HomeMy WebLinkAboutChauncy St. #235 - 4/9/2003Massachusetts Department of Environmental Management Office of Water Resources ` 108799
TYPE OR PRINT ONLY Well Completion Report
1. WELL LOCATION
GPS OPTIONAL) LATITUDE UONGITUDE '
Address at Well Location:..-135 (.'Aat" c St +k rota ebod
Subdivision Name: (frupos ec9 &nk Mailing Address: d `ti 7ed aid Lo'2L (k
Cityrfowrr -' Z I' n 5- iit'ldl Al a City/Town: A—IQrA fingg 'Lea IV A) �
Assessors Map Assessors Lot #: NOTE: Assessors Map and Lot # mandatory if no street address available
Board of Health permit obtained: Yes ❑ Not Required ❑ Permit Number Date Issued
Z WORK PERPORMI=b
3. FL OPOSED't1SE, 4. DRILLING METtIOD.
ElNew Well ❑ Abandon
❑ Domestic ❑ Irrigation ❑Cable❑ `Auger
❑ Deepen ❑Recondition
i Monitoring ❑ Municipal ❑ Air Hammer ❑ Direct Push 1
❑ Replace ❑Other
❑Industrial ❑ Other ❑ Mud Rota ❑' Other Z�, r %,' >' •
5. WFLL LOO' ".
m
uJ
Permeability
Unconsolidated
D
E
Consolidated
"
From (ft) To (ft)
Q
High
Low
`o
a
m
Other
Rock Type
a' -
a
puma 8tua '
yi
Ear � 4f
taw Pi
(
01
' AGit iru
0
a,5
A
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7.`WELL CONSTRUCTION
'.
S..CASING
.
Total Depth Drilled
From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type
Date Drilling Complete
Q
Sy .
C d/ I e o L<C
`l� i i t?
174
9.SCREEN
From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter
' 5 . a 0 . C "-V1- o Pvc. ai
10. FILTER PACK! GROUT /ABANDONMENT MATERIAL
11. ADDITIONAL WELL INFORMATION
Developed? ❑Yes C] No
From (ft) To (ft) Material Description Purpose
Fracture
Enhancement? ❑ Yes ❑"No
Method
Disinfected? ❑ Yes L No
5 G
t• CL d h
I %+,eF
b n t` .r'
er1
72 WELL TEST DATA(RR,4DUCTION WELLS)
13_ STATIC WATER LEVEL
(ALL WELLS)
Yield Time Pumped Drawdown to Time Recovery to
Depth Below
Date Method (GPM)' '>,.(Ins & min) (Ft. BGS) (Ins & min) (Ft. BGS)
Date Measured
Ground Surface (FT)
9 I -3
14. PERMANENT
PUMP (IF
AYAILABLI)
.:
15. NAMEIADDRESSiOF PUMP INSTALLATION COMPANY
Pump Description &Z4 Horsepower
a
Pump Intake Depth - (ft) Nominal Pump Capacity (gpm)
16,"COMMENTS„ 1�5 Yw^�rtt.Tkxtr`vaI ('or'° I,��lyAAW (Z/,S—/V,6
17, WELL DAILLER'S STATEMENT This well was drilled and/or abandoned under my supervision, according to applicable rules
and regulations, and this report is complete and correct to the best of my knowledge.
Driller: r t51 OU; //C ffiZ Supervising Driller Signature: . < Registration #: ( 41
Firm: co' 1-n C Date: Rig Permit #: LiL12 (Oa
NOTE. Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
BOARD OF HEALTH COPY