HomeMy WebLinkAboutPratt St. #157 - 4/19/2007Massachusetts Department of Conservation and Recreation
Office of Water Resources
TYPE OR PRINT ONLY Well Completion Report A
1. WELL LOCATION
I GPS (Required) North A- -2 --LL �. ' —0 L, —-:I-West -7 . T 7 �777'
Address at Well Location: Property Owner/Client: N (, 0: -P r Ly'
Subdivision Name: Mailing Address: 1-10 o 6) Lr 41� 6
City/Town: %f City/Town: /1A I -),!I IL
Assessors Map Assessors Lot #: NOTE: Assessors Map and Lot # mandatory if no street address available
Board of Health permit obtained: Yes 0 Not Required Permit Number — Date Issued
2. WORK PERFORMED
3. WELL TYPE
4. DRILLING METHOD
6. CASING
IF]HEOverburden
IT]
Bedrock
From (ft) To (ft) Type Thickness Diameter
151 M
El
El
I
E100
5. WELL LOG
OVERBURDEN
Water
Bearing
Zone
Los s or
Addition
of Fluid
Y N
Drop in
Drill
Stem
Y N
4x�� or
Drill Slow Rate
F S
F-1 F-1 0
LITHOLOGY
7.SCREEN
From (ft) To (ft) Type Slot Size Diameter
Frorp (ft) To (ft)
Code Color Comment
J
Y N
Y N
F S
1:1 El El
El El 0
Y N
Y N
F I S
8. ANNULAR SEAL/IFILTIER PACK/ABANDONMENT MTL.
Y N
Y N
F S
From (ft) To (ft) Material Description Purpose
Y N
Y N
F S
Op
I
Ou
Y N
Y N
F S
[A, El
AD
Y N
Y N
F S
El M;
E] Ell
Y N
Y N
F S
WELL LOG
BEDROCK
Water
Bearing
Zone
Drop in
Drill
Stem
Extra
Large
Chips
I
Extra
Fast orLITHOLOGY
Slow
Drill Rate
visibie
Rust
Staining
Loss or
Addition Fractures
of Fluid
ri of
e�
per foot
9. SITE SKETCH
pj
`IJ
From (f) To (f)Code
Comment
Y NY
NF/S
Y N
Y N
Y NY
N
F/S
Y N
Y N
k Y
(56
Y N
Y N
F S
Y N
Y N
UD
Y N
Y N
F S
Y N
Y N
Y -N
Y N
F S
Y N.Y
N.
Y N
Y N
IF S
Y N
Y N
Y N
Y I N
F S
Y N
Y N
Y N
I Y / N
F S
Y N
Y N
IY
=
F S
Y N
Y N
F S
Y N
Y N
10. WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS)
11. STATIC WATER LEVEL (ALL WELLS)
Yield Time Pumped Pumping Level Time to Recover Recovery
Depth Below
Date Method (GPM) (hrs & min) (Ft, BGS) (hrs & min) (Ft. BGS)
Date Measured Ground Surface (ft)
12. PERMANENT PUMP (IF AVAILABLE)
13. ADDITIONAL WELL INFORMATION
Pump Description ❑❑❑❑Horsepower
Developed Y lejy Fracture Enhancement Y
Pump Intake Depth (ft) Nominal Pump Capacity — (gpm)
Disinfected Y /(�) Surface Seal Type El H 0-
Total Well Depth i 4 Depth to Bedrock
14. COMMENTS
15. WELL DRILLER'S STATEMENT This well was drilled, altered, and/or abandoned under my supervision, according to applicable
rules and regulations, and thus report is complete and Correct to the best of my knowledge.
Driller: Supervising Driller Signature: Registration
Firm: Date Complete: Rig Permit #:
NOTE.- Well Completion Reports most be filed by the registered well driller within 30 days of well Completion.
BOARD OF HEALTH COPY