HomeMy WebLinkAboutMiscellaneous - 623 TURNPIKE STREET 1/11/2016 Massachusetts Department of Environmental Protection
Bureau of Resource Protection
Well Completion Reports
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Well Driller
Please specify work performed: Address at well location: JNl
New Well Street Number: Street Name:
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623 TURNPIKE
Please specify,well type: Building Lot#: Assessor's Map#:
Monitoring
Assessor's Lot#: ZIP Code:
Number Of Wells:
1
City/Town:
Well Location NORTH ANDOVER
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In public right-of-way: GPS (GPS for the deepest well)
Yes , No North: West:
42.39839 71.06793
Subdivision/Property/Description:
Mailing Address:
Cclick here if same as well location address)
Property Owner: Street Number Street Name
451 P O BOX
City/Town: State:
Engineering Firm: EXETER NEW HAMPSHIRE
EXETER ENVIRONMENTAL ZIP Code:
03833
Board of health permit obtained:
_j°Yes ji Not Required
Permit Number: Date Issued:
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Massachusetts Department of Environmental Protection ❑
Bureau of Resource Protection—Well Driller Program
} Well Completion Reports(Monitoring) n
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
10 I10 I Fine To Coarse San 6 Brown 6 �, [j,YES j NO i ,j Fast J, Slow _fit Loss j
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PERMIT INFORMATION
DEP 21 E RTN# DEP Groundwater Discharge#
ADDITIONAL WELL INFORMATION
Developed Yes $ No I Are these wells nested? Yes , No
Surface Seal Type Cement Area of group(sq.ft)
Total Well Depth 10 Depth to Bedrock
CASING ( ,�:Is Casing above ground?j
From To Type Thickness Diameter
Polyvinyl Chloride Schedule 40
0 2 Pol F 1 6 I L
u n F1 c
SCREEN I c No Screen
From"> To Type Slot Size Diameter
12 -� 110 Slotted PVC 6
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WATER-BEARING ZONES
From To Yield(gpm)
F1 ❑ ❑
ANNULAR SEAL/FILTER PACK
From To Material V5 Weight Material 2 Weight Water(gal) Batches Method Of Place
10 I I1 Native Material 6', L -Choose Material--- 6 Gravity
1 10 Sand 6 Choose Material--- 6 Gravit
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program ❑
Well Completion Reports(Monitoring) ❑
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WATER LEVEL
Date Measured Static Depth BGS(ft) Flowing Rate(gpm)
112/17/2015-1 19 --- ----�
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
Driller ERIC BOUCHER Registration# 606 Monitoring[M] Supervising Driller Signature PETER,W
TECHNICAL
DRILLING Date Job Complete
Firm SERVICES, INC. Rig Permit# 70 12/17/2015
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.