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Home My WebLink About0383 WHEELER ROAD - Health (2) -383 Wheeler,Road', IVlarstons Mills n \, I �,I _.Massachusetts Department of Environmental Management 114362 l_J Office of Water Resources TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION GPS(OPTIONAL) LATITUDE LONGITUDE Address at Well Location:3.873 Property:Owner: Co 17-Is Subdivision Name: Mailing Address: �� '/6'oX Cit /Town: My/STo.•s n%+ , e r��. o oc �� $ City(fown: GS�duw, �o Mu o rY3o 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 O d OO ST Date.lssued' a 2.WORK PERFORMED 3.PROPOSED USE 4. DRILLING METHOD L New Well ❑ Abandon Domestic '❑ Irrigation ❑ Cable Ef;Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer ❑ Direct Push ❑ 'Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud'Rota ❑ Other 5.WELL LOG oC Unconsolidated Consolidated 6.SITE SKETCH (use permanent landmarks with distances) kPermeeability a — v d �, l �r__ From (ft) To (ft) `� cis E� m Other Rock TypeJ _ ,Y t RE cr9VED 7'.WELL CONSTRUCTION 8.CASING r From A To ft "_Total Depth Drilled 3' Ow. ( } Casing Type and Material Size O.D. (in) . TpWW�I S&tP3tE - Date DrillingC mplete� C) c 9. SCREEN From (ft) To (ft) Slot Size F Screen Type and Material Screen Diameter 60 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11.ADDITIONAL WELL INFORMATION T_ , Developed? ElYes ElNo From (ft) To (ft) Material Description . Purpose Fracture Enhancement? ❑ Yes ❑ No . Method Disinfected? ❑ Yes ❑ No 12.WELL TEST DATA(PRODUCTION WELLS) 13. STATIC WATER LEVEL(ALL WELLS) Yield.,'e'�T►me Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) (hr's&min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) /Yva Y7� 14. PERMANENT PUMP(IF AVAILABLE) 15.NAMEJADDRESS OF PUMP INSTALLATION`COMPANY Pump Description � �` Y✓ Horsepower Pump Intake Depth '`- (ft) Nominal Pump Capacity (gpm) 16. COMMENTS ` 17. WELL DRILLER'S STATEMENT This well was drilled and/or abandoned under my supervision, according to applicable rules and regulations, and this report is"co plete and correct to the best of my kno ledge. w Driller: - Supervising Driller Signature:� = Registration n Firm:ODA #. Iltu Date: 7/00A Rig Permit#: L P 16 NOTE Well Completion Reports must be filed by the registered well driller within 30 days of well completion _h r. 6 M1 ?k"..p y y." S '1-ri% S T -"f T 9 4"'c B• 4 •.t3 e M1 r $OARD OF:HEALTH COPY £ c V x � rs+ +F^ s- E k?� c' ♦ '. t i ' t ' ar a - r ". Yl ' 4 • .if Y . tiki, 44{lSr c45 ♦ r .