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MONITORING WELL Massachusetts Department of'Conservation and Recreation 160670 Office of Water Resources 16 0 6 7 U TYPE OR.PRINT ONLY Well Completion Report 1 WELL LOCATION GPS (Required) North N 222 3J-la— �ff:—— West So" .Address at Well Location: Wa_.P-dvaS' Si-- Property Owner/Client: 1-1ccL4 c f eto.caK on &&ui ur Subdivision Name: Mailing Address: P o•(301 LP-;t d S fa 666-14r 5jk, City/rown: SCA\eM City/Town: Board of Health permit obtained: Yes ❑ Not Required [ Penrtlt Number ry D ,Isst address available Assessors M Assessors Lot#: —NOTE: Assessors M and Lot#mandato d no stye P eq ued 2.WORK PERFORMED 3.WELL TYPE -T&14. DRIWNG METHOD: ` &CASING E®E© Overburden I Bedrock From (ft) To (ft) Type',- Thickness Diameter ® © I ❑ ❑ o to ®t'T'I sk:yo i" S.WELL LOG"' OVERBURDENExtraWater Loss or Drop in. �}❑El❑ LITHOLOGY Bearing Addition Fast or 0 Drill From ft To ft Zone of Fluid Stem Slow 7. O O Code Color Comment Drill Rate Y N Y From(ft)rTo(ft)%' Type Slot Size Diameter Q No h / / N F / S Cofiedt�r Y / N Y / N F ,t ❑❑❑ 1. - - - Y / N Y / N F / S --, ❑❑❑ Y/ N Y / N F / S , 8."ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL- Y7 N Y / N F /.S- From`((t) To (ft) Material Description Purpose Y / N Y / N Y / N Y / N FyS* .ZO ❑fl Y / N Y / Nl''F,/S6 El El El El Y / N Y / NtVW ❑❑ F WELL LOG BEDROCK 5ma 9:SITE SKETCH 7x ' AMW - Water Drop in Extra �Viisible, Loss or d of , - LITHOLOGY Bearing Drill fasl w. r Large Saw Rust Addition Fracdr r- From ft To ft Zone Stem Chips•• Staining of Fluid 'per foot teL`( Si- O O Code Comment Dw sate Y / NYF%N, F�/ SY / NY / N Y / NY,JtJ l / S Y / N Y / N Y / NY`/-NF / SY / NY / N � ib� rY / N,Y / NF / SY / NY / N , Y,/aNY / NF / SY / NY / N Y,/`NY / N F Y / N Y / N 4 N Y 7 NJ F / S Y / N Y / N Y / N Y / N F / S Y / N Y / N Y / N Y / N F./ S Y / N Y / N Y / NY / NF / SY / NY / N 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) (Ars&'min)' (R. BGS). (his&min) (R. BGS) Date Measured Ground Surface (ft) 12'PERMANENT;PUMP.(IFAVAILABLE)!N _ a =t 13.'ADDITIONAL WELL INFORMATION � Pump Description ®���❑ ❑ Horsepower Develope(o7 N Fracture Enhancement Y /Q Pump Intake Depth (ft) Nominal Pump Capacity (gpm) Disinfected Y Surface Seal Type ❑ 14.`COMMENTS: Total Well Depth_RD�_Depth to Bedrock N A 15.'WELL DRILLER'S STATEMENT '. This well was drilled, altered, and/or abandoned under my supervision, according to applicable W rules and regulations,and this report is complete and correct to the best of my knowledge. Driller. " f�= _: Mac Supervising Driller Signature: Registration #:18, la IM I ' �< x;'14 Firm: ' 'f 11&rA iaf� Tn1A TMC . Date Com Tete: 6/ql04 Rig Permit#: I I ' I I IyOTE ,Well Complehol,$spm t'musthe filed.by the,registered.well driller within 3Q,days of well completion Well Completion Report Codes Section 2 '1 r _ _ - T Section 3 • Section 4 Work Well Drilling Work Performed Type Method Performed -_ Code ' Well'Type Code Drilling Method Code Decommission DC 3 Cathodic Protection CTPR Air Hammer AH Deepen DP t 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 dmgation IRRG Drive and Wash DW Monitoring MONT Dug DG v q r,• p Public Water Supply PBWS Mud Rotary MRj 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 Amphibolra AM Cena-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 s' Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS d Dark Gray .DG Diorite .DI HDPE NDP Schedule 80 F-4 Cobbles C Greenish Gray GG "- Gabbro GB NSF Coated Steel NCS Schedule 160 w r Fine Sand I FS si t Light Gray LG Gneiss GN PVC PVC SDR 13.5 z Fine to Coarse Sand FCS Reddish Brown RB Granite GR Stainless,Steel SST SDR 17 r Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 't Q 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# Silly Clay SILL' Schist Sc 19# Silty Sand SIS —- - — Shale SH Silly Sand&Gravel STSG Slate/Phyllite SLlPH Till T_ Pegmatite PM I I 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 -- fCST Bentonite Chips/Pellets BC Fill FL Air Blow with Drill Stem AS Continuous Wire PVC CWP Bentonite Grout BG Filter FT Air Lin 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 1 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 Paint SSP 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 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 1 Jet JET 5 - "75 r Line Shaft Turbine LST 4 . 7 112 100 Centrifical CENT 10 125 15 , . .150 . . . . . .. , 200. Massachusetts Department of Conservation and Recreation v I r ( e Office of Water Resources 160672 TYPE OR PRINT ONLY - Well Completion Report 1.WELL`LOCATION GPS (Required) North -Y— a o -9-L� La . YY-' West -1-0-2 SH'aL.5—� Address at Well Location: l(Ala FGCRJ'al 54-• Property Owner/Client a1 e rAA(ftNffi SwV ice Subdivision Name: Mailing.Addressi O. o t '/9e 1511- E s„ Gityfrowm Cf ke m Cityfrown: &k3gXLq t Assessors Map Assessors Lot If: NOTE:-Assessors Map and Lot# mandatory if no�re. address available Board of Health permit obtained: Yes ❑ Not Required Rr Permit Number Dat�JAssue 2.WORK'PERFORMED ,, 3:WELL:TYPE 4;`DRILLING METHOD 6 CASING„ �.`.H ^�: a Overburden Bedrock From (ft) To (ft) Type Thickness Diameter 0 0 ®��0 ® ® ❑ ❑ 5.'WELL'LOG( OVERBURDEN Extra "` Ya®❑ Water Loss or Drop in Fast or h'❑❑❑"- LITHOLOGY Bearing Addition Drill Zone of Fluid Stem Slow 7, SCREEN •z` From (ft) To (ft) Code Color Comment Drill Rate From(it) To(ft)a,� Type Slot Size Diameter 0k S k[W ' KI - Ltd ► Y / N Y / N F / S ❑❑❑ Ie1 G Y Y / N ' F S +a ❑❑❑ 1. - - - 1A 16 IML Y (N Y / N F / S ; B ANNULAR SEAL/FILTER PACK/ABANDONMENT MM Y / N Y / N F /,S� From--(it) To (ft) Material Description Purpose Y Y / N Fg I ®ff] El Y Y / N F /<S? (S ®® El El Y / N Y ❑❑ ❑❑ WELL LOGS: BEDROCK txoa Vise 9.'SITE SKETCH,SFr k �a - - - Water Drop in Extra Visible .Loss or k of LITHOLOGY .: Bearing Drill Large.. FSbwr "Rust Addition Fracture From(ft) To(ft) Code Comment Zone. Stem Chi '.Drill Rate ening of Fluid per foot Y / NYl,'N; Fy/ S Y / N Y Y / N,Y,%" F / S Y / N Y Y,,INY'/* F Y / NY / N ,r[Y4AN,Y / N F / S Y / N Y / N s Y,iJ Y / N F / S Y / N Y / N 10L Y, /`NY / N F / S YIN Y / N Y-iNY / N F Y / N YIN Y / N Y ! N F / S Y / N Y / N 7 „ YINYlN `F"/ SY / NY:y. NJ �? , Y / NY / N F / S Y / N Y / N 10.WELL'TESTDATA(ALL SECTIONS MANDATORY,FOR PRODUCTION WELLS) ttr`STATIC WATER LEVEL-(ALLWELLS) Yield Time Pumped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) (his&min) (R. BGS) (hrs& min) (Ft.BGS) Date Measured Ground Surface (ft) 12. PERMANENT,PUMP.OF,AVAILABLE) 43; 13:ADDITIONAL WELV INFORMATION giveRoftv Pump Description '®s0'❑ ❑ Horsepower Developed/ N Fracture Enhancement Y /� � " Pump Intake Depth , (ft) Nominal Pump Capacity (gpm) Disinfected Y /® Surface Seal Type ❑� 14. COMMENTS Total Well Depth t b Depth to Bedrock tU/A 152 WELLDRILLER'S STATEMENTThis well was drilled, altered, and/or abandoned under my supervision, according to applicable 1 - - -rules and regulations, and this report is complete and correct to the best of.my knowledge. Drillers_ tY �5 Supervising Driller Signature;'G� Registration #:ISS' Firm: G,tryVtiu42cUt6 ITrontt TD'S Date Com fete: 30 O Rig Permit#: LI-LI--j yOTE:xWell,Completion �teportS must,be,filed,by,the.registered,well driUer•withim30,days,of•well completwn ._ ..... .....,.. . :`'. SSaOaa Well Completion Report Codes r Section 2 Section 3 - Section 4 Work r Well +? v r Drilling Work Performed Type Method Performed , Code . ? . Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH Deepen DP i 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 l 7 i Public Water Supply 7 PBWS r Mud Rotary MR A" 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 i(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/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS t Dark Gray OGDionte DI HDPE HDP Schedule 80 6 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 % Fine Sand FS n r Light Gray —LG )n Gneiss GN PVC PVC SDR 13.5 Fine to Coarse Sand FOS Reddish Brown RB Granite GR Stainless Steel SST SDR 17 Gravel G Yellowish Brawn YB Limestone ':LS Steel STL SDR 21 � ti�„ Medium Sand MS Marble MA SDR 26 w� Organics 0 Quartzite Q2 SDR 32.5 Sand& Gravel. SG Rhyclite RH SDR' _ Silt i SI ,� Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty Sand&Gravel_SISG __ Slate/Phyllite SUPH Till t T Pegmatite PM ...t Section 7 Section 8 Section 10 ;,[', ` Annular Seal/Filter L I 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 Bentorttte Grout BG Filter FT Air Lill 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 Section 12 Section 13 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 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 160673 ' TYPE OR PRINT ONLY Well Completion Report 1°WELL,LOCATION W GPS (Required) North _d_o M:AL Y ! West 7—9-2 SW/'A, 5a"_ — Address at Well Location:- 1Fecer0J Property Owner/Client: Heco kvi, tdwo`in' ervirst Subdivision Name: Mailing Address: e.el,P,6V 419e 15(e 4 S 4c City/Town: Rb e_m Cdy/Town: ` Assessors Map- Assessors Lot#i NOTE: Assessors.Map and"Lot_#mandatory ff no sVeet,address available Board of Health permit obtained: Yes ❑ Not Required Its' Permit Number Date,lss ed 2."WORK PERFORMED J,I WMELL TYPE. Q, 4'DRILLING METHOD - Overburden Bedrock From (ft) To (ft) w4ype` Thickness Diameter FO I 1W I - ❑�K l7❑ © ❑ ❑ O S- kE®�' S�11 X10 I " 5.WELL"`LOG OVERBURDEN Extra ^ ® ❑ Water Loss or Drop in Fast or ❑❑ LITHOLOGY Bearing Addition Drill Zone of Fluid Stem Slow 7.SCREEN From (ft) To (ft) Code Calor Comment Drill Rate From (ft) To(ft)'v ' Type Slot Size Diameter fJ NIGo: Qr . . ,.. Y /N_ .Y /,N ,F,/. S.. � � Fla y g SILL gQ Y / N Y / N F / S eZ 011 SIS Cs Y Y / N F ❑❑❑ - - >a 10 S}CVsq- Y / N Y / N F / S ❑❑❑ . _ _ _ B. ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL Y / N Y / N F /;S„I, Fiom'(f[) To (ft) Material Description Purpose Y / N Y / N . F, /'Ss � a ®� 9:1 - Y / N .:Y / Ni tF%tSr, ❑❑ �❑ Y / N MY:;Ili NtF /�S'� ❑❑ ❑❑: ` WELLLOG BEDROCK Fxtm. ” . 9.'SITE SKETCH ` ,.. - Water. Drop in Extra Ysible Loss or #of • - Fast or. .. LITHOLOGY Bearing Drill Large Sbw Rust Addition Fractu t From (ft) To (ft) Code. Comment Zone Stem i Drill Rate Staining of Fluid per foot ' - a Y / NY?%N 'F,/ S Y / N Y / N Y / N,Y}ISN 0 Y / N Y / N X / NYAN F Y / N Y / N Y�/.N Y / NIF S Y / N Y / N1 I 'Y tSt 1�12J5Y / NF / SY / NY / N t�INY / NF / SY / NY / N Y4 Y / N F / S Y / N Y / N I Y / NF / SY / NY / N Y`/ NFYSY /%NYPNY / NF / SY / NYFN 10.'WELL .DATA(ALL SECTIONS MANDATORY,FOR PRODUCTION WELLS) 11. STATIC WATER LEVEL{ALL WELLS) Yield Time-PumH ped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) rign)' (FL BGS) (hrs&min) (Ft. BGS) Date Measured Ground Surface (ft) 6136101 /A. K., 12.°PERMANENT PUMP IF AVAILABLE) 0-1, :r y­_ -t` 13:ADDITIONAL WELL`INFORMATION � 777 r Pump Description -VEIE'❑ ❑ Horsepower Develope / N Fracture Enhancement Y❑/nN 's Pump Intake Depth (ft)Nominal Pump Capacity (gpm) Disinfected Y 6 Surface Seal Type C hL"tJl t } 14 COMMENTS 4 Total Well Depth--ho Depth to Bedrock NIA t 15 WELL DRILLER'S STATEMENT = This well was drilled, altered,and/or abandoned under my supervision, according,to applicable t roles and regulations, and this report is co, plate and correct to the best of my knowledge. { Driller: r. � Supervising Driller Signature: Registration #:Ig R la IM �4. Firm: Date Complete: G Rig Permit#: I I I I I NOTA ,Well JComple ion lfepoTo mast be fi[ed.by,the.registered-well duller within 30 days of well completion J S If III, I I ,", fblJ tfl2lls J +} .. ._ _.... .,. ...... .. . . . . . . . . . . . . . . . : . t, .'80ARD•OFMEAL'fHCOPY= . . . . . . . . , . ., ... ... . t' Well Completion Report Codes Ewa Section 2 "' Section 3 Section 4 L, Work . 4Lr. Well fi t , 1 Drilling Work Performed Type Method Performed - • Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH Deepen DIP t ' 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 V PBWS I LMud 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 7777771 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG' Schedule 10 .1 Clay CL Brown SR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 - s . Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand FS �• Light Gray LG Gneiss ON PVC PVC SDR 13.5 Fine toCoarseSand FCS Reddish Brown RB Granite OR Stainless Steel SST SDR 17 Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 ' 2 x Medium Sand MS Marble MA SDR 26 = u Organics 0 Quartzite 4Z SDR 32.5 ssmv`,. 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__SISG _ Slate/Phyllite SUPH Till j T Pegmatite PM _,; ) Section 7 Section 8 Section 10 i 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 l_ Bentonite Chipsl Pellets BC Fill FL Air Blow with Drill Stem AB Continuous Wire PUG 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 SID _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 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 314 25 Cement lBentonite - 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 3 60 Jet JET 5' ' 75 Line Shaft Turbine LST 7112 100 Centrifical CENT 10 125 15 150, 200. 4 , Massachusetts Department of Conservation and Recreation Office of Water Resources 160699 TYPE OR PRINT ONLY Well Completion Report' 1.WELL LOCATION ; GPS(Required) North M_a_° 3_1�1 _ _ West Z Q�_ ° n'2,1L. SS1" Address at Well Location: 1" I eAora l '_W Property Owner/Client: c F e6LA;-A ,eru,;W r Subdivision Name: Mailing-Address: P•O.RQ 9Z 6 CQ6io t City/Town: Sa 12f1n Cityrrown: goer i Assessors Map.- Assessors Lot#: NOTE: Assessors Map and Lot# mandatory ii no street`ad cess available Board of Health permit obtained: Yes EJ Not Required CEJ rPermit Number DafeAss6ed 2.WORK PERFORMED-W 13.-WELLTYPE «�fr „w;z 4.'DRILLING METHOD AX 6.-CASING '* _- 0M Overburden Bedrock From (ft) To (ft) Type Thickness Diameter 0 F ❑ 0 ® © ❑ ❑ o . fir. 'TA 06 l" 5.WELU LOG OVERBURDEN F�tra AR, Water Loss or Drop in _ - � E]LITHOLOGY Bearing Addition Drill Fast or From ft To ft Zone of Fluid Stem Slow 7. SCREEN •- ` " m '# _ �°•" _ O O Code Color Comment Drill Rate ` y Alo Y / N Y.L.N F,/.S , From (ft) To (ftJ4, °. Type Slot Size Diameter g G , .. Y / N Y / N F / S O % , ' ]"FelE - .0 I-O tw., I2 Y Y F � ,. ❑❑❑ - - - ((� Y / N Y / N F / S 87ANNULAR SEAL/FILTER PACK/ABANDONMENT WE ((, a 0, r Y / N Y / N F /,S From(ft) To (ft) Material Description Purpose Y / N Y / N FItiex q C ®f Y / N Y / N FR/:Stgtl .10 S❑6 Elf]-.Y / N Y / N,4F,/(S( El ❑❑ Ej Y / Nr Y /sNF %S ❑❑ ❑ WELL'LOG:$ BEDROCK Extz ' : ' 9 SITE SKETCH Water- Drop m F�ctra As Loss or ;,k,of " T .. d LII HOLOGY Bearing Dnll ,Large -Fast br.gRust Addition Fracture fi From ftTo ft Zone Stem Chips+- Slow Staining of Fluid perfoot - FeG3PJtl.� S}'. Y ) O Code Comment �, ,� Doll Rate _ Y / N' F*/ SY / NY / N Y / N,Y,I+NF / SY / NY / N Y`/LLN F / S Y / N Y / N I62 dYil�N.Y / NF / SY / NY / N Y'*%,N•Y / N F / S Y / N Y / N TP$ 'NY / N F / S Y / N Y /-N Yom'% NY / N F / S Y / N Y / N a Y / NYlN F / S Y / N Y / N . Y-/ NY=I'NF /'SY / NY`/,N _ _ Y / NY / N F / S I Y / N Y / N 10:WELL°TEST:DATA(ALL'SECTIONS MANDATORY,FOR PRODUCTION WELLS)41,# 11 STATIC WATER LEVEL"*(ALL WELLS) Yield ,Time Pumped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) ;'(firs 8 min)` (R.BGS) (hrs&min) (Ft. BGS) Date Measured Ground Surface (ft) 12.'PERMANENT,PUMP,(IF:AVAILABLE) ,W` 13:ADDITIONAL-WELL INFORMATION``:"' Pump Description ZVOE1011 ❑ Horsepower Developed / N Fracture Enhancement Y / t Pump Intake Depth x (ft) Nominal Pump Capacity (gpm) Disinfected Y 43 Surface Seal Type ❑ 14'COMMENTS Total Well Depth Depth toBedrockA)A 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 complete and correct to the best of my knowledge. - Driller, C$i oi` 1(f5rd(fr Supervising Driller Signature:_ Registration #:Ig Iq A )+h Firm: 0fSrhA#ltlnu)e AW,. Tnf iA. Wk. Date Complete: Rig Permit #: L • > NOTE ,Weld;Cargpletiou„Reports.must,befiled.6y,-the.registered well driller within 3 , 0,daysofwell completion > .. . . .. . . . ,. >. . . .> Well Completion Report Codes Perloa.L Section 2 - r Section 3 Section 4 Work Well Drilling Work Performed ' Type Method Performed. Code Well Type Code Drilling Method Code Decommission OC Cathodic Protection CTPR Air Hammer AH Deepen DP Domestic DMST Air Rotary AR Hydrofracture 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 t Public Water Supply i PBWS Mud Rotary MR a 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) k Casing Type- Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Cera-LokGTL Schedule 5 , Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 " Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe r GLP Schedule 40- w sa Coarse Sand CS Dark Gray DG Diorde DI HDPE NDP Schedule 80 Cobbles C Greenish Gray GG r Gabbro GB NSF Coated Steel NCS Schedule 160 , FineSand- 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 .; v Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite QZ SDR 32.5 g Sand&Gravel SG Rhyotte PH SDR 40 Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silly Sand SIS Shale SH Silly Sand&Gravel STSG Slate/Phyllite SL/PH Till r T Pegmatite PM I Section 7 Section 8 Section 10 Annular Seal/Filter Screen Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type Code I Pack/Abandonment Material Code Purpose Code Method Code Carbon Steel — -- CST i 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 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 Section 12 Section 13 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 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 t Jet JET 5 75 Line Shaft Turbine LST 7 112 100 Centrihcal CENT 10 125 J5 150• . - 200. I