HomeMy WebLinkAboutWest St. #1007 - 11/24/2014Massachusetts Department of Environmental Protection
Bureau of Resource Protection
s ' Well Completion Reports
Well Driller -- --r NOV 2 4 ZU14
Please specify work performed: Address at well locationSY._,v., �__ _
New Well Street Number: Street Name:
1007 WEST STREET
Please specify well type: Building Lot#: Assessor's Map #:
(Monitoring
Assessor's Lot#: ZIP Code:
Number Of Wells:
i2
CityRown:
Well Location MANSFIELD
In public right-of-way: GPS (GPS for the deepest well)
Yes C., Noi North: West:
42.02082 71.26361
Subdivision/Property/Description:
ST. GREGORY CHURCH Mailing Address:
r click here if same as well location address
Property Owner: Street Number. Street Name:
166 RAYMOND HALL
DRIVE
City/Town: State:
Engineering Firm: NORTH MASSACHUSETTS
ATTLEBOROUGH
NORTHEAST GEOTECHNICAL ZIP Code:
02760
Board of health permit obtained:
C Yes t. Not Required,
Permit Number: Date Issued:
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
Well Completion Reports(Monitoring)
Well Driller - Monitoring Form
DRILLING METHOD
Overburden Auger I Bedrock i-Choose Bedrock
WELL LOG OVERBURDEN LITHOLOGY
From To(ft) Code Color Comment Drop in drill Extra fast or Loss or addition of
(ft) stem slow drill rate fluid
-- SAND SILTY SAND
0 12 Ftne To Coarse Sand �i8rown f' YES ND r Fast r Slow' Loss C Addition!
12 25 'Boulders __. Black... __.. WEATHERED ROCK' f- YES r NO' I C Fast C Slow r Loss f Addition
PERMIT INFORMATION
DEP 21E RTN # DEP Groundwater Discharge #
ADDITIONAL WELL INFORMATION
Developed Ali r Yes r Nol Are these wells nested? (' Yes r Nol
Surface Seal Type Cement Area of group (sq. 8) 50
Total Well Depth 25 Depth to Bedrock
CASING r Is Casing above ground?[
From To Type
0 10 (Polyvinyl Chloride
SCREEN No Screen'
From To
10 25
Type
(Slotted. PVC _.. _....
WATER -BEARING ZONES
Yield
From To
(gpm)
ANNULAR SEAL / FILTER PACK
From
To
Material I
0
1
Cemenl/Bentonite Grout
1
6
'Native Material
6
8
lBentonite Chips /Pellets
8
25
.._
Sand
Thickness
Schedule 40
Slot Size Diameter
0.010 2
Weight Material 2
Choose Material
---
--- Choose Material--
Choose Material --
'--- Choose Material ---
WATER LEVEL
Date Measured Static Depth BGS (ft) Flowing Rate (gpm)
h 1 /14/2014 1 0
Diameter
2
Water
Weight (gal) Batches
Method Of Placement
(Gravity _.
i
Gravity
Gravity
(Gravity �a
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
Well Completion Reports(Monitoring)
COMMENTS
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 GEORGE GUINTO
SOIL EXPLORATION
Firm CORPORATION
Registration # 681
Rig Permit# 442
Monitoring [M] Supervising Driller Signature SONETTI,
M MARILOU,
Date Job Complete `11114/2014
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Well Driller Program
I`.' Well Completion Reports(Addendum)
IT • _ • • III
WELL COMPLETION ADDENDUM FORM MONITORING WELLS
Screen
Well ID Well Depth Interval
FROM
4 20 10
0 0 0
Screen GPS Coordinates (WGS 1984) Degree
Interval TO Decimals
20 North: 42.02070 West: 71.26355
0 North: 00.00000 West: 00.00000
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.