HomeMy WebLinkAboutPratt St. #17 - 1/23/2001Massachusetts Department of Environmental Management
Office of Water Resources 113993
TYPE OR PRINT ONLY Well Completion Report
1, WELL LOCATION
GPS (OPTIONAL) LATITUDE ' L011OITUDE
Address at Well Locatir: /7 r Gtye,ct Property Owner. & ,/ee J 5kivif® -` We,h
Subdivision -Name` �r's7f�i'.71f Mailing Address:'. rC :icy
City/Town: f?u l.. f 1W City/Town: ct pr 'e'% 9,60 '" 6 9$
Assessors Map Assessors Lot If: NOTE' Assessors Map and Lot tt mandatory if no street address available
Board of Health permit obtained: Yes ❑ Not Required TZ Permit Number Date Issued
2.11VgRK'PER�ORMER ; `ffDomestic
USE
ii}LING METHOD
❑ New Well ❑ Abandon
❑ Deepen ❑ Recondition
❑ `Re lace ❑ Other
❑ Irrigation
❑ Municipal
❑ Other
❑ Cable Auger
❑ Air Hammer ❑ Direct Push
❑ Mud Rota ❑Other
S.,WELL 1,9Ca' �, � �
'
¢
W
H
Q
Permeability
High
Low
N
—
Unconsolidated
a
W
>
d
g
g'
Other
Consolidated
Rock Type
6, R�T���ETCH (usepeT.L t landmarks with distances)
N%11
From (ft) To (ft)
7, WELL CONSTRUCTION'
'.
8.
CASING
Total Depth Drilled /t/
From (ft) To (it) Casing Type and Material Size O.D. (in) Well Seal Type
Date Drilling Complete °
9.SCREEN
e,! /
" j
2-
From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter
g
ill. FILTER PACK / GROUT;/ ABANDONMENT MATERIAL � .�
From (ft) To (ft) Material Description Purpose
t). ADDITIONAL WELL INFORMATION
Developed? ❑ Yes ❑ No
Fracture
Enhancement? ❑ Yes ❑ No
Method
Disinfected? ❑ Yes ❑ No
12. WELL
TEST DATA (PRODUCTION WELLS)-
. �N.
;14, STATIC WATER LEVEL (ALL WELLS)
Yield Time Pumped Drawdown to Time Recovery to
Date Method (GPM) " (hrs & min) (Ft. BGS) (hrs & min) (Ft. BGS)
Date Measured
Depth Below
Ground Surface (FT)
14 PERMANENT PUMP (IF
AVAILABLE)
.1$, NAMEIADDflESS'AF PUMP INSTALLATION COMPANY
Pump Description Horsepower
Pump Intake Depth (ft) Nominal Pump Capacity (gpm)
75. COMMENT$', ' l ��' /%I c'7"`�%b� ���. I c,"s�✓i c`�j, /�
17_wELL D{� LER�SSTATIuIENT This well was drilled and/or abandoned under my supervision, according to applicable rules
and regulations, and this repo colm�p)�Jt�( n clorrac�to the best of my knowledge.
Driller:�� � �� Supervising Driller Signature: �s i v �r ' f Registration #: ( Sj 6
Firm: 4 J /I! bl1l/mlS _�//o, Date: ') r ' �Q- Riq Permit#:
NOTE. Well
Completion Reports must be
filed by the registered well driller wit tin 30 days of well completion.
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:;:BOARD OF HEALTH COPY..