HomeMy WebLinkAboutNorth Main St. #408 - 5/11/2015iS
Massachusetts Department of Environmental Protection
Bureau of Resource Protection
� Well Completion Reports
Well Driller
Please specify work performed:
Address at well location:
New Well
Street Number: Street Name:
408 NORTH MAIN STREET
Please specify well type:
Building Lot#: Assessor's Map M
I
(Monitoring_.,,,_
Assessor's Lot#: ZIP Code:
Number Of Wells:
1
____�� __
City/Town:
Well Location
MANSFIELD
In public right-of-way:
GPS (GPS for the deepest well)
f Yes G No
North: West:
._—._._.__.._......
42.02060 71.13104
Subdivision/Property/Description:
Mailing Address:
r click here if same as well location addresA
Property Owner:
Street Number: Street Name:
21 B
City/Town: State:
Engineering Firm:
BURLINGTON MASSACHUSETTS
EBI
ZIP Code:
01803
Board of health permit obtained:
r Yes r 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 Direct Push _I Bedrock
WELL LOG OVERBURDEN LITHOLOGY
-- Choose Bedrock
From(ft) To(ft) Code Color Comment Drop in drill Extra fast or Loss or addit
stem slow drill rate fluid
- -
15 Coarse Sand �.. Brown �', !' YES f NO [(-_Fast r Slow C Loss C
PERMIT INFORMATION
DEP 21E RTN # DEP Groundwater Discharge #
ADDITIONAL WELL INFORMATION
Developed I !' Yes 6 No Are these wells nested?
Surface Seal Type Cement Area of group (sq. ft)
Total Well Depth 15 Depth to Bedrock
CASING Lr is Casing above ground'.
From To Type
16, = [5= I Polyvinyl Chloride �!
SCREEN I r No Screen
From"> To Type
I5 --_ _1 15I Slotted PVC
WATER -BEARING ZONES
From To Yield (gpm) I
ANNULAR SEAL I FILTER PACK
Thickness Diameter
Schedule 40 �..I r2
Slot Size �Diameter
n
From
To
Material 1
Water"> Weight Material 2 Weight (gal) Batches Method Of Place
0
3
Native Material .
--- Choose Material— +i Gravty
3
I4
Bentonite Chips/Pellets .
---Choose Material --- . Gravity
4
5
Sand
Choose Material w Gravity
Massachusetts Department of Environmental Protection
Bureau of Resource Protection — Well Driller Program
0 Well Completion Reports(Monitoring)
WATER LEVEL
Date Measured Static Depth BGS (ft) Flowing Rate (gpm)
(05/11/2015 I I10 ��
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.
Monitoring [M] Supervising Driller Signature NEWSHA
Driller BRETT BALYK Registration # 606 PETER, W
TECHNICAL
DRILLING Date Job Complete
Firm SERVICES, INC. Rig Permit # 70 05/11/2015
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.