HomeMy WebLinkAboutWInthrop Ave. #20 - 5/1/2015Massachusetts Department of Environmental Protection 15—1 7
Bureau of Resource Protection
�'- Well Completion Reports
Well Driller
Please specify work performed
IN Well ._._ ...I
Please specify well type:
(Monitoring
Number Of Wells:
I1
Well Location
In public right-of-way:
yes Kb
Subdivision/Property/Description:
Property Owner:
Engineering Firm:
COMMON SENSE ENVIRONMENTAL
Address at well location:
Street Number: Street Name:
20 WINTHROPAVENUE
Building Lot#: Assessor's Map #:
Assessor's Lot#: ZIP Code:
Cityrrown:
MANSFIELD
GPS (GPS for the deepest well)
North: West:
42.01811 71.13343
Mailing Address:
Lr click here if same as well location addres�
Street Number: Street Name:
38 ELM
City/town: State:
NEW BEDFORD MASSACHUSETTS
ZIP Code:
02740
Board of health permit obtained:
r Yes G Not Required
Permit Number: Date Issued:
L - I
Massachusetts Department of Environmental Protection
Bureau of Resource Protection —Well Driller Program
0 Well Completion Reporfs(Monitoring)
Well Driller - Monitoring Form
DRILLING METHOD
Overburden Auger I Bedrock Choose Bedrock --
Bedrock
WELL LOG OVERBURDEN LITHOLOGY
From(ft) To(ft) Code Color Comment Drop in drill Extra fast or Loss or addit
(stem slow drill rate fluid
I0 115 .,_) Medium Sand . Brown �, I C YES C Np I_C- Fast Slow f r Loss C
PERMIT INFORMATION
DEP 21E RTN # DEP Groundwater Discharge #
ADDITIONAL WELL INFORMATION
Developed Yes
G Nol
Are these wells nested?
C Yes C No
—C
Surface Seal Type (Cement
Area of group (sq. ft)
Total Well Depth 15
Depth to Bedrock
CASING [ r Is Casing above ground?j
From To Type
Thickness
Diameter
Polyvinyl Chloride....
Schedule 40
SCREEN I r No Screer♦
From"> To
Size
Diameter
5 . _ _._) I15 _.._�
olled PVC
L Slotted _
( I
_.._�
—Slot
1Z:
WATER -BEARING ZONES
From To Yield (gpm)
1 I _I L __]
ANNULAR SEAL / FILTER PACK
From
To
Material 1 Weight
Material 2 Weight
Water">
(gal) Batches Method Of Place
_
(O
._..
113
r
� Native Material �-' I--__�
---Choose Material--- _ Lr .. ---
�—
I I----- ) �__� Gravity.
_.._
I3
I14
) �Bentonile Chips/Pellets . C.
_� --Choose Material--- _ I _
� _ � (.,. Gravity
4
15
Sand I
) ---Choose Material--- I _
_� L _----� Gravity
1 _ _
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
[Lil Well Completion Reports(Nloniforing)
WATER LEVEL
Date Measured Static Depth BGS (ft) Flowing Rate (gpm)
105/01/2015 l 18
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.
NEWSHA
Monitoring [M] Supervising Driller Signature
Driller GARY COUETTE Registration # 606 PETER,
W
TECHNICAL
DRILLING Date Job Complete __
Firm SERVICES, INC. Rig Permit # 67 o51ot/2015
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.