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160 FEDERAL STREET Massachusetts Department of.Conservation and Recreation Office of Water Resources 160692 TYPE OR PRINT ONLY Well Completion Report I. WELLLOCATION3 GPS (Required) North _7° __T___ AT- W -7 West 7 C S -q--, 3 S ea Address at Well Location: 160 Fo,8e/nl S+ Property Owner/Client: 5 eDh's Schoo( Subdivision Name: Mailing Address: o ern�l5 Cityrrown: —smem . /Ufa City/Town: SOdern Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot#mandatory if noosst ett,address available- Board of Health permit obtained: Yes E] Not Required d Permit Number Da t',IsssNe 2:WORK PERFORMED 3r WELL°TYPEI ,,,, 4.DRILLING METHOD ?'« 6.'CASING ElOverburden Bedrock From(ft) To (ft) Thickness Diameter I 0 © ❑ ❑ 6 a1 tE"®U` S,ti ci I / S. WELL LOG)t OVERBURDENExtra ❑'❑❑ Water Loss or Drop in Fast or AN-"'❑❑❑ LITHOLOGY" Bearing Addition Drill From(ft) To (ft) Code Color Comment Zone of Fluid Stem Dolow Rate 7. SCREEN P. ''-o >- u t�IV ,F a c Y / N Y / N ri / a From(ry)"To(ftJ\` Type Slot Size Diameter t( $ NS RL Y / N Y F oZ ti3 PSR. Y / N Y / N F / S ❑❑❑ I. - - - Y / N Y / N F / S : 6, ANNULAR SEAL/FILTER PACKIABANDONMENT;MTL' Y / N Y / N F /;5, From(ft) To(ft) Material Description Purpose Y Y F_ ) d ®© ®, ] Y / N Y / N 1 / $ +�o�L /2 ©® EILI Y / N Y / Nr(�70//iSC � El El I El El Y / N Y //N� S El El 1 ❑❑ WELL LOG`' BEDROCK Water Drop in Extra �' Ysible Loss or a of 9:SffE SKETCH LITHOLOGY Bearing Drill Large Sol wr"'JRust Addition FractimisFGda'+ck.l$'F' From (ft) To (ft) Code Comment Zone Stem bnll Rate Staining of Fluid per toot _ Y / N % N F�/ S Y / N Y / N Y / NY,/jNF / SY / NY / N Y/ N Y`/-114 F / S Y / N Y / N Ib0` � Yj/'WY / N F Y / N Y / N {;eZval YtfaNY / N F Y Y 5+• Y%`NY / N F Y Y Y-% NY / N F Y Y AyY / NYlNF / SY / NY / N Y / N Y / N F / S Y / N Y / N ` Y / NY / N FS Y / N Y +_MW1°( 10. WELL,TEST DATA'(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS),7,e s 11:'STATIC WATER LEVEL(ALL WELLS) Yield ,Time Pumped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) (tus& min)' (Ft. BGS) (his&min) (R.BGS) Date Measured Ground Surface (ft) I Am 4 I��rD9 12 PERMANENT:PUMP(IF,AVAILABLE) ; ° ,' "3 _ x "'. r f� 13.ADDITIONAL WELL INFORMATION ". ;.=xr. Pump Description ❑rEYO ❑ Horsepower Developed Y / NDFracture Enhancement Y AD Pump Intake Depth (ft) Nominal Pump Capacity (gpm) Disinfected Y /O Surface Seal Type ❑ 14.COMMENTS a Total Well Depth Depth to Bedrock N/A 15. WELL DRILLER'S STATEMENT_2222ej This well was drilled, altered, and/or abandoned under my supervision, according to applicable s, rules and regulations, and this report is com fete and correct to the best of my knowledge. Driller tis IjArnIot Supervising Driller Signature: Registration #:19 19 67 M I Firm: 4 lt.. TAC. Date Complete: al Rig Permit#: I I I I I NQS WeU,Complehaa Reports'must befded,by:the,registered weU driller within 30 days of weU completion.. y •`f'I R! i• r f 13 ! F!! r •f f I f' T f 1 f . i. !f-I f t! r •.. • . a a I , e a I• ! f •'BOdRO'OP}IEALTH *C' Well Completion Report Codes seaoal Section 2 Section 3 - Section 4 Work Wellt Y , t Drilling Work Performed Type I Method Performed Code _ Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH , Deepen DP Domestic DMST Air Rotary " AR Hydrofracture HF Geoconstruction GCON Auger AG New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA A Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP /,/ Irrigation IRRG Drive and Wash DW A�(,'►� t/' Monitoring MONT Dug DG `TW� ,. Public Water Supply PBWS Mud Rotary MR! ,- C/ a Recovery RCVR Reverse Rotary RR �O,�op� Test Wells TSTW Sonic SN �meq`; Section 5 Section 6 Overburden I I ICasing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Calor Code Bedrock Name (BR Code) -Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 a Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown BR Conglome ate/Breccia CG/BR Galvanized Pipe UP Schedule 40 # Coarse Sand CS Dark Gray DG Diorite DIHDPE HDP Schedule 80 Cobbles C 4 Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 # ' Fine to Coarse Sand FCS Reddish Brown RB Granite GR Stainless Steel SST SDR 17 Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 L , Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite OZ SDR 32.5 }' Sand&Gravel SG Rhyclite RH SDR 40_ p' Silt SI Sandstone SS 17# Silty Clay _ SICL Schist SC 19# Silty Sand SIS -' Shale SH Silty Sand 8 Gravel STSG Slate/Phyllite SL/PH- Till ; T Pegmatite PM Section 7 Section 8 Section 10 1 L Annular Seal/Filter Screen Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type Code Pack/Abandonment Material Code Purpose Code Method Code Carbon Steel CST Bentonite Chips/Pellets BC Fill FL Air Blow with Drill Stem AB Continuous Wire PVC CWP Bentonite Grout BG Filter FT Air Lift AL Galvanized Wire Wrapped GWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP - + Concrete CT Constant Rate Pump CR Pre-pack PUC PPP Sand SO Variable Rate Pump VR Pre-pack Stainless PPS Native Material NM Slug SG Slotted PVC SLP Stainless Steel Vee Wire SSV Stainless Steel Well Point SSP Section 12 Section 13 t' Pump Description Well Seat Pump Description Code Horsepower Surface Seal Type Type Code 3 Wire Variable Speed Submersible 3WVS 112 20 Cement CM 2 Wire Variable Speed Submersible 2WVS 3/4 25 Cement/Bentonite CB 2 Wire Constant Speed Submersible 2WSS 1 30 Concrete CT 3 Wire Constant Speed Submersible 3WSS 1 1/2 40 None NO Constant Speed Submersible Turbine CSST 2 50 Variable Speed Submersible Turbine VSST 3 60 Jet JET 5 75 Line Shaft Turbine LST 7 112 100 Centrifical CENT 10 125 15 .150 200'. .. ,