HomeMy WebLinkAboutMiscellaneous - 37 ALCOTT WAY 3/7/2016 Massachusetts Department of Environmental Protection
Bureau of Resource Protection
Well Completion Reports
Well Driller
Please specify work performed: Address at well location:
INew Well Street Number: Street Name:
7 ALCOTT WAY
Please specify well type: Building Lot#: Assessor's Map#: ECEIVED
Monitoring
Assessor's Lot#: ZIP Code: R "I A �0 r)
Number Of Wells:
� TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
City/Town:
Well Location NORTH ANDOVER
In public right-of-way: GPS (GPS for the deepest well)
0 Yes j No North: West:
42.39837 71.07049
SubdivisionlProperty/Description:
Mailing Address:
click here if same as well location address
_.... ..............
Property Owner: Street Number: Street Name:
446 MAIN
Cityffown: State:
Engineering Firm: WORCESTER MASSACHUSETTS
TIGHE AND BOND ZIP Code:
01608
Board of health permit obtained:
J,Yes I" Not Required
Permit Number: Date Issued:
Massachusetts Department of Environmental Protection ❑
Bureau of Resource Protection-Well Driller Program ❑
L i
Well Completion Reports(Monitoring) ❑
Well Driller - Monitoring Form
DRILLING METHOD
Overburden (Direct Push Bedrock Choose 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
(O 1 115 ( Fine To Coarse San 6 Brown 6 YES �; NCl - Fast , Slo] Loss
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PERMIT INFORMATION
DEP 21 E RTN# DEP Groundwater Discharge#
ADDITIONAL WELL INFORMATION
Developed C ,Yes J, No Are these wells nested? 4 Ye�
Surface Seal Type Cement _I Area of group(sq.ft)
Total Well Depth 15 Depth to Bedrock
CASING c Is Casing above ground?'
From To Type Thickness Diameter
10 15 Polyvinyl Chloride 6 Schedule 40 6 �2
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SCREEN I .No Screen'
From"> To Type Slot Size Diameter
15 -� 115 - Slotted PVC 6
Ll ❑ ❑ ❑ ❑
WATER-BEARING ZONES
From !! To Yield(gplm)
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ANNULAR SEAL/FILTER PACK
Water
From To Material V5 Weight Material 2 Weight (gal) Batches Method Of Place
0 3 Native Material _ ---Choose Material--- 6 Gravity
3 4 Bentonite Chips/Pellets 6 Choose Material--- 6 Gravity
1 I =1
14 15 Sand 6, ( ---Choose Material--- 6 Gravity
I --- —
F r n
n n n n n
Massachusetts Department of Environmental Protection Lj
Bureau of Resource Protection—Well Driller Program El
Well Completion Reports(Monitoring) ❑
,t
WATER LEVEL
Date Measured Static Depth BGS(ft) Flowing Rate(gpm)
103/07/2016 1 (10
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 TYLER NEWTON Registration# 606 PETER,W
TECHNICAL
DRILLING Date Job Complete
Firm SERVICES, INC. Rig Permit# 65 03/07/2016
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.