HomeMy WebLinkAbout201503301209 Massachusetts Department of Environmental Protection
Bureau of Resource Protection
Well Completion Reports
Well Driller --- —
Please specify work performed: '
New Well Address at well location:
Street Number: Street Name:
Please specify well type: 564 CHICKERING ROAD
,Monitoring Building Lot#: Assessor's Map#:
{Number Of Wells: Assessor's Lot#: ZIP Code:
3
Well Location Cltylrown:
NORTH ANDOVER
In public right-of-way:
GPS (GPS for the deepest well)
i' Yes re No
North: West:
Subdivision/Property/Description: 42.69643 71.11927
Mailing Address:
Property Owner: click here it same as well location address'
Street Number: Street Name:
2 SHAKER ROAD
?ngineering Firm: City/Town: State:
VILLIAMSON ENVIRONMENTAL SHIRLEY MASSACHUSETTS
ZIP Code:
01464
Board of health permit obtained:
r Yes're 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 Auger I Bedrock i- 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
0 3 Urban Fill Black o I — C YES Fast Slowi I Loss g^o
t3 10 Silty Sand And Gra ®� Brown z YES {` 1\10 C` Fast !` Slow Loss
PERMIT INFORMATION
DEP 21 E RTN# DEP Groundwater Discharge#
ADDITIONAL WELL INFORMATION
Developed r Yes C: Nol Are these wells nested? i r Yes ro Nol
Surface Seal Type Cement Area of group(sq.ft) 350
- -
Total Well Depth 10 Depth to Bedrock
CASING Is Casing above ground?j
From To Type Thickness Diameter
Schedule 0 a 2 2 -�
i
SCREEN No Screen
From"> To Type Slot Size Diameter
- — - --
2
110 Slotted PVC 0.010 2
(._
WATER-BEARING ZONES
From To Yield(gpm)
ANNULAR SEAL/FILTER PACK
From To Material V5 Weight Material 2 Weight Water(gal) Batches Method Of Place
10 Choose Matenal--- l I �__. _ 1 Gravity -
0 0 5 Cement/Bentonite Grout
�0 5 1 Bentonite Chips/Pellets �--Choose Material--- I Gravity
Massachusetts Department of Environmental Protection
LA Bureau of Resource Protection—Well Driller Program
Well Completion Reports(Monitoring)
N
4
Sand - — --� - - - - -
1 10 ®� i ---Choose Matenal -
- o Gravity
WATER LEVEL
Date Measured Static Depth BGS(ft) Flowing Rate(gpm)
1 -
12/02/2014 3.i
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 BONETTI,
Driller GEORGE GUINTO Registration# 681 M MARILOU,
SOIL EXPLORATION Date Job Complete
Firm CORPORATION Rig Permit# 442 12/02/2014
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program
Well Completion Reports(Addendum)
Well Driller ® Addendum Form
WELL COMPLETION ADDENDUM FORM MONITORING WELLS
Well ID Well Depth Screen Interval FROM Screen Interval TO GPS Coordinates(WGS 1984)Degree Decimals
�2 10 2 10 North: 42.69631 West: 71.11912
I° _ r F_ North: 42.69603 West: 71.11949
P_ W IO P- P_,_ North: 00.00000 West: 00.00000
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.