HomeMy WebLinkAboutBranch St. #235 - 6/25/2007Massachusetts Department of Environmental Management
Office of Water Resources 113942
TYPE OR PRINT ONLY Well Completion Report
1. WELL LOCATIQN ' .
GPS (OPTIONAL). LATITUDE ''LONGITUDE
Address at Well Location: f �Yi i2 (!&a7lCG1 0/)" Property Owner f19sul�It o
Subdivision Name � J� (lr�-l--tS�Yff Mailing Atldres r�� I�(An')�%�f� r+'�r%t
City/Town: d"!(1i7571��Cd, f`�t (J/��ti� , City/Town: f_, /f� 9` W)1&006
Assessors Map Assessors Lot #: NOTE: Assessors Map and Lot # mandatory if no street address available
Board of Health permit obtained: Yes' ❑ Not Required 0 Permit Number Date Issued
2, WORK PERFoRHIEO . 7 77%
7 PROPO51 U:IJSE`
; A. DRILLING METHOD
❑ New Well ❑ Abandon
❑ Deepen ElJE1
El'Re lace ❑ Other
❑ Domestic ElIrrigation
0 Monitoring El Municipal
Industrial ❑Other
ElCable IN Auger
❑ Air Hammer , El Direct Push
❑ Mud Rotary ❑ Other
5. WELL 11-66
Ir
NPermeability
High
Low
°
Unconsolidated
m
s
m
m
Other
Consolidated
Rock Type
S. 91T ;SKETCH, (use peonanent landmarks wah'dioinnes)
/V/
From (ft) To (ft)
CJ
16
is,
I x
7. WELL CONSTRUCTION
$.
CASING
,
Total Depth Drilled
From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type
DateDfi!ing �plpte
/
�.,.7 /
%
' .-.
'(rj"."; d) - C�
9. SCREEN
From (it) To (ft) Slot Size Screen Type and Material Screen Diameter
// / . C>fo a PUf ,. tr
10. FILTER PACK GROUT/ ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION
From (ft) To (ft) Material Description Purpose Developed? ❑Yes I--] No
Fracture
lGJ r Od r/ Enhancement? El Yes ❑ No
13rl l i°p�i - Method
Disinfected? ❑ Yes ❑ No
12. WELL
TEST DATA (PRODUCTION \HELLS).
-13. STATIC WATER LEVEL
(ALL WELLS)
Yield Time Pumped Drawdown to Time Recovery to
Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (Ft. BGS)
Depth Below
Date Measured Ground Surface (FT)
14. PERMANENT PUMP (IF:AVAILABLE)
t$. NAMEIADDAESSOFPUMPINSTALLATION COMPANY
Pump Description Horsepower
Pump Intake Depth Nominal Pump Capacity (gpm)
/J(4)
16. COMMENTS lam,// 7 In 7, > 4
17. WELL DRiLLER'$-$TATEI+IENT `, This well was drilled and/or abandoned under my supervision, according to applicable rules
and regulations, and this report is c mpf�te and p)rrect to the best of my knowledge.
<t, � t E9 �
Driller: ?i) Gl;l Cii917lrc/ Supervising Driller Signature: 1W7' /I Registration#:1 1�1;1e'It
I
Firm: C'�I�` �/r o. Cl S r(, Date:. ��- � Rig Permit #:
NOTE. Well Completion Reports mast be filed by the registered well driller within 30 days of well completion.
BOARD OF HEALTH COPY rr:
dcr
Mw-+sAw�hgsans
, NN
Massachusetts Department of Conservation and Recreation
Office of Water Resources
Well C.021pleti(2n R.epca.rt'1
21-JUN-07 15:24:19
WELL LOCATION 250310
GPS North: 420 .974' GPS West: 710
12.394' 11 ,D
Address:253 , Branch Street
Property Owner/Client: JGI Eastern
Subdivision Name:
Mailing Address: 77 Sundail Avenue, 'tql U4'Mil$ 10�i
City/Town: Mansfield
City/Town, State:Manchester NH
Assessors Map:
Number:
Assessors Lot #: Permiber:
Board of Health permit obtained:N
Date Issued:
Work Performed Proposed
use Drilling Method Overburden Drilling Method Bedrock
New Well Monitoring - 4 wells
at this location. Auger
CASING
From (ft) To (£t)
Type Thickness Diameter
.00 -2.00
PVC Schedule 40 2.00
SCREEN
From (ft) To (£t)
Type Slot Size Diameter
-2.00 -12.00
Slotted PVC .010 2.00
WELL SEAL
/ FILTER PACK / ABANDONMENT MATERIAL
From (ft) To (ft) Material Description Purpose
.00
-1 Concrete Seal
-1.00
-3 Native Material Fill
-3.00
-4 Bentonite Chips/Pellets Seal
-4.00
-12 Sand Filter
WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS)
Date Method
Yield Time Pumped Pumping Level Time to Recover Recovery
(GPM) (bra & min) (Ft. BGS) (Hrs & Min) (Ft. BGS)
STATIC WATER LEVEL (ALL WELLS)
PERMANENT PUMP (IF AVAILABLE)
Date Depth Below Ground
Pump Description:
Measured Surface (ft)
Type: Intake Depth:
06/11/2007 10
Nominal Pump Capacity: Horsepower:
WELL DRILLER'S STATEMENT
ADDITIONAL WELL INFORMATION
Driller: Darwin Newton
Developed: No Fracture Enhancement:No Supervisor: Marilou Bonetti Rig #: 616
Disinfected:No Well Seal Type:Cement Firm: Soil Exploration Corporation
Total Well Depth: 12.000 Depth to Bedrock: Registration #: 681 Date Complete:06/11/2007
Comments:
OVERBURDEN
From To Description
Color Cement Water LOSS/Add Drill Drill
(ft) (ft)
Zone of Fluid Stem Drop Rate
.00 12.00 Fine to Coarse Sand
Brown Yes N/A No Normal
BEDROCK
From To Code
Comment Water Drill Extra Drill Rust Loss/ # of
(ft) (ft)
Zone Stem Large Rate Stain Add of Frac
Dron per ft
1/1
Office of the Massachusetts State Geologist::Well Driller's On-line Report
Page 1 of 1
1�
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dr0 of Cnnsf! sein
Data entered on: Thu Jun 21 15:27:07 EDT 2007
The well located at 253 Branch Street, Mansfield has a well completion report number of: 250310
Without orthophoto:
IM
http://maps.massgis.state.ma.us/welldrillers/? flowExecutionKey— cOE14ODDC-68B7-99... 6/21/2007
06/11/?RP17, 11:52 113000
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