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162 FEDERAL STREET Massachusetts Department of.Conservation and Recreation Office of Water Resources 160680 TYPE OR PRINT ONLY Well Completion Report " 1:WELL LOCATION , GPS (Required) North �° �. a ��— West �_° 5 Z Address at Well Location: �--Prle,calSk Property Owner/Client: IAe(WIs Et IUML10n SVC J Subdivision Name: Mailing Address: •o• o r Y9 a2 i S b Cu ho SHtt.. City/Town: so-keM City/Town: lserfrl }}r! Assessors Map Assessors Lot#:_ NOTE:Assessors Map and Lot#mandatory if no streehad�dre s.available Board of.Health permit obtained: rYes O Not Required FT Permit Number DatbJssuedd 2 WORK PERFORMED&�N3.WELL TYPE!*A ,_", ' 4.DRILLING METHOD 11 6:CASING Overburden Bedrock From (ft) To (ft) OcTypeV� Thickness Diameter 5-WELL LOGOVERBURDEN Extra ` w❑❑•❑ Water Loss or Drop in Fast or - .AI N❑E1 LITHOLOGY Bearing Addition Drill - Slow ,, az i ¢ x Zone of Fluid Stem 7.'SCREEN ,c YftA V a> € s i From (ft)-To (ft) Code Color 1 Comment Dnll Rate p L) tin Y / N rcn- Y / N F / S From(ft)aTo(ft)� ° Type Slot Size Diameter N 8 5 LCL (L Y / N Y F / S la LF.S 0- Y / N Y F / S ❑❑❑ ...NN' r-r I ❑❑❑ 1. — 1 D. 15' SLFS f, Y / N Y / N F / S g'ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL` Y / N Y ! N I F /,S , From(ft) To(ft) Material Description Purpose Y / N Y / N F / [Add Y / N Y / N F�kS" ❑fl ®0Y / N Y / Nj �/=SC ❑❑ ❑❑YlN Y /,M 1FIr4s ❑❑ ❑❑s WELLLOG BEDROCK Water Dropin Fxtra Ebra� -V ibles or Rof9."SITE SKETCHLfTHOLOGY Bear ng Drill Large Fast°r �Fiust ition FracturesZone Stem Chips Sbw Staininguid per foot From (ft) To (ft) Code Comment 4�r brill Rate Y / N`Y'iVII,/ S Y / NY / N Y / N,Y4"N F / S Y / N Y X / N '6 F / SY / NY / N YI NY / NF / SY / NY / N I6� /y`YJ1NY / N F / S Y / N Y / N � Y /`°NY / NF / SY / NY / N Y % NY / N F / S Y Y GL YlNY / N FISY / NY / N Y / NY / NF / SY / NY / N Y / NY / N F / S Y Y 10. WELL TEST DATA(ALL'SECT13NS MANDATORY FOR PRODUCTION WELLS)i 1.1.STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) (tus&'min)' (Ft BGS) (hrs& min) (Ft BGS) Date Measured Ground Surface (ft) l `f G 130 109 10 6 ' 12. PERMANENT PUMP,(IF AVAILABLE) „1 a ' -_" 13.ADDITIONAL WELL INFORMATION* Pump Description "VE S'❑ ❑ Horsepower Developek3 / N Fracture Enhancement ❑� Pump Intake Depth - (ft) Nominal Pump Capacity (gpm) Disinfected Y h Surface Seal Type 14. COMMENTS' Total Well Depth. /3 Depth to Bedrock 15. WELL DRILLER'S STATEMENT_ � � This well was drilled, akered, and/or abandoned under my supervision, according to applicable ,„, rules and regulations,and this report is complete and correct to the best of my knowledge. Driller: SPf7k,-n t-i)r a La t Supervising Driller Signature:��r Registration #J K 1� W V4 J _ Firm: Crvvin it r WA '(n.J, r�L Date Com fete: 6 Ri Perri#: � ( L NATE Well Completion,geport must be filed.by the.registered well driller,within 30 days.of weU completion :. :,�� _ ',BOdF2D'OF•)IEt1LTH• . . . ._..__,...... .. ... . ... =.r .. ..,. _ . , , .. . .. COPY, , , . . .. . . . . +.. . . . . , . , . . .... . ., - .,'r`„ Well Completion Report Codes os8aa �� _ Section 2 Section 3 Section 4 Work Well Drilling Work Performed Type Method Performed • Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH Deepen DP Domestic DMST Air Rotary AR Hydrofmclure HF Geoconstruction GCON Auger AG New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement .CA Replacement RE Industrial INDS Core - CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary "RR Test Wells ' - TSTW Sonic SN Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type L" Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Cena-Lok CTL Schedule 5 ' Boulders B^ Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorhe DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 I Fine to Coarse Sand FCS' Reddish Brown RB Granite GR Stainless Steel SST SDR 17 tt Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite OZ SDR 32.5 <" Sand&.Gravel SG Rhyolite PH SDR 40 Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silly Sand SIS Shale SH Silly Sand&Gravel SISG SlatelPhyllite SLIPH Till T Pegmatite PM r Section 7 Section 8 Section 10 Annular Seal/Filler 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 CementlBentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP Concrete CT Constant Rate Pump CR Pre-pack PVC PPP �O Sand SO - Vadable Rate Pump VR Pre-pack Stainless Native Material NM Slug SG Slotted PUC Stainless Steel lee it Stainless Ste SSP P.0% 1 � G. ate.: GxN n C Section 12 Section 13 CSF,. Pump Description Well Seal Pump Description• Code Horsepower Surface Seal Type Type Code 3 Wire Variable Speed Submersible 3WVS 1/2 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 JET51 ' 75 Line Shaft Turbine LST 7 1/2 100 CenMtical CENT 10 125 15 150- 200. Massachusetts Department of Conservation and Recreation Office of Water Resources 160681 TYPE.OR PRINT ONLY Well Complet1OB Report 1.WELL LOCATION GPS (Required) North _�L 4R—' --I-- . a D__ Ll— -West -7— o 5 �,L-. -3--(^ 1- Address at Well Location: fto;t FPr\prW S+- Property Owner/Client: Ult e6u nkhn Svc. w Subdivision Name: Mailing Address: 0• &Y 'V'911 1,5(0 CCAbXY+ S+• a City/Town: )ro nen Cdy/Town: 0)2 U2r/ Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if nois reet,address available44 - Board of Health permit obtained: Yes E Not Required Er Permit Number Daate,lssued ` 2.WORK PERFORMED3:WELL TYPE 4. DRILLING METHOD; 6 CASING', ❑❑❑❑ Overburden Bedrock From (ft) To (ft) Type' Thickness Diameter I N T C El F1 I ❑ g 0 3 cE1®'p' s,ti Bio 5.WELL LOG OVERBURDEN . ^ ��'®,❑ Water Loss or Drop in, LITHOLOGY Bearing Addition Will Fast or � ❑El El ow From (ft) To (ft) Code Color Comment Zone of Fluid Stem D S1 Rate 7.'SCREEN 0 ' . �/ $ Y / N Y /:N =F /.S From (ft)'�T,o'(ft)� Type Slot Size Diameter q (7 SLS - Y / N Y / N F / S S❑©D G /U SLS 2 Y / N Y F • ❑❑❑ - - � ❑❑❑ . — _ _ / "SC-L 2r; Y / N Y / N F / S l 8.ANNULAR SEAL/FILTER PACK/ABANDONMENTMTL'' G Y / N Y / N F /,S From(ftj To (ft) Material Description Purpose Y / N Y / N F Y / N Y / N F.,11/5t rr, IS ©fl ❑ YIN Y / N.{ F,jS, " ❑❑ ❑❑ Y / N Y /rN,�F;/.S� El1:1 ❑❑. WELL LOG BEDROCK 'ExUa: " 9.4 SITE SKETCH;. as.:+ t Water Drop in Extra Visible Loss or #of _ LITHOLOGY Bearing Drill Large Swr'�Rust Addition Fracture From (ft) To (ft) Code Comment Zone Stem Drill Rate Staining of Fluid per foot Y / NYT%N Fa/ S Y Y / N �y Y / NYa/1N- F / SY / NY / N1Pt3 Yti/ NYS/-•N F / S Y / N Y / N• ,t,YjkN,Y / N F / S Y / NY / N lbs �Yj/;N,Y / NF / SY / NY / N Y,/`'NY / N F / S Y / N -Y / N Y^7NY / N F / S Y / N Y / N ry-- * ds �-Y /;:NYI.NF /XISY / NY-/.N - Y / N Y / N F / S Y / N Y / N Y / N Y / N F / S Y / N Y / N 10:WELL';TEST.DATA(ALL SECTIONS MANDATORY,FOR PRODUCTION,WELLS)W, -r 11:STATIC WATER LEVEV(ALU WELLS) Yield Time Pumped _Pumping Level Time to Recover Recovery Depth Below . Date Method (GPM) I rs&min)' (Ft. BGS) (hrs&min) (Ft. BGS) Date Measured Ground Surface (ft) i 06,i 11. '1 12. PERMANENT.PUMP(IF AVAILABLE)-A; M a�*s.?%o*W'j' 5#' ,'� . r9r _ 13."ADOITIONAU WELL"INFORMATION rai 4 � p mp Description0b0'❑ ❑ Horsepower Develope ./ N Fracture Enhancement /(:p Pump Intake Depth (ft) Nominal Pump Capacity (gpm) Disinfected Y /(@ Surface Seal Type '❑©� ; 14. COMMENTS Total Well Depth 1S r Depth to Bedrock ; 15.WELL DRILLER'S STATEMENT t% This well was dolled;"altered, and/or abandoned under my supervision, according to applicable rules and regulations, and this report is complete and correct to the best of my knowledge. Driller. $Cfdol;, "5 Supervising Driller Signature: �xf Registration *�� j lad INP«I Firm: _FdrdA tnr . Date Complete: 7 r ,✓0 — Rig Permit#: NOTA ,Well,Cpmpletia/e,Reports n{usl be. [ed.bydhe,registered-weUdnller wrthin"30 days"of well completion, . , "a + r e r e. ., :'r`:':'x`BOARD'OF•�IEALTH COPY . ... . . ,. .., . �, . . . r les . Well Completion Report Codes 1Ra4a.A_ Section 2 rt - Section 3 _ Section 4 Work Well Drilling Work` Performed Type 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 Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells - TSTW - Sonic SN Section 5 Section 6 Overburden t: Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black RL Amphibolite AM Certa-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 t Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 j Coarse Sand CS Dark'Gray DG Diorite DI HDPE HDP Schedule 80 #I Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NGS 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 Medium Sand MS Marble MA SDR 26 ° •v. y Organics 0 Quartzite QZ SDR 32.5 Sand& Gravel SG _ Rhyolite RH SDR 40 Silt SI Sandstone SS 17# Silty Clay SICL Schist Sc 19# Silly Sand SIS Shale SH Silly Sand&Gravel . SISG SlatelPhyllite SL/PH Till T Pegmatite PM t Section 7 Section 8 Section 10 Annular Seel/Filter I Screen Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type t 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 PUC CWP Bentonhe 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 PVC PPP Sand SO Variable Rate Pump VR Prepack Stainless Pp.�e+"� Native Material NM Slug SG Slotted PVC Stainless Steel V� Stainless Steela SSP F S;Q� ction 12 Section 13 CP Pp00% Pump g0 Description Well Seal 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 314 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 v Variable Speed Submersible Turbine VSST- 3 60 T Jet JET 5 - 75 Line Shaft Turbine LST, ,7 112 100 Centrifical CENT 10 125 15 150 Massachusetts Departrn6t.of Conservation and Recreation Office of Water Resources 160682 TYPE OR PRINT ONLY Well Completion Report 1c WELL"LOCATION GPS (Required) North _�L a o 0 West Address at Well Location: Hoa a Fe rte rc�1 S4-- Property Owner/Client: a 14 A P rrnl,,n CSUc. 1 - . Subdivision Name: Mailing Address: P,U. Qo t 4/9r2 1 /Ste rrr.ho s-r City[Town: Scoey\ City/rown: &ye' 14 � t a. Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot#mandatory if no s rat addr0ss available _ _Board of Health permit obtained: Yes El Not Required � Permit Number Date.lssued 2. WORK PERFORMED,.`, 3 WELL TYPE E. 14. DRILLING METHOD k` 6.CASING P` Overburden Bedrock From(ft) To (ft) ,a TypiaV,,*Thickness Diameter 0 ❑ JEMEE11 © © I ❑ ❑ o to®o' 5:WELL LOG r'. OVERBURDENFx[ra o:o❑ Water Loss or Drop in Fast or Ati ` *E1 El 1-1LfTHOLOGY- - Bearing Addition Drill Zone of Fluid Stem " Slow 7. SCREEN n '-i " �„„, .' From (ft) To (ft) Code Color Comment - Drill Rate m - Y / N Y d N ;F /-S- From(4)'�To(ft)�` Type Slot Size Diameter O ifJo eCnv L1 FS k (okyiq Y / N Y / N F / S 34� ❑®� .21_0 ,l " I1 lSCL C�, Y / N Y / N F / S ❑❑❑ - - - ,wR%V'/''f ❑❑❑ . — I 1 SCl MGG Y / N Y / N F / S 6. ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL. Y / N Y / N I F /,,Sl' From((t) To (ft) Material Description Purpose Y Y F_/�5 ( ©Cl1�❑ Y Y F,1-S* /E/ ©© E7ffl Y Y / Nf7` ///*Sh, El El El El Y / N Y /LN• Fa/S ❑❑ 11M❑ v )s WELL LOG M BEDROCK Water Drop in Extra �,-Ysible Loss or Nof 9• SITESKETCH . `x fast ori :` - - LITHOLOGY Bearing Drill large Slow " Rust Addition Fractu t From (ft) -To (ft) Code Comment Zone Stem Chips-pd�Hate Staining of Fluid per foot :- Y / N'Y %Nt/ SY / NY / N Y / N,Y,%-NF / SY / NY / N Y� N Y1"N F Y Y / N ,11Y,PNY / NF / SY / NY / N ,It -Y, MN -Y / N F Y Y 4111�-Y, /`NY / NF / SY / NY / N `7-4NY / N F Y Y ti.'+ .F •Y /-.N Y /:N F /'s$ Y-/ N Y-/ N Y / NY / NF / SY / NY /N Y / NY / N F / S Y / N Y 10. WELL'TEST;DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 11. STATIC WATER LEVEL(ALL WELLS) Yield Time,Oumk Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) ,.,(hrs 8 min) (Ft BGS) (firs&min) (R. BGS) Date Measured Ground Surface (ft) L -711 /09 11 . 5, 12. PERMANENT PUMP(IF AVAILABLE) 13. ADDITIONAL WELL INFORMATION 't Pump Description ACEO E'❑ ❑ Horsepower Developed(3) / N Fracture Enhancement ©© y Pump Intake Depth - (ft) Nominal Pump Capacity Win) Disinfected Y ( Surface Seal Type 14. COMMENTS Total Well Depth 2 . Depth to Bedrock 15.WELL DRILLER'S STATEMENT This well was drilled, altered,and/or abandoned under my supervision, according to applicable rules and regulations, and this report is comple a and correct to the best of my knowledge. Driller: 'Qc Tia n Itt Supervising Driller Signature: Registration #:Ig 19 0 k-1 Firm: ro=w a 1 Date Complete: — Rig Permit #: I I} I N( W�1�,Completiag,Repor�s-must be.f(ed.by-the registered well driller within,AO,days,of.well completion..... .. . . . + .. ,. - - ...... . . . . .... . . . . . .... .. . .>t „ >>F. . ,B�ARQ`OF•Mi=ACTH COPY .,, Well Completion Report Codes, ssaoa.� Section 2 Section 3 Section 4 Work Well * Drilling f Work Performed Type 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 Replacement RE — Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells TSTW — Sonic SN Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Cera-Lok CTL T Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brawn BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160m Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 I Fine to Coarse Sand FCS Reddish Brawn RB Granite GR Stainless Steel SST SDR 17 Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 Medium Sand MS Marble MA SDR 26 Organics-- 0 Quartzite OZ SDR 32.5 }` Sand&Gravel SG Rhyolile PH SDR 40 d Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silly Sand SIS Shale SH Silty Sand&Gravel SISG Slate/Phyllite SUPH Till — - T Pegmatite PM s t r Section 7 Section 8 Section 10 Annular Seal/Filter Screen Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type Code Pack/Abandonment Material Code Purpose Code Method Code Caton Steel CST Bentonite Chipsl Pellets BC Fill FL Air Blow with Drill Stem AS 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 PVC Sand SD Variable Rate Pump SVR G Pre-pack Stainless Native Material - NM Slug SG Slotted PVC Stainless Ste V Stalnns nt SSP QS � Section 12 Section 13 C;%v 7` Pump O&W Description Well Seal G Pump Description Code Horsepower Surface Seal Type Type Code 3 Wire Variable Speed Submersible 3WVS 1/2 20 Cement CM 2 Wire Variable Speed Submersible 2WVS 314 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 1/2 100 Centrifical CENT 10 125 15 150 200'. , Massachusetts Department of Conservation and Recreation. . _ Office of Water Resources 160683 TYPE OR PRINT ONLY Well Completion Report - 1.WELL LOCATION k`' GPS (Required) North !1 c -3— -1—, d o {L West Address at Well Location: I to;L Fe deyc,l S+-. Property Owner/Client: Wcx 14 to i _ ((a 1"tr,SU C Subdivision Name: - Mailing Address: . P o City/Town: Saw^ City/rown: evffl t Aim Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot#mandatory if nos-r etadd available ' Board of Health permit obtained: Yes El Not Required 2' Permit Number D�.iss ued 2:WORK PERFORMED,°,.' 3.1WELLTYPE r F_k 14.--DRILLING METHOD" 6r-CASING ,, ,, Overburden I Bedrock From (ft) To (ft) ,psTyppVj Thickness Diameter ❑ S❑❑❑© © ❑ ❑ 0 3 gp-gr I S,k I./o Water Loss or Drop in , '5.WELLLOG`$.. OVERBURDEN Extra 4J Fast or A�`Q❑❑❑ LITHOLOGY Bearing Addition Drill Slow Zone of Fluid Stem 7i SCREEN From (ft) To (ft)- Code Color Comment Dnll Rate From(ft) To`(ft} Type Slot Size Diameter Y /.N'- Y / N sF /-S- Y / N Y / N f / S � 3 ( FSLz ry ❑❑❑ x(i - - - ❑❑❑ to SLCt- RSA Y Y F ,«.�li' /'^� 1. 1O l4 "LCL, GG Y / N Y / N F / S ; 8. ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL Y / N Y / N F /,S�- From Otj To (ft) Material Description Purpose Y Y F /'Ss © ] ©❑ Y / N Y / N FXS� /c Y r N Y / Nr �F,/ sC ❑❑ ❑❑ _ Y / N Y 14N, F1 F1 I ❑❑ cm WELL LOG 4 7 BEDROCK Fxt a - 9:SITE SKETCH , zww X, Water Dropin Eutra Vsxble Loss or tY of LITHOLOGY Bearing Drill Large Fast°r'jRus[ Addition Fractures From ft To ft - Zone Stem CFiipsE Slow Staining of Fluid per foot �{ O (.) Code Comment Drill Rate Y / N`X1PN F,/ S Y / N Y / N Y / NYS/11f} 0 Y / N Y / N Y,,/ N16,44F / S Y / N Y / N A[YfjTN,Y / N F SlY / N Y / NJ 1 �(oZ YhN`�� / NF / SY / NY / N 415�'Y,i`NY / NF / SY / NY / N I Y*% NY / N F / S Y / N Y / N jplf Y N Y4, N F /�S Y /,N Y4 N a. Y / NY / N F Y / N Y / iN Y / NY / NF / SY / NY / N 10 WELL DATA(ALL,SECTIONS MANDATORY,FOR PRODUCTION WELLS)'-,At11!STATIC WATER LEVEL!(ALL WELLS) Yield - Time'Pumped , Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) (hrs`& m n) (FL BGS) (hrs&min) (FL BGS) Date Measured Ground Surface (it) 709 /o : 3 r 12.PERMANENT PUMP(IF AVAILABLE)3/ = � 13.'ADDITIONAL WELL INFORMATION ' War Pump Description tion ®c0 ❑ El Horsepower Developed/ N Fracture Enhancement Y Ag- Pump Intake Depth - (ft) Nominal Pump Capacity—(gpm) Disinfected Y /ON Surface Seal Type _ g 147COMMEN_TS Total Well Depth 13.x/ Depth to Bedrock 15. WELL DRILLER'S STATEMENT: 'L This well was drilled, altered, and/or abandoned under my supervision, according to applicable '�� rules and regulations, and this report is complete and correct to the best of my knowledge. Driller: �910!t n Ir i Supervising Driller Signature: Registration #:I E 17 1- IM;I Firm: LSCA 14 1 Date Complete: -71, Rig Permit#: I I I IJ I NOTE:,Well,ComQletion,$epotts mustbe,.filed by,'the.registered,well driller-wUlgn i0,dgys,of well compLefiom � .',' rrr, : : rr,F,„ra + ire, r::< °,BD'I1RD"E)F`FIEALTFF COPY ' " ' • • Well Completion Report Codes Section 2 " Section 3 Section 4 F Work Well Drilling Work Performed Type 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 Geoconstmction GCON Auger AG New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR 1 Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Cena-Lok CTL Schedule 5 p_ Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 4 Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand- FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 " r 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 Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite OZ SDR 32.5 Sand&Gravel SG - Rhyolite RH SDR 40 Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty Sand&Gravel STSG SlatelPhyllite SL/PH Till T Pegmatite PM r Section 7 Section 8 Section 10 Annular Seal/Fitter Screen Annular Seal/Filter Pack/Abandonment Purpose 'Method Screen Type Code Y Pack/Abandonment Material Code Purpose Code Method Code Carbon Steel CST Bentonite Chips/Pellets BC Fill FL Air Blow with Drill Stem AS 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 PVC PPP Sand SD - Variable Rate Pump VR Pre-pack Stainless PPS Native Material NM Slug SG Slotted PVC SLP Stainless Steel Vee Wire SSV Stainless Steel Well Re: S$P Section 12 Section 13 Pump Description Well Seat 8 tion Code Horsepower Surface Seal Type Type Cade e Variable Speed Submersible 3WVS 1/2 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 . ' r 7 1/2 100 Centrifical CENT 10 125 15 150 200: . Massachusetts Department of Conservation and Recreation Office of Water Resources - 160684 TYPE OR PRINT ONLY Well Completion Report 1.'WELL:LOCATION 'i? GPS (Required) North -�L �2-0 3 L. a o West 7 0 5 N J_ G 7 Address at Well Location: U0,2 r2 FP A P*rx 1 SF- . Property Owner/Client: 14,(,04-fn I FJiAmA'ozq SuC . SubdivisionName: Mailing Address: O t/ 6 C'a a. Citylrown: - W PM City/Townr & uer( 'Assessors Map Assessors,Lot#: NOTE: Assessors Map and.Lot# mandatory if no streetaddress available Board of Health permit obtained:' Yes ❑ Not Required PJ'� Permit Number Dat,lssued t 2.WORK PERFORMED 3.'WELL-TYPE, 4.-DRILLING METHOD; 6.'CASING,_ fi, :. yy�� g sxf3^3 e SI`?+h+nn .-vYE v Mi Overburden Bedrock❑ From (ft) To (ft) Type{ Thickness Diameter DD❑D � © ❑ ❑ 0 3 "ken-E], I S.WELL''LOG t OVERBURDEN Extra '❑'❑ Water Loss or Drop in Fast or - A� RQ❑❑ LITtfOLOGY Bearing Addition Drily From ff .To ft ' Zone of Fluid . Stem Slow 7.'SCREEN O O Code Color Comment Drill Rate From (ft)�To~(4)�" Type Slot Size Diameter fid:: CSCL"' RCL ' 4' 7 `Y !-N Y / N FF / S LCL 8a- Y Y F / S J� hkk�4{1 ❑© . 0 I O / Y ! N 'Y / N F / S � � ❑❑❑ - - - O /t/ ;Lc C miG Y / N Y / N F ! S 8:ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL Y / N Y / N F /,S From(ft) To (ft) Material Description Purpose Y / N Y / N F_/YS.s -°^� ®0 ,CI- Y / N Y / N fr/,VSA i /C/ �fl E .© Y '/ N Y / Nsk%Si" ❑❑ ❑❑ Y / N Y / N ,CFS/ 5 ❑❑ ❑❑ WELL LOG' BEDROCK Fxt a y a. 9. SITE SKETCH s„, ° € 2T _ Water. Drop in 6ctraVisible Loss or #of . a LITHOLOGY Bearing Drill large FS owr ARust Addition Fracture From (ft) To(ft) Code Comment Zone Stem C�hips,r Drill Rate Staining of Fluid .per foot - Y / N"Y'GN,'Fa/ S Y / N Y / N Y / N,Y�'/,N F / S Y / N Y / N Y / NY"/-14FIS Y / N Y / N A ,Y4tIN,Y / NF / SY / NY / N f6� , `;Yif�NY / N F / S Y / N Y / N " ,Yi�NY / N SJY Y / N Y / N Y-'% NY / N F / S Y / N Y / N Z:Y /i,N Y ¢-N F /$S_Y/ NYE/ N a. . .. ' -.._.. .. Al Y / NY / NF / S' Y / NY / N fiPl6' Y / N Y / N F / S Y / N Y / N 10. WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS)�ff, 11. STATIC WATER LEVEL(ALL,WELLS) Yield Tiime`FGmped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) p (firs&'min) (Ft. BGS) (hrs& min) (Ft.BGS) Date Measured Ground Surface (ft) 12.PERMANENT:PUMP(IF AVAILABLE) Igg, _: 13."ADDITIONAL WELL INFORMATION 1 _ Pump Description Horsepower Develope j Y / N Fracture Enh ancement ©® Pump Intake Depth (ft) Nominal Pump Capacity (gpm) Disinfected Y /0 Surface Seal Type El 14. COMMENTS Total Well Depth i3,3 Depth to Bedrock 15. WELL DRILLER'S STATEMENT ;�.' This well was drilled, altered, and/or abandoned under my supervision, according to applicable ” 8 rt : rules and regulations, and this report is complete and correct to the best of my knowledge. Drillecr: 1B1?00 Yn 1L/ Supervising Driller Signature: Registration #:hC IG le? IM I Fir: Trrn A Xrr .. Date Complete: Rig Permit #: I I I NOTE„Wf11,Cornplet:olt_Repor4mustbpfiiled,by the,registeced,well driller wUhin 30 r(gys,of well completion f . �.:.”.. :.".:.::!.".':. . !:'.','. .:'. .`:. .',',' �r:xt°.',`,',°•BO'ARO'D�t(EALTM COPY, , . . r.`.';. ., .. :. .,.. Well Completion Report Codes Asaoa� Section 2 Section 3 Section 4 Work Well Drilling Work Performed Type Method Performed Code Well Type Code Drilling Method Code Decommission DC _ _Cathodic Protection CTPR Air Hammer AH Deepen DP Domestic DMST Air Rotary AR Hydrofraclure HF Geoconstruction GCON Auger AS New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR _ Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW (Monitoring MONT Dug DG 'Public Water Supply PBWS _ Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells — TSTW Sonic SN Section 5 • Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness , (NO CODE) Artificial Fill AF Black BL Amphibolite AM Cena-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 a Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe UP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 j 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 Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite -OZ SDR 32.5 Sand& Gravel SG Rhyolite RH SDR 403 Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty Sand&Gravel SISG Slate/Phyllite SL/PH Till T T Pegmatite PM Section 7 Section 8 Section 10 Annular Seal/Filter Screen Annular Seat/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 AS 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 PVC PPP Sand SD 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 r Section 12 Section 13 Pump �! Description Well Seal v�tv-_, dmp D Code Horsepower Surface Seal Type Type Code g �Y `enable ersible 3WVS 1/2 20 Cement CM W Val�'?? mersible 2WVS 3/4 25 _ CementlBentonite CB 2 Wi am ed Submersible 2WSS 1 30 Concrete CT Wt Speed Submersible 3WSS 1 1/2 40 None NO eed Submersible Turbine CSST 2 50 able Speed Submersible Turbine VSST 3 60 Jet JET 'S —75 Line Shaft Turbine LST 7 1/2 100 Centrifical CENT 10 125 15 150 200'. :, Massachusetts Department of Conservation and Recreation Office of Water Resources 160685 ° TYPE OR PRINT ONLY WellCompletionReport 1.WELL LOCATION tOl GPS (Required) North LL a _3__ 1. - L v West Z a2 ff-- N . -I- Address at Well Location: FedPr(0 2, Property Owner/Client: 14'Q 1 ucf.h'. uc . Subdivision Name: Mailing Address: (11- bo r t-12�Z 5 G (-a k )l City/Town: 5,)0.1.em City/Town: (3everi } Assessors Map Assessors Lot#: NOTE: Assessors Map and LoY# mandatory if no street-address available Board of Health permit obtained: Yes O Not Required 21' Permit Number DateJssued` _ "mar' It 2. WORK PERFORMED. ,: 3 WELL TYPE 4. DRILLING METHOD 6.,CASING Overburden Bedrock From (ft) To(ft) Type Thickness Diameter W❑ ❑�❑ Q ® ❑ ❑ O 3 kEJOU S41 Bio b!WELL'LOG 9 OVERBURDEN Extra "14419U111 Water Loss or Drop in Fast or 1i�t 't❑❑❑ LITHOLOGY Bearing Addition Drill Zone of Fluid Stem SIOM1 7 SCREEN F,r-'st.<. <7 <f`..:. From (ft) To (ft) Code Color Comment Drill Rate From.(ft) To(ft)1 Type - Slot Size Diameter :v L .. ,_.. J.,..x Sty /.N ' y / N :F / S4 O 1'Jo Reco" NI ❑❑� �I CCL B2 Y Y F '(�'•,` ❑❑❑ 1. LCL G(, Y / N Y / N F / S a 's 3 LC t Q Y / N Y / N F / S I8.'ANNULAR SEAL/FILTER PACK/ABANDONMENT MIL' Y / N Y / N F /,S7, From-(ft) To (ft) Material Description Purpose Y Y F_/#Si I ©El AE Y / N Y / N F4/,,S- e ! 1 a 5❑ _ ❑El Y Y / N '`F, 'xS( El El I El El Y / N ' YLiM /pS ❑❑ ❑❑ WELL LOG'_ BEDROCK Extiai�""t- 9. SITE SKETCH IQ,. �; a Water Drop,in Extra Fast or.ftibl, Loss or _ tf of LITHOLOGY Bearing Drill Large Rust Addition Fractu From (ft) To (ft) Code Comment Zone Stem Chips.-p slaw Staining of Fluid per foot - - -. YS Y Y Y / NY,%W F / S Y Y / NY'/* F1SY / NY / N 1(00 Ax7/'RY / NF / SY / NY / N SPI] A Yj%NN Y' / NF / SY / NY / N YPAY / NF / SY / NY / N -4NY / NF / SY / NY / N ;v �. Y / NY /,N FLS Y,/ NY4N V § n ` a `+ lfr Y /kN Y / N F / S Y / N Y / N Y / N Y / N F / S Y / N Y / N 10. WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS)--, 11. STATIC WATER LEVEL(ALL`-WELLS) Yield Time'Pumlied Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) (his=&min)` (Ft BGS) (his&min) (R BGS) Date Measured Ground Surface (ft) 12. PERMANENT PUMP{IF-AVAILABLE) ,, t .' 13. ADDITIONAL WELL INFORMATION,; j.. a Pump Description - "r °❑}❑ ❑ Horsepower Developed / N Fracture Enhancement Y Pump Intake Depth -, (ft) Nominal Pump Capacity (gpm) Disinfected Y /® Surface.Seal Type ❑❑0 14. COMMENTS ' Total Well Depth--h-2 Depth to Bedrock ' 15. WELL DRILLER'S STATEMENT,v __ = This well was drilled, altered, and/or abandoned under my supervision, according to applicable rules and regulations, and this report is complete and correct to the best of my knowledge. Driller 9"r w' f rrLl e r Supervising Driller Signature: Registration #:0 19 V K; I Finn:r_Or%& f l w 14(6 1;�A k 'fC • Date Com tete: - Rig Permit#: tyOZE ,i1ell Complehop Repo".must be fled,by:the,registered well duller wUhin 30 days,of well completion., . . .. .._L.r.'..'.°.�.':�, !�°...".`:-Il."'. ,'a .•r..a ', .°, ...BOARD'OF•149ALTH'CDPY� r— � aaa.� — Well Completion Report Codes � Section 2 Section 3- Section 4 Work Well Drilling Work Performed Type 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- Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code. Thickness '.(NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 60 ri• .i Cobbles ' C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand, FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 I Fine to Coarse Sand FCS Reddish Brown RB Granite GR Stainless Steel SST SDR 1.7 Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite QZ SDR 32.5 e Sand& Gravel SG Rhyolite PH SDR 40 _ Silt SI Sandstone SS 17# Silly Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silly Sand&Gravel SISG Slate/Phyllite SUPH Till T , Pegmatite PM I I Section 7 Section 8 Section 10 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 PVC 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 SteelWel t SSP VAkeG Section 12 Section 13 ,1 Pump - _yA Description Well Seal Pump;Oescription Code Horsepower Surface Seal Type Type Code 3 Wire Variable Speed Submersible 3WVS 112 20 Cement CM 2 Wire Variable Speed Submersible 2WVS 314 25 Cement/Bentonite CB 2 Wire Constant Speed Submersible 2WSS 1 30 Concrete CT 3 Wire Constant Speed Submersible 3WSS 1 1l2 40 None NO Constant Speed Submersible Turbine CSST 2 50 Variable Speed Submersible Turbine VSST 3 ` 60 Jet JET 'S ` 75 Line Shaft Turbine LST 7112 100 Centrifical CENT 10 125 15 150. . 200:•. ., Massachusetts Department of Conservation and Recreation Office of Water Resources r" 16 0 6 8 6 TYPE OR PRINT ONLY Well Completion Report . 1:WELL LOCATIONS t GPS (Required) North v 2 3 1 0 0 West ZCI-° S!1L. - L--L- Address Address at Well Location: ) G P r P A e to l 9 Property.Owner/Client: )-k u I f f F C to ra h on SOC . 3 Subdivision Name: Mailing Address: P. �• you t19� 156Pal� Cf 7 City/Town: 20f" City/Town: dPuU)N l Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if nooss`trtr etaddress available Board of Health permit obtained: Yes ❑ Not Required ✓d Permit Number DateAss ed 2. WORK PERFORMED,;'-! 3.WELL'TYPE .,,_ 4 DRILLING METHOD; WCASING"y+ T T Overburden Bedrock From (ft) To(ft) ♦r,Type�,,�Thickness Diameter UJ❑ ®ElC❑ [i] [fl ❑ ❑ o j k®f0' J ti t/o 5.WELL LOGY OVERBURDEN Extra ❑'❑❑ Water Loss or Drop in, Fast or �'©❑❑ LITHOLOGY Bearing Addition to Slow Zone of Fluid Stem 7. SCREEN t, .. From (ft) To (ft) Code Color Comment Drill Rateil ' From,($) To(Tt)1,' ,Type Slot Size Diameter O Lllo2xcoYN ..Y / N 7F / S'" . ( iovtn Y Y FfS rA� ❑❑❑ g Ia LCL �2 fY / N Y F / S .-.NJ4 ❑❑❑ . - - - 6 C L B 2 Y / N Y / N F / S. ; B:ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL Y / N Y / N .F /;.S From`(it) To (ft) Material Description Purpose Y Y F_/p§_ Y / N Y / N Fw/�S? /02 ❑I] ©© Y Y / Nd'�.f..,/'�Sw El El El El Y /-N Y 4 IS-F /+5 ❑❑ I ❑❑ WELL'LOG F BEDROCK Fxt ai t isi 9.SITESKETCH Water .Drop in Extra Visible Loss or :>f of . - Fast or. _ LITHOLOGY Bearing Drill Large Slow Rust Addition Fractures From ft To ft Code Comment Zone_ Stem Chipsv, Staining of Fluid per foot O O w d,4 Drill Rate _ Y / N"Y,�%N. F� SY / NY / N Y / N Y,/tN F / S Y / N Y / N — Y / NYA/AN F / S Y Y Y,/ �Y{/,N.Y / NF / SY / NY / N -Y;/kN4 / N F / S Y Y Y,rNY / N F / S Y Y Y"/ NY / N F / S Y / N Y / N1ei� - T • o .;�; �, 4* /'N Y /IN F /;;S Yr/ N Y+/ N 4, Y / NY / N F / S Y / N Y / N Y / NY / N F / S Y / N Y 10. WELL'TEST,DATA(ALL SECTIONS'MANDATORY,FOR PRODUCTION WELLS) 11:STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) (h(s& m(n)J (Ft. BGS) (hrs 8 min) (R. BGS) Date Measured Ground Surface (ft) 12. PERMANENT PUMP(IF -13..ADDITIONAL WELL INFORMATION 7�,- 7 a., ;., r Pump Description 0»❑ ❑ Horsepower Developedo / N Fracture Enhancement t. Pump Intake Depth (ft) Nominal Pump Capacity (gpm) Disinfected Y O Surface Seal Type 4 14. COMMENTS� � .�� Total Well Depth /6 Depth to Bedrock 15. WELL'DRILLER'S STATEMENT tL",":gig I This well was drilled, altered, and/or abandoned under my supervision, according to applicable v rules and regulations, and this report is compigle and correct to the best of my knowledge. Driller: SP_ }j xn 1 r t Supervising Driller Signature: I r Registration #:18 19 b1 IM I 1Aln % Date Complete: � `IFirm: CCxm tcFRig Permit#: I I I I I IVOZE ,WeUaCorppl¢twp ., ports rleust b¢filed,by the,registered,weU.drrller pkh}n 30 days,of well completion rs.must - ,+ I• r . . ..a-. .,..:.ax vis >. . . . , ... .. . .. . . ., . .. . , .. ... . , , . . .„ e.,. •BOARD'tSFMEALTHCOPY, . , , .. . . ._. . Well Completion Report Codes ) o8ca0ca.� Section 2 r. Section 3 Section 4 Work Well Drilling Work Performed Type 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 Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply - PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (09)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Adrficial Fill AF Black BL Amphibolite AM Ceda-Lok CTL Schedule 5 F Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown BR Conglomerate%Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray OG Diorite DI HDPE HDP Schedule 80 b Cobbles C 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 =_ Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite OZ SDR 32.5 Sand&Gravel _ SG .- Rhyolite RH SDR 40 Silt Sl Sandstone SS 17# Silly Clay SICL Schist SC 19lk Silty Sand SIS Shale SH Silty Sand&Gravel SISG Slate/Phyllite SL/PH Till T Pegmatite PM Section 7 Section 8 Section 10 Annular Seal/Filter }Screen ; Annular SeallFilter 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 AS 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 PVC' 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 to\ Section 12 Section 13 �v Pump 0 Vrp )eal %sell Codeription Horsepower Surface Seal Type Type Code 3 r2 B d Submersible 3WVS 1/2 20 Cement CM r le Speed Submersible 2WVS 3/4 25 CementlBentonite CB { Constant Speed Submersible 2WSS 1 30 Concrete CT Wire Constant Speed Submersible 3WSS 1 112 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 20(r. . Massachusetts Department of Conservation and Recreation . Office of Water Resources "` ~ 160687 TYPE OR PRINT ONLY = Well Completion Report 1 WELL LOCATION >, GPS (Required) North =_2 2 3 L. r?-- V West 7 -a—° Address at Well Location: Fe deal S Property Owner/Client: Per, I t In P !: d Urah', Silt. . Subdivision Name: Mailing Address: p.(). r N9A ISG (ahs Sfc City/Town: - SQ I o nn City/Townt r r Assessors Map Assessors Lot#i NOTE: Assessors Map and Lot# mandatory if no treetaddress available Board of Health permit obtained: Yes ❑ Not Required 2 . Permit Number Date.lssued 2:WORK PERFORMED"—" 3:WELL TYPE c rt K ` + 4.DRILLING METHOD~mss 6.CASING ..r"3 Overburden Bedrock From(ft) To (ft) ,r,Type' Thickness Diameter Fu,)] ❑ N❑ T❑❑ FD 1:1 ❑ U s to"®O` s,ti'Vo l 5.'WELLLOG• OVERBURDENExtra - ��❑❑ Water -Loss or Drop in h�°'F �❑El❑ LITHOLOGY Bearing Addition Drill Fast or From ft To ft Zone of Fluid Stem Slow 7,'SCREEN yip ,uKNOU 4z~ .5 r O O Code Color Comment Drill Rate b } C 5 2 f{ * } From.(it) T,o:(ft)� Type Slot Size Diameter Y /'N Y./• N'.' F / ST . 3 Fmsri. (L Y / N Y / N F / S 3 k1+4S' V ❑Q E) +t ❑❑❑ • - - - FSGI Q2G6 Y / N Y / N F / S ❑❑❑ 1. 50 C? r5E6 BR[G Y / N Y / N F / S 8. ANNULAR SEAL/FILTER PACK/ABANDONMENT,MTLt 17 1;tC GV Y / N Y / N F /,Sl Frgm'(it) To (ft) Material Description Purpose Y / N Y F /�S; '_ ©© F1 F] Y / N Y Ff $* . 1S I]E _F]El Y / N ,Y / N F,%a--S r 1:11:1 ❑ Y;/ NiFY /eNr� >/�s �� ❑El 3 - -AWELL LOG.,F - BEDROCK. .Water Dro m Extra �k Vsible_ Lossor - tiof ,9:'SITE SKETCH %*4W#fW�,0a'. LITHOLOGY - Bearing Drill. :Large Slowr,4"Rust Addition FracturesFt'd�rul From (ft) To(ft) Code Comment Zone Stem Chips.Drill Rate Staining of Fluid per foot — Y / N`M,,,`N- F,/ SY / NY / N Y / N,Y,/* F / S Y / N Y / N Y• / NY'r/-1 F Y Y / N A,YYF/'N. Y / N F / S Y / N Y / N Yj&N, Y / N F / S Y / N Y / N Y,/ANY / NF / SY / NY / N 1af`I Y"% NY / NF / SY / NY / N /=N Y'/iN F /-;S Yr/.N YJ N r * •„ �_, e Y / NY % NF / SY / NY / N Y / NY / N F / S Y / N Y / N 10.-WELL'TESTDATA'(ALL SECTIONS MANDATORY,FOR PRODUCTION WELLS)"'=* 11."STATIC WATER LEVEL'(ALL'WELLS) F ",, -_ - Yield i:iecl Level Time to Recover Recovery Depth Below Date Method (GPM) (t rs&min (R. BGS) (hrs 8 min) (Ft. BGS) Date Measured Ground Surface (ft) 12PERMANENT,PUMP (IF AVAILABLE) "' --' !.'""'�F ^"as .13:ADDITIONALWELL`INFORMATIONtw4i , �? Pump Description ❑ Horsepower DevelopedQl / N Fracture Enhancement Y❑/ I� C M❑ Pump Intake Depth - _ (ft) Nominal Pump Capacity (gpm) Disinfected Y J Surface Seal Type' 14. COMMENTS Total Well Depth �y ��e Depth to Bedrock 15 WELL DRILLER'S STATEMENT,`t � j This well was drilled, altered, and/or abandoned under my supervision,according to applicable rules and regulations, and this report is complete and correct to the best of my knowledge. Driller. SF cera G r Supervising Driller Signature: Registration #JI G Id }L{ I Firm; 1 r>/YMnv rt (o/LA 1 nnle TY' . Date Complete: 76101 — Rig Permit#: I I I I lY C nlP $P )efile . s 1 driller within 30 days of well completion We o ehon a orfs,must d,by: e.registered,' tared well. . .*•. .. .'.'.`_'..':'.!.'. �.'.``. ., r,,,r•, �*�,:r • . � BOARD'OF"}iEl(LTt4 EUPI!_ :.•, _ . . .. ,, ..,< < Well Completion Report Codes Section 2 - Section 3 Section 4 Work Well Drilling Work Performed Type 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 Replacement RE Industrial INDS Core . CR Injection INJC Direct Push DP Irrigation [RAG Drive and Wash DW' Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section 5 ` 1 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 i Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 q Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 • T. Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C 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' _ Medium Sand MS Marble MA SDR 26 a Organics - 0 Quartzite QZ` ` SDR 32.5 Sand&Gravel SG Rhyolite RH SDR 40 Silt Si Sandstone SS 17# Silty Clay SICL Schist SC 19lt Silly Sand SIS Shale SH Silly Sand&Gravel STSG Slate/Phyllite SL/PH Till T Pegmatite PM Section 7Section B _ Section 10 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 AS Continuous Wire PVC CWP Bentonite Grout BG Filter FT Air Lit AL Galvanized Wire Wrapped GWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP Concrete CT Constant Rate Pump CR Pre-pack PVC 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 _&Wtipn 12 Section 13 _eY Pump t� Description Well Seal Pump Code Horsepower Surface Seal Type Type Code 3 WiIVQR able Speed Submersible 3WVS 112 20 Cement CM 2 Wire Variable Speed Submersible 2WVS 314 25 Cement;Bentonite CB 2 Wire Constant Speed Submersible 2WSS 1 30 Concrete CT 3 Wire Constant Speed Submersible 3WSS 1 112 40 None NO Constant Speed Submersible Turbine CSST 2 50 Variable Speed Submersible Turbine VSST i 3 60 Jet JET 5 -75 Line Shaft Turbine LST 7 112 100 Centritical CENT 10 125 15 ,150 200, :r. x Massachusetts Department of Conservation and Recreation Office of Water Resources 160688 TYPE OR PRINT ONLY Well Completion Report 1:WELL LOCATION,1 GPS (Required) North _ 3 1 a U U West 7 O -5— v -3- G -7 Address at Well Location: f ria- rrrlej ( S+ Property Owner/Client: PCA 4 In r {=du rnA-Go �Mr_ „ Subdivision Name: Mailing Address: pi.[), Roz Ng.2 I ro Tri Fo City/Town: Sra)Pnn City/Town: 60rrc// Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot#mandatory it noo�tree'address available Board of Health permit obtained: Yes ❑ Not Required lr Permit Number DatbAss ed 2. WORK PERFORMED n, 3.WELLTYPE . "r, 4 DRILLING METHOD ..l 6:CASING Overburden Bedrock From(ft) To (ft) Typed Thickness Diameter ❑�❑T F:11 El © I El El a 3 , t®n :.kfo 5.-WELL LOG OVERBURDENExtra ®'❑❑ Water Loss or Drop in - ^N� 10 El ElLITHOLOGY � Bearing Addition Drill Fast or From ft To. ft Zone of Fluid Siem Slow 7. SCREEN w.,, O O Code Color Comment Drill Rate r y,- From,(ft) To(ft)%` Type Slot Size Diameter b o ecikxI Y /'N 'Y y S FM SCL"( Y / N Y / N F / S k ❑ OE .-U l_o l S -7 SLCL MsG Y / N Y / N F / S 'V ❑❑❑ . - - — �. '1*4v ❑❑❑ . — 1 g SLCL 66 Y / N Y / N F / S ; 6_ANNULAR SEAL/FILTER PACK/ABANDONMENTMTL' S No Q u Y / N Y / N F /,,SZ From(flf To(ft) Material Description Purpose Y / N Y F /�S' 11 ( ©0 0E Y / N Y F,�hS* Z S ©�] F❑Cr] Y / N YlNd€ FF,ASL ❑❑ ❑❑ Y / N Y /!N*tF'I' ' ❑❑' ❑❑. T WELL'LOG a BEDROCKFie z a 9.'SITE$KETCH " Water Drop in Extra'. F w Ysible Loss or p of LITHOLOGY Bearing Drill Large Slow Rust Addition Fracturese ( Sf From (ft) To (ft) Code Comment Zone Stem Z-1051 Drill Rate Staining of Fluid per foot Y ! N`Y-1 N.'F�/ S Y / N Y / N Y / N,� F / SY / NY / N Ya/ NY4[N= F / S Y / N Y / N AFYI N. Y / NF / SY / NY / N i{j Y�l�NY / N IF / S I Y / N Y / N 4 Aor%�'YrNY / NFISY / NY / N Y4NY / N F / S Y / N Y / N N Y hN F I S Yc/ NY/ -� i y, Y / NY / NF / SY / NY / NZPA 1 � } Y / NY / NF / SY / NY / N 10.WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 7_" 11.STATIC WATER LEVEL(ALL'WELLS) Yield Time^P`u`mped Pumping Level Time to Recover Recovery ' Depth Below . Date Method GPM *hrs'&"mm Ft BGS) (hrs&min R.BGS Date Measured Ground Surface ft 12 PERMANENT PUMP, a 13.ADDITIONAL"WELL INFORMATION 4C t Pump Description `❑tor❑ ❑ Horsepower Developed()? N Fracture Enhancement Y / Pump Intake.Depth , • , (ft) Nominal Pump.Capacity (gpm) Disinfected Y 0 Surface Seal Type LLJ 14?COMMENTS ' Total Well Depth N--61- Depth to Bedrock- 15. WELL DRILLER'S STATEMENT` This well was drilled, altered, and/or abandoned under my supervision, according to applicable y rules and regulations,and this report is complete and correct to the best of my knowledge. Driller. (t`RT0�, Mlyo-IPr Supervising Driller Signature: Registration #:I8 I9 P (M I Firm: Ny;� ifra I( Tnl. Tnr. Date Complete: Rig Permit #: I I I I AQ]E Wgll Compleapp hPeports'm4vt be fi(ed,8y.•the.registered,well driller within 3,I1 days of well completion . . . ,. ... . .a; . ., :':. .'. .,. .`. ,',',` :'s`,':`:' r..'.BOARD'O�•FI•EALTFh EOPY ": . , . . .. . ?. . '. . . . . . , . . . . • : , , Well Completion Report Codes 88KE Section 2 Section 3 Section 4 Work Well Drilling Work Performed Type 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 GOON Auger AG New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type, Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 y Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 x „ Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C 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 Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite QZ SDR 32.5 Sand&Gravel SG Rhyolite RH SDR 40 i Silt Si Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty Sand&Gravel SISG SlatelPhyllite SL/PH Till T Pegmatite PM Section 7 J Section 8 Section 10 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 Litt AL Galvanized Wire Wrapped GWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP Concrete CT Constant Rate Pump CR Pre-pack PVC 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,; OOe�J w Section 12 Section 13 Pump Description Well Seal Pumo�e ig�pR� Code Horsepower Surface Seal Type Type Code 3 Q4� be Speed Submersible 3WVS 1/2 20 Cement CM ariable Speed Submersible 2WVS 3/4 25 Cement I Bentonite CB 2 ire Constant Speed Submersible 2WSS 1 30 Concrete CT 3 Wire Constant Speed Submersible 3WSS 1 112 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 20P, Massachusetts Departmentf Water nervation and Recreation � Resources 160689 TYPE OR PRINT ONLY Well Completion Report Y WELL LOCATION LA71 GPS (Required) North 15 .CL_° _31_ a L SZ West 7 LL ° 5 Y 6 Z___ Address at Well Location: 1(no Fedfrr,Ll S+ Property Owner/Client Lp IJ 6 Fclucctt'j-^ SUc Subdivision Name: Mailing Address:. eo 'w IS 6 roxi S+'..-, Cityfrown nlPM. City/Town: lu' :. F�� 5. Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory d no 6treet address available Board of Health.permit obtained: Yes ❑ Not Required Permit Number Date,lssoedd 2 WORK PERFORMED%-�` 32,WELLTYPE -3 4.DRILLING METHOD V, 6.-CASING ­4 Y n x t _ - a?.a 4f_1„ �: Overburden Bedrock From(ft) To(ft) ,04yp #Thickness Diameter N W T_ N T C I El P o 3 , tE®©' sa, C' 5:WELL LOG i OVERBURDEN Water Loss or Drop in FYr ❑EI-El LITHOLOGY Bearing Addition Drill Sl - Zone of Fluid Stem . SCREEN ` ` �i ,.'"'�' `,4'a?• From (ft) To (ft) Code ,Color Comment ow 7i Drill Rate From j(f[) To(ft) � Type Slot Size Diameter Y / N Y / N' F / S 3 V'4 ❑❑i❑ O 1—O 1 1 ) oZ. �eCuOUN Y / N Y / N FIS c ❑❑❑ la 13 MS Y Y / N . F �N-N. 1:1011 .1. - - - 13 15 .(.C I. GG Y / N Y / N F / S ; WANNULAR SEAL/FILTER PACKIABANDONMENT MTL Y / N Y / N F /;S, From To (ft) Material Description Purpose Y Y / N F /tSi l ©'❑ ® >❑ Y Y / N Fes`/,$. +' S ❑© F❑� Y / N. Y / NS ❑❑ ❑❑ Y / N Y /aNT.^F / S ❑❑ [j E] ,-WELL LOG' BEDROCK Water Drop in Extra ��Y�ble Loss or #of 9• SITE SKETCH LITHOLOGY Bearing -Drill Large FsbWr"rRust Addition Frdcti _ - - Zone Stem Chips: - Staining of Fluid per foot - 17eoerco S+_ From - From (ft) To (ft) Code Comment ,� ,� Dntl Rate -- - Y / NYT/,N ;FO/ S Y / NY / N Y / NX,%�N F / S Y Y / NYINF / SY / NY / N Y�/�N,Y / N F / S Y / N Y / N j('0 ��YthM Y / N F / S Y / N Y / N f, Y, NY / NF / SY / NY / N NY / NF / SY / NY / N € Y / NY /iNF / S. YI/ NY /Nr Y / NY / NF / SY / NY / NTP3t Y / N Y / N F / S Y / N Y / N 10.WELL TEST DATA(ALL'SECTIONS MANDATORY,FOR PRODUCTION WELLS), ",t. 11.STATIC WATER LEVEL,(ALL WELLS) Yield ,Time Pumped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) (his`&min)' (Ft. BGS) (hrs& min) (R.BGS) Date Measured Ground Surface (ft) ( 716 O IO.NI f 13.ADDITIONAL`'WELL INFORMATION 12:PERMANENT PUMP(IF ,��. , `°�' ;°=t r�==•- Pump Description `®-E`❑ ❑ ' Horsepower Developed Y / N Fracture Enhancement Y / N Pump Intake Depth ,(ft) Nominal Pump Capacity (gpm) Disinfected Y I N Surface Seal Type ❑❑❑ 141COMMENTS ; Total Well Depth Depth to Bedrock 15:WELL DRILLER'S STATEMENT'i't y This well was drilled, altered, and/or abandoned'under my supervision, according to:applicable rules and regulations, and this report is compI to and correct to the best of my knowledge. Driller: 7c't : v Supervising Driller Signature: Registration #:19 I R P IM �a S �tr».1 S Firm: Conr.hno tarn u I t L Tnn)A Snr. Date Com fete: 04 Rig Permit#: I I I I I ',',,yo7TT,;Iyey,Completiop,,#eportS.must be,filed.by,the.registered.well driller-within,30,days.of well completion... I �. .. ..._,. .. ..S a•r x r e4 s, .�, .:r E�e i r e<a � >e a.-:,s'i.'.','.,B�AR{�'6F•I'�EALTFfCOPY ` ,_ :.: r. . . . .. .. ..,e:.. . ,.. �a epclfiaj Well Completion Report Codes Section 2 Section 3 section#4 Work Well Drilling Work PerformedType Method Performed Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH j Deepen DP Domestic DMST Air Rotary AR Hydrofracture HF Geoconstructicn GCON Auger AG New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic" SN r Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Ceda-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown BR Conglomerate/Breceia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 - R Fine Sand FS Light Gray LG Gneiss GN PVC PVC SOR 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 Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite QZ SDR 32.5 Sand&Gravel SG, Rhyolite RH SDR 40 Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silly Sand&Gravel SISG Slate/Phyllite SLIPH Till T Pegmatite PM Section 7 Section 8 Section 10 Annular Seal/Filler 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 FLAir Blow with Drill Stem AB Continuous Wire PVC CWP Bentonite Grout BG Filter FT Air Lift AL Galvanized Wire Wrapped GWW r. Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP Concrete CT Constant Rate Pump CR Pre-pack PVC 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 63�� — IT,—$ Se,tion 12 Section 13 �Jq Of ff�TM Description Well Seal Pump 1 Code Horsepower Surface Seal Type Type Code 3 Wire Variable Speed Submersible 3WVS 112 20 Cement CM 2 Wire Variable Speed Submersible 2WVS 314 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 1/2 100 Centrifical CENT 10 125 15 150 20a—', Massachusetts Department of Conservation and Recreation Office of Water Resources 160690 TYPE OR PRINT ONLY Well-Completion Report " 1.WELL LOCATION'f: GPS (Required). North -Y--4P--2 -3- J-. a o 0 West Z OL-0 L- -i Z— Address at Well Location: ) 7fAera-\ Sf Property Owner/Client: I-ka 14 k d u(a6,on SUC - Subdivision Name'- Mailing Address: P- v t/yd- i 6 nbbo j*— City/Town: &)Jeal City/Town: 6euvlU �t AIV Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no streeCaddress available Board of Health permit obtained: Yes El Not Required 121�- Permit Number Dt Js sued 2.WORK PERFORMED 3.`WELL TYPE :':=' S :f 16 14. DRILLING METHOD' „: 6:CASING Overburden Bedrock From (ft) To (ft) Type` Thickness Diameter ❑W N❑ T❑0 ® ] ❑ ❑ C, 3 tFOMR srtit/o / 5.WELL LOG OVERBURDENExtra R0'❑•❑ Water Loss or Drop id Fast or ,01 ', N❑❑❑ LrrHOLOGY Bearing Addition Drill Slow - Zone of Fluid Stem 7.`SCREENs From(ft) To (ft) Code Color Comment Drill Rate From MK N' Y /'N' F / S Tro (tiJ', -Type Slot Size Diameter 2 Ye Ot❑El I. CZ L 0- !Yi�I LCL GP— -- Y / N Y / N F / S -. "- ❑❑❑ $ ( 1- SICL fit Y / N Y / N F-/ S w ' +m, ❑❑❑ 1. - I Iq 5ta R- Y / N Y / N F / S ; 8. ANNULAR SEALIFILTER PACK/ABANDONMENT MTL: Y / N Y / N F /E From(ft) To (ft) Material Description Purpose Y / N Y / N F_/ S ®© ® ❑ Y % N Y / N F / Sr la CIE ET-1 Y / N Y / Nd*F,'/I C ❑❑ ❑ ❑ Y / N YIAN 11Fi/ S J; El 14 ❑ Ej WELL LOG BEDROCK Exfri'Wit9.SITE SKETCH 3 u tx.x i -Water, Drop in Extra_ visible Loss or #of LITHOLOGY Bearing .Drill Large Fa "'J'Rust Addition Fracture Fecle/c t S+- - Zone Stem Chips, STOW Staining of Fluid per foot ' From (ft) To (ft) Code Comment -, ,4 Drill Rate Y / N'YV/ N: Fa/ S Y / N Y / N Y / N,'Y /tN F / S Y / N Y / N Y,,/ NY'/>N F / S Y / N Y / N I6 prYj/IN,Y / N IF / S Y / N Y / N 'Ya"/aN •Y / NF / SY / NY / N 'ty' NY / N SJY Y / N Y / N Y-k% NY / NF / SY / NY / N / N Y / :N F / 8. YI/'N Y'/ Ni A4� I Y / NY / N SIY YI/ N Y / N 1 Y / NY / N F / SF / N Y / N tiriPdi' 10. WELL TEST,DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) I,- t, 11f STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) min)" (Ft. BGS) (hrs&min) (Ft. BGS) Date Measured Ground Surface (ft) `.i 6 o4 2, 57 AP'N7 12. PERMANENT,PUMP(IF AVAILABLE) :,tt=s + a'n ,' 13.ADDITIONAL'WELL'INFORMATION ' r 1 e Pump Description ❑ G� ❑ r =` Horsepower DevelopecLY / N Fracture Enhancement YY//(© Pump Intake Depth * t(ft) Nominal Pump Capacity (gpm) Disinfected 'Y C5 Surface Seal Type 14. COMMENTS= Total Well Depth 11,21 Depth to Bedrock 15.WELL DRILLER'S STATEMENT: .xP� This well was drilled, altered, and/or abandoned under my supervision, according to applicable #� a rules and regulations, and this report is complete and correct to the best of my knowledge. Driller' 1rnn(P( Supervising Driller Signature: Registration #:IF I9 b2 IM I Firm: r n d ( Date Com fete: 7 74/n4 Rig Permit#: I I I I N(3TE WeIE Completion Reports mitstbe diled,"by,-the.registered,well driller-within 30 days,of well completion • . . r x a etrr.. it iert a:tt r tse -..BQARAa�t=a)•I�ALTtf COPY' - •. Well Completion Report Codes oleaQa I Section 2 Section 3 Section 4 Work Well Drilling Work Performed Type Method Performed Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH Deepen DP DomesticDMST 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 Replacement RE Industrial - INDS Core CR Injection. INJC Direct Push DP - Irrigation IRRG Drive and Wash DW 'Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C 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 Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite OZ SDR 32.5 a Sand& Gravel SG Rhyolite RH SDR 40 Silt Si Sandstone SS 17k Silty Clay SICL Schist SC 19N Silty Sand SIS Shale SH Silty Sand&Gravel STSG Slate/Phyllite SL/PH Till T Pegmatite PM Section 7 Section S Section 10 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 Ft. Air Blow with Drill Stem AB Continuous Wire PVC CWP Bentoriite Grout BG Filter FT Air Lift hL Galvanized Wire Wrapped GWW em nt/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP ( ete CT Constant Rate Pum CR Pre pack PVC PPP `�w and SO Variable Rate Pump VR Pre-pack Stainless Ap�s��V-0 Native Material NM Slug SG ., Slotted PVC A 1�1nvp� Stainless Steel Vee Wire SSV 13 t Stainless Steel Well Point SSP C,0 of N Section 12 Section 13 Pump Description Well Seal 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 ,