CRESCENT DRIVE MONITORING WELLS Massachusetts D ent of Environmental Managem �t/
fice f Water Resources �"7"��` 132989
TYPE OR PRINT ONLY Well C mpletion Report
1.WELL LO_CATON GPS (OPTIONAL)+ ATI E -- s;9., - LONGITUDE - ?'t eY *- " r
Address aYWefl Location:_ —`Y _ '�! t,4rbV4-Propprty Owner: ftdvl� l F
Subdivision Name'-� p - -j'Wglfifig Address.
City/Town: a39f /_ City/Town:
Assessors MapAssessors Lot : NOTE: Assessors Map and Lot # and tory l no streetdd
aress.available
Board of Health permit obtained: Yes f1� Not Required ❑ Permit Number La Date Issued
2. WO PERFORMEDs , u, x 3: ,_PROPOSED:USE r ' , Y ^ x_k „ 4. DRILLINGMETHODIn)
New Well El Abandon ❑ ntestic ❑ Irrigation ❑ Cable ,r " $ r
le El Deepen EJ Recondition Monitoring ❑ Municipal ❑ Air Hammer' , Direct Push
❑ Re lace ❑ Other ❑ Industrial ❑ Other ❑ Mud-Rota ,❑ Other-
5:
ther5°WELL"LOG") '4 cz Unconsolidated Consolidated 6r SITE SKETCH (use Permanent 6n-dmg-u wim-aistAces)'
W Permeability
Q m m p.19
From (ft) To (ft) High Low g m Other Rock Type
7. WELL"CONSTRUCTION8 CASING
Total Depth'Drilled From ft To ft Casing TYend-Material Size O.D. (in) Well Type
Date Dri mg C le E uta t(!t�•
9. SCREEN%. _,V4A q ^� a :.'> •• .sr . . :a ;:-
From (ft) To (ft) Slot Size Scree`nyType and Material Screen Diameter
O`10
10. FILTER PACK/GROUT/ABANDONMENT,MATERIAL",- " gem ii ADDITIONAL"WELL INFORMA ION fm
From (ft) To (ft) Material Descr � v Purpose Developed? EJ Yes No
p ii n
Fracture
Enhancement? El Yes No
Method
(t Disinfected? ❑ Yes o
12.WELL`TEST=DATd'(PRODUCTION WELLS) , e, 13. STATIC WATER LEVEL(ALL;WELLS)`'
Yield `NTime Pumped Drawdown to Time Recovery to Depth Below
Date Method (GPM)"(hrs;&min) (Ft. BGS) (firs & min) (Ft. BGS) ate Measured Ground auqace (FT)
14. PERMANENT PUMR(IF AVAILABLE)t `k�t� t,.mow, - " a '' 15.NAMEIADDRESS OF.PUMP MISTALLATIONCOMPANY
Pump Descriptions'"*� Horsepower
Pump Intake Depth $ Nominal Pump Capacity (gPm
)
16. COMMENTS
17.WELL D L R'S A MENT.55n' ` IlThis well was drilled and/or ab done under my supervision, according to applicable rules
and regulations, and this rep i o an rfect to the best of my knowledge.
Driller: ` J Supervising Driller Signature: (� Registration #: I SI-4I
Firm: 1CZtl l nl St CLS .TIC. Date: &&) / Rig Permit#: I I
NOTE. Well Completion Reports must be filed by the registered wel d 'ler within 30 days of well completion.
BOARD OF HEALTH COPY
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OCT`13'2004 ' ` O' '
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LEM
BOARD OF HE
4CITYOEALTH
• �.Kv-� 1 141 , /Y {`
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TECHNICAL DRILLING SHRVYCYi.S, Y
SEP 2 8 2004
CITY OF SALEM
'Boa An ` r' 1 lEALTH
FACSIMILE TRANSMITTAL SHEET
O ROlL
vv� � • Q . � h
MPANY: ATB:
'S t OQ p, - 3y
AX KUNOER� ZOTAL NO.OF PAGES INCLUDINO WYM
❑URGENT Vojt REYIEW 0nBA&R4wmmErT OnsASE]t8I'LY CTrLRASERECYCL8
NOTESICOMNBNTO:
Y.O. BOX 10 - STERLING, MA 01564
PRONNi (775) 0220000 - FAX, (070) 0It-0006
- i
CITY OF SALEM$CARD 01;14EAUR
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GlIon pan"it ARR AM
Date: 9 1 t4 WSW Ch0*peye6te to the Mof Sawn{na ash}
Location: Ci2£St NC lAc.' Pol Gkaa�t Salem;mk 0970
OWfret: JN6'lltt lYitir)hi�!�AfFdt85sIL�bAlsA y. aunuc�eL t8/ •2f 6'`t3rof
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Type of well-t SAM.ifS' Vtjt Welt ase lV1ot9MIi d1{sr .
Wellconractur. Tt351.10c. PumpConVactor �1A
Address; of,Ttt- beAoCtsltxt(#J*rth Address:
Phone: 97g Hai •eco Phone;
Rea.s: Sb*
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to the mace p/owdW below 1e 06 taad{t straw th IMWI a of dm. wea Aw"6 h 60
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m Intersection of Crek*d and Sudtmir Street Figure 2 Aya>6
�`' Sslem, 7vlessachuseris ELIYIT♦ItRlel�dl
Technologies, Inc.
64mmsety to
Release Ana Slaetch qmn,Met sachusetls. srrso
Note: Locations of utilities are approximate.
Refer to onmite Digsaf:taarkiogs fdr exact
locations of utilities.
Residems
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- - - - - - .- - - - - - - - - - Sidewalk
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C DRIVE a
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gs Crich Basin , - {V-- Nater LineI& Utility Pole Dam: 04127/04
_ Overhead Elecirk Line ---8---- Sewer Line Proposed Well
File:012466
N ♦ Location Compiled By: 8C
m ---F.'- Naooal Gras Line -Sp-_. Stom Drain Line Drafted By: BC
Not to Scale
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