
2 of 2 3/7/2018, 1:47 PM
Well Driller- Transaction #1071385 https:Hedep.dep.mass.gov/eDEP/WebForTns/WeIlDriller[WellDrill...
Massachusetts Department of Environmental Protection
�— Bureau of Resource Protection — Well Driller Program
Well Completion Reports
ti+b
Well Driller
Please specify work performed:
Address at well location:
Decommissioned
Street Number: Street Name:
70 ICOPELAND DRIVE
Please specify well type:
Building Lot#: Assessors Map #:
Monitoring_ __
Assessor's Lott: ZIP Code:
Number Of Wells:
Cityrrown:
Well Location
MANSFIELD
In public right-of-way:
GPS (GPS for the deepest well)
Yes R No
North: West:
42.01701 71.13693
Subdivision/Property/Description:
0
Mailing Address:
Fr click here if same as well location addres I
Property Owner:
Street Number: Street Name:
��
2 _ __MERCHANT
City/Town: State:
Engineering Firm:
ISHARON IMASSACHUSETTS
ENVIROTRAC
ZIP Code:
02067
Board of health permit obtained:
e Yes o Not Required
Permit Number: Date Issued:
I of 1 12/13/2018, 11:14 AM
Well Driller - Decommission Form- Transaction #1071385
https:Hedep.dep.mass.gov/eDEPAVebForms/WeIlDriller/WELLD...
Massachusetts Department of Environmental Protection
Bureau of Resource Protection— Well Driller Program
Well Completion Reporls(Decommission)
Well Driller - Decommission Form
WELL INFORMATION
Date Decommissioned 12/05/2018
Depth of Decommissioned Well 15
ADDITIONAL INFORMATION (IF AVAILABLE)
Original WCR#torDeco
_......
r r
Well
Well ended in formation type
Bedrock
Wass new
Wasanaw well drilled?
r"Ves WCR#for New Well
r
,Overburden
DEP 21E Site#
—:�DEP Groundwater Discharge If
CASING
Casing Type
1391xvpsiChloride Casing Diameter
[22�
Was casing nipped or
Was Casing left in place? Fr Yes ra No
perforated? Ves No
Were obstructions left In
thewell?
if yes, what type? --Choose Description--
Surface Seal Type Cement
DECOMMISSIONING MATERIAL
From ft(BGS)
To ft(BGS)
Material 1
Weight
Material 2
Weight
Water (gal)
Batches
Method Of Placement
0
15
Bautonite Grout
O
...Choose Material--
O
O
O
Gravity
WATER LEVEL
Date Measured
Static Depth BGS (ft)
Flowing Rate (gpm)
COMMENTS
Maximum Characters(300)
WELL DRILLERS STATEMENT
This well was dotted or altered under my direct sups vislon, according to the applicable rules and regulations, and this report is complete and accurate to the best of my
knowledge.
Driller BRETTBALYK ReglsValion# 580 Monitodng(M) =SupeMsing Driller Signature: ZORK, MARK,_
Firm TECHNICALORILLINCRIg Permit# ag Date Job Completeif2/OS/2018
NOTE: Well Completion Reports must be filed by the registered well dollar within 30 days of well completion.
' of 1 12/13/2018, 11:14 AM