23 CHESTNUT STREET - WELL COMPLETION REPORT Massachusetts Department of Environmental Management 2 c6
f Office of Water Resources
TYPE OR PRINT ONLY Well Completion Report
1.WELL"LOCATION ;: GPS (OPTIONAL) "_° ' "LATITUDE "' LONGITUDES • - - •- x5MV_R' s
Address at Well Location: Property Owner:
'Subdidision Name: Mailing Address:
City/Town: City/Town: car.:. M A-
Assessors Map Assessors Lot#: NOTE:Assessors Map and Lot# mandatory rf no street address available
Board of Health permit obtained: Yes LAY Not Required El Permit Permit Number��-�� D Iss ed
2.WORK PERFORMED xs : " 3:PROPOSED USE S ''j� . .; » 4 DRILLING METHOD
New Well ❑ Abandon ❑ Domestic ❑ Irrigation ❑ Cable a_ ` ❑jAuger R
❑ Deepen ❑ Recondition KiY9onitoring ❑ Municipal _ ❑ Air Hammer *-C7-BtPect Push
❑ 'Replace El Other ❑ Industrial ❑ Other ❑ Mud Rote -'�',❑ Other
5. WELL LOG S' m- CC Unconsolidated Consolidated 6.,SITE SKETCH (use peimenent 6ndr6dm with Aistances)
W Penmbility ,� y
`m
From (ft) To (ft) High Low f4 N m Other Rock Type a
v x > 131
7.WELL9CONSTRUCTION ElvZ 8 CASINO= „' :kh 2 ' 'x `
x
..
4 w
Total Depth Drilled From (ft) To (ft) Casing Type;and Material Size O.D. (in) Well Seal Type
Date Drilling Complete O
�-23-mss
m m s
9. SCREEN. R Z ,u",ZI-?.. 3r^ :.,..aTM •" 'i ;..:, .°'
From (ft) To (ft) Slot Size Screen-Type and Material Screen Diameter
• vA V
10. FILTER PACK'/GROUT!ABANDONMENT;MATERIAL 11 ADDITIONAL WELL INFORMATION
Developed? ❑ Yes No
From (ft) To (ft) Material Descriptions)` Purpose Fracture
0,5' C, "� Enhancement? ❑ Yes 4f1-0
Method
Disinfected? ❑ Yes Vo
12 WELL TEST DATA'(PRODUCTION WELLS) `, 1; 4,e w. IV-xtAW 13 STATIC WATER LEVEL(ALL WELLS) P, ;
Yield'-Time Pumped Drawdown to Recovery
to Depth Below
(
Date Method GPM) .+ (hrs&min Ft. BGS) (his & min) Date Measured Ground Surface (FT)
14. PERMANENT PUMP(IF AVAILABLE) - €fir: `Z:K ,I...: , 15 NAMEIADDRESS OF PUMP INSTALLATION COMPANY"
Pump Description '��� Horsepower
w'��` _
Pump Intake Depth ,- (ft) Nominal Pump Capacity (gpm)
16. COMMENTS ,. Nv�
17. WELL DRILLER'S STATEMENT„, .' ' This well was drilled and/or abandoned under my supervision, according to applicable rules
and regulations, and this reit - compete and correct to the best of my knowledge.
Driller: /'x.11 �f'`r"'� Supervising Driller Signature: /y/ � Z— �_Registration #:i
Firm: EnviC 1 L-C— Date: Rig Permit#:
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
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1C." OF SALEM
BOARD OF HEALTH
# ^1Vlassachusetts Department of Environmental Management 112361
f Office of Water Resources
TYPE OR PRINT ONLY -;k Well Completion Report
1. WELL LOCATION `ri=I GPS(OPTIONAL) LATITUDE = --" a LONGITUDE m `<-
Address.at Well Location: 3 6ANA Property Owner:
Subdivision Name: Mailing Address: `22 C `{v S
CitylFowm Sr �e,V: Ciry/Town: leh G 1g)o'AN
s.
Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no, treat address available
��,.,��,� l-p
Board of Health permit obtained: . -Yes 1 Not Required F-1Permit,Number� Date Isseued�r.
2. WORK PERFORMED, 3.PROPOSED USE !-W&'14i DRILLING METHOD.
New Well ❑ Abandon ❑ Domestic ❑ Irrigation ❑ Cable ❑;Auger
❑ Deepen ❑ Recondition 0�%.Monitonng ❑ Municipal ❑ Air Hammer$'15; 6irect Push
❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ MUd'ROta - `❑ Other
5. WELL LOG ¢ Unconsolidated Consolidated 6. SITE SKETCH(Use permanent lsndmerk,wM dlat.n )-
W Pem�bft
>
m a e
From (ft) To (ft) High Low n Co 0 g m Other Rock Type qqy /y
V{V/ OL
7.WELL CONSTRUCTION ,t 8."CASING
f '�
Total Depth Drilled From ft To (ft) Casing Type,a"d
Material '.Size-0.D. (in) Well Seal Type -
Date Djrilling Complete
ihAg
8. SCREEN : ':#: u wir" •k a. : axa
From (ft) To (ft) Slot Size Screen.Type and Material Screen Diameter w a
0\0 Yv C-
...� 1W."FILTER PACK!GROUT!ABANDONMENT MATERIAL ' ,rx ° 11':ADDITIONAL WELL INFORMATION
From (ft) To (ft) Material Descriptio n Purpose Developed? EJ Yes K No
Fracture
f, Enhancement? ❑ Yes U5-<o
�. i ,. Method E: s
/ Disinfected? ❑ Yes t-No
12. WELL TEST DATA'(PRODUCTION WELLS) _."_ R4 a
13 STATIC WATER LEVEL(ALL WELLS)
Yield `iTime Pumped Drawdown to Time Recovery to Depth Below
Date Method (GPM) (firs&min) (Ft. BGS) (hrs•& min) (Ft. BGS) Date Measured Ground Surface (FT)
M
14. PERMANENT PUMP(IF AVAILABLE). _ v r 73:NAMFJADORESS OF PUMP INSTALLATION COMPANY` '•_
Pump Descriptions Horsepower
:�.,
Pump Intake Depth - (ft) Nominal Pump.Capacity (gpm)
16.COMMENTS
17.'WELL DRILLER'SSTATEMENT s This well was dolled and/or abandoned under my.supervision, according to,applicable.rules
and regulations, and this re rt is,/Conn
y plate and correct to the best of my knowledge.
Driller: '/� � _ Slel` Registration #:I
Firm: 111C Date: "�o���s — Rig Permit#: I
=' NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
BOARD-OF'HEALTH.COPV s ' ,.'3-; *.q:fir..`it:st = H '. ,, ,-•'i <
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PI'V"' 2 4 2005
DITY OF SALEM
BOARD OF HEALTH
Massachusetts Department of Environmental Management
Office of Water Resources 112360
TYPE OR PRINT ONLY f k" /Well Completio&Report
ro tiros..rxs '.>r:h:wc� .n a _ , •.'m:
1. WELL LOCATION.,= GPS (OPTIONAL) TITUDE LONGITUDE
Address at Well Location: a 3 C he-5 n ial S 4 Property Owner: Sea LAA V
Subdivision Name: Mailing Address: µ W �4
5 rte- `7
Citylfown: SAC..t_✓l/�-' 1�-�' City/Town- I�� � . /�'1i� � /�r"s . ;
Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot'# mandatory Jf no street address available F
Board of Health permit obtained: Yesy Not Required ❑_ Permit Number001-05 Date'Issued z G
2. WORK PERFORMED' ' " ," _ ;_ 3_PROPOSED USE °x't= �_ < 3 4, 4,DRILLING METHOD•Nay is �.e 3
New Well ❑ Abandon .,,. ❑ Domestic ❑ Irrigation ❑ Cable `-jiVE];Auger
Deepen ❑ Recondition Monitoring EIMunicipal EIAir Hammer. t Direct Push
ElReplace E] Other Industrial E] Other ❑ Mud(RotaT JJ E] Other'
5. WELL LOG ir Unconsolidated Consolidated 6:SITE SKETCH(Usepermenemiai+"arks"wue`aistm es)s
W PenneaNiity m T
From (ft) To (ft) tType
High p
1 tp` $J'k
fff
7.,WELL CONSTRUCTIONS, .' S.CASINGy
Total Depthbrilled Z From (ft) ;;To (ft) Casing Ty'pearid Material Size O.D. (in) Well Seal Type
Date Drilling Complete (0 1 KfS- coa- 0-PV
qj, Seo—PvG i
9.SCREEN ' ' >_ p..s. _ e r} •_ .. a " r s r 3r,:
From (ft) To (ft) Slot Size Screen-Type and Material Screen Diameter.
Z / O, O/v, S,G l-j"-,yo J G / :.
10 -PACK/GROUT/ABANDONMENT;MATERIAU-f-.Oz '
... .", IVADDITIONALI WELL,INFORMATION " ui
a Developed? ❑ Yes 0 No
From (ft) To (ft) Material Description Purpose Fracture
No
Enhancement? ❑ Yes. >r
D Cj .S ' .
Method
" Disinfected? ❑ Yes CQ7 No
12.WELL TEST DATA(PRODUCTION WELLS)!
ri p 13. STATIC WATER LEVEL'(ALL WELLS)
t YieldTirrie Pumped Drawdown to Time Recovery to t Depth Below
Date Method (GPM) (hrs"& min) (Ft. BGS) (hrs& min) (Ft. BGS) Date Measured Ground Surface (FT)
14. PERMANENT PUMP(IF"AVAILABLE) 15:NAMFJADDRESS OF PUMP INSTALiAflDN CDMFANY:e
Pump Descri tion`'
p Horsepower '
'r. Pump Intake Depth °R ~' (ft) . Nominal Pump Capacity
(Qpm)'
;s
16."COMMENTS j
17.WELL DRILLER'S STATEMENT. r '- This well was drilled and/or abandoned under my supervision, according to applicable rules {
r.' and regulations, and this r%:is complete and correct to the best of my knowledge.
Driller. � w �� ^� Supervising Driller Signature: /^/ Registration #:I I
Finn: ` A/� ICAtTl'e Date: Rig Permit#: I I I
.' NOTE.- Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
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CITY OF SALEM
BOARD OF HEALTH