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HomeMy WebLinkAbout0240 PARKER ROAD - Health 24 Parker Road btk:cor X U b -*7--jo W. Barnstable A = ? e 0 a RECEIVED Massachusetts Department of Environmental M nagement �21901 Office of Water Resources TYPE OR PRINT ONLY Well Completion Report JUN 13 2003 t 1 -WELLfLOCATION ;g GPS.,(OF?TIQNAL} LAT[TUDE � , .L Address at Well Location: Property Owner .Subdivision Name. Mailing Address: t�r-� - if �r City/Town: City7Town. Assessors Map Assessors Lot'# NOTE: Assessors Map and Lot #.mandatory if noi Itreet address available 200 Board of Health.permit obtained. Yes Not Required El �n1 Permit Number s�'$�Ate.Issued � v3; 2 Ol'tK PERI=ORIUIE[)" ' "3 PROPOSEDUS � 4`[DEiILLING METHOD j � >. _ s � .. . :_ -. ... New Well ❑ Abandon EV Domestic ❑ Irrigation Q Cable Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal Q Air Hammer ❑ Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other Mud Rota ❑ Other 5 WELL`LOG ,` [C Unconsolidated Consolidated 6 SIT,SKETCH (use permanent landriiarks'wrcn;d+star es) = W Permeability N a - Ca From (ft) To (ft) High Low `� L3 m Other Rock Type --3v " t=-Nt-C _ 01 7 WELL COfVSTRUCTION 'k 1wo' Total Depth Drilled From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type Date Drilling Complete 4- ey, 9 SCREEN '�`x+` s$- A.r . .,,.', ;n. .. .:P �:.., r.i > d �°2 �,xl 1.�,�...'�`..��..re, �,�,- �,:,s. ,.t ;-.:.;'".s_..�,'�°• .�-r:�t ��,�.„€�+kro `,._ sc�;�,'s From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter 10 FILTER PACK/GROUT 1 ABANDONlV1E1VT MATERIAL ;:11 ADDITIONAL WELL INFORMATIONS , � �� Developed? � EYYes ❑ No From (ft) To (ft) Material Description Purpose Fracture Enhancement? ❑ Yes WNo Method Disinfected? I es ❑ No 1;2 WELL TESL DATA; PRObUCTION WELLS a 13 STATIC WATER LE�/EL,ALLY WELLS Yield , Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) &I� -14 PERMANENT PUMP IF AVAILABLE ,` '�� i _ 15;NAMEIADDRE$S OF PUMP INSTALLATION_COMPANY Pump Description Q G-r"'G 2�S Horsepower ilk _ # 1 i %Y. Pump Intake Depth - .zL1a (ft) Nominal Pump Capacity (gpm) 16"`CON1MEPttS �, ' 17 WELL DRILLER S STATEMENT This well was drilled and/or abandoned under my supervision, according to applicable rules and regulations, and this repo :s complete and correct to the best of my knowledge. Driller:� j � �ai� r�( Supervising Driller Signature:f�f/ L�u� >l s„� Registration #: Firm: - 77 �i _l1 T , I 1 , =-r - Date: (� — Rig Permit#: 2� U� NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD OF HEALTH COPY RECEIVE® Massachusetts Department of Environmental M nagerrient 21901 Office of Water Resources .- TYPE OR PRINT ONLY well Completion Report. J U N 13 2003 1. WELL LOCATION GPS-(OPTIONAL) LATITUDE LIMO , 9 Address at Well Location �'� f�e:!i•- �r- ( . Property Owner. ' '' r Subdivision Name Mailing Address ry " { CitylTovvozx t,"r►t r P~ 00� 3 Assessors Map Assessors Lot# NOTE: Assessors Map and L-ot# rriandatory if no street ad"dre'ss available Board'of:.Flealth„permit obtained'' Yes. Not Required ❑ , Permit Number W070?r`dl&ate.lssued- w, ,.2. OR PER - " 3. PROPOSED.USi: 4 DRILLING 1VIEiT IOD New Well ❑ Abandon EY Domestic ❑ Irrigation E`Cable -X EN,Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal [Ij Air Hammer ''E Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other M Mudlhota "s ❑ Other 5. WELL LOG oC Unconsolidated Consolidated 6. SITE SKETCH (Use permanent landmarks with distances) W. Permeability F— Ca a a ro -0 From (ft) To (ft) � High Low `� U) 0 m Other Rock Type J, ,�. FIAf214 G72.. 2c>A1> - 7.WELL CONSTRUCTION 8. CASING a` From ft To ft Casing T` Wand Material Total Depth Drilled �� O O 9 YP 4 : �Size O.D. (in) Well Seal Type _ Date Drilling Complete '(- it 9. SCREEN From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter =Y 10. FILTER PACK!GROUT l ABANDONMENT MATERIAL_ 11. ADDITIONAL WELL INFORMATION Developed? Yes ❑ No t From (ft) To (ft) Material Description°_ Purpose Fracture Enhancement? ❑ Yes En/110 Method Disinfected? Yes ❑ No 12. WELL TEST DATA(PRODUCTION WELLS) 13. STATIC WATER LEVEL(ALL WELLS) Yield Tiine Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) _'`(hr's-8 min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) Ftfyn 14. PERMANENT PUMP (IF AVAILABLE) v . r 15.NAME(ADDRESS OF PUMP INSTALLATION COMPANY Pump Description t cfs 1 GAG- ©5 Horsepower JIQ Pump Intake Depth -`' ' (ft) Nominal Pump Capacity L (gpm) }Pr> ©r-1,!Se�rx:5 16. COMMENTS 17.WELL DRILLER'S STATEMENT This well was drilled and/or aba doned under my supervision, according to applicable rules and regulations, and this repo s complete and correct to the best of my knowledge. 1 Driller. ` -1� t�� Supervising Driller Signature: f v� �+ Registration #:1 171 Firm: D _L r _— , Date: Rig Permit#: Z NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. BOARD OF HEALTH COPY. T TOWN OF BARNSTABLE '- UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION . 7 � OWNER•AND INSTALLER INFORMATION pi ADDRESS: Ala MAP NO. PARCEL NO. Z' " OWNER NAME: b`�r y INSTALLATION DATE: i BY: /Z-' ADDRESS: t~ r° ' `, C "� `"f+ `"L a. CERT. NO. TANK INFORMATION q LOCATION..,OF—TANK: hr Moo r ?1 =�_ FL%CHEMICAL= - - _- - _-- - TESTING CERTIFICATION I I T>ASS E ] FAIL' DATE LEAK DETECTION E ,] CHECK IF N/A TYPE/BRAND - ZONE OF CONTRIBUTION E ] YES C ] NO DATE. TO BE REMOVED FIRE DEPT. PERMIT ISSUED E ] YES E , NO DATE CUNSERVATION 'Ejq.] CHECK IF N/A DATE BOARD ,OF. HEALTH TAG NO.i ' ]E ]E 31 7 DATE SOS' PLEASEIPROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD t1 + Y