12-18 GOODHUE STREET /a? - /8 G.e„/,yrris S/TJtteT
�µECYCIfp�
UPC 10333
NOPOa.co�s
HASTINGS. MN
Massachusetts Department of Environmental Management
Office of Water Resources. 113.964
TYPE OR PRINT ONLY Well Completion-Report
i . . tDchT1b � yes oPra .. ATTfiD
Address at Well Location: Property Owner: S
9nbdivrsmrt�dja>rt2. /2 �iv,,tn hull, �YC� .Mailing Address7777
:
Assessors Map Assessors Lot# NOTE:Assessors.M.ap and Lit# mandatory if no.street-adbress available
r.°' `tea::
Board of Health permit obtained: Yes ❑ Not.R-equired.❑ Permif filumber DateJssuetl'
2€WQRK.PERFORMED". , �x 10, 3°}?40_00t!20!'Ol � '•c z" ` A gJLLING M)~THOD'
New Well ❑ Abandon Domestic El Irrigation ❑ Cable *❑pAuger
❑ Deepen ❑ Recondition Monitoring ❑ Municipal ❑ Air Hammer" Direct Push
❑ 'Re lace ❑ Other ❑ Industrial ❑ Other ❑ Mud!Rota ;> ,0 Other
5F WELL LOG e; M Unconsolidated Consolidated 'WSITE`SK HMtandmadswithifiSt,u"ires)T
W Pertneabiliry
Q _NT = c > a a
From`(ft) To (ft) Hign Low o g m Other Rock Type '
7
d �
7:;WELL CONSTRUCTION),§,r, 8.;
.M V
Total Depth Drilled From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type
Date Drilling Complete Zr Z CYl\
9.SCREEN 4',f" , a "a r" # * * _; ". • t; . x � '" fib.. .'AX13 i 10*
From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter
ZI oknn
11M,FPLTER PACK/GROUT/ABANDONMENT,MATERIAL w =z ` ' m F; 11 ADDITIONAL-WELL INFORMATION -, 4
From(ft) To (ft) Material Description Purpose Developed? ❑ Yes El No
Fracture
Qt ' r Enhancement? ❑ Yes EJ No
( L Method
Disinfected? ❑ Yes ❑ No
12.WELL'TESTOATA(PRODUCTION WELLS) -Z. 13.`STATIC WATER LEVEL.(ALL WELLS)";
Yield Time Pumped Drawdown to Time Recovery to Depth Below
Date Method (GPM) (hrs & min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT)
" " ¢ " ' `t° 15.NAMEIADDRESS OF PUMP INSTALLATION COMPANY
14rPERMANENT.PUMP-(IF:AVAILABLE 'x'��`', ' � :. � � •, , m
Pump Description Horsepower
Pump Intake Depth (ft) Nominal Pump Capacity (gpm)
15 60MMENT$;0
17 WELLDRILLER'S STATEMENT."_ This well was drilled and/or abandoned under my supervision, according to applicable rules
fy / and regulations, and this report is compim and cqfrct to the best of my knowledge.
Driller:�� 1� l ������� Supervising Driller Signature: Registration #:
Firm: 1 /f , ' Date: /��` Rig Permit #: I I
NOTF. Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
_ . 1qa-:)y3
Massachusetts Department of Environmental Management
Office of Water Resources113964
TYPE OR PRINT ONLY Well Completion Report
1. WELL LOCATION *. GPS(OPTIONAL) = LATITUDE -0* LONGITUDE- - - -E
Address at Well Location: Property Owner: S
Subdivision.N(aZtr2: o
//Z//o hL/dCG
at—Mailing Address:/
17Q��?. I T�
City/ n: , Cit /Town:
Assessors MapAssessors Lot# NOTE: Assessors Map and Lot # mandatory rf
no; taddress available
h
Board of Health permit obtained: Yes ❑^ Not Re cared ❑ 4' Permit Number Date lssu tl`
2. WORK PERFORMED; 3.PROPOSED USE., "*Y K JVDRILLING METHOD t t
New Well ❑ Abandon Domestic ❑ Irrigation ❑ Cable "' ❑-Au era.
9 + 9
3
❑ Deepen El Recondition � Monitoring EJ Municipal ❑ Au Hammer-;.,K Direct Pushup;
❑ Replace ❑ Other IEJ Industrial ❑ Other ❑ Mud Rotary—T0 Other
_.._
S. WELL LOG-, ¢ Unconsolidated Consolidated 6tS1TESKETCH (use`nemia'n"e
F- Permeability dlandmarks wIIM1distsnces)
m y
From"(ft) To (ft) High Low N g m Other Rock Type
4x YX
m ,tea
J
.,5
7.WELL CONSTRUCTION - 8.CASINGS s?. ? $.; '3s"
�_ r
T
Total Depth Drilled From-(ft) To ft Casing Type`"
and Material Size O.D. (in) Well Seal Type
Date Drilling Complete Zr U Z f.!, ;�(L QLO7
9. SCREEN . ., . . ,.
From (ft) To (ft) Slot Size Screen-Type and Material Screen Diameter
Z 1 d. , �\4 . L n
1O: FILTER PACK/GROUT/ABANDONMENT,MATERIAL = r' _ s_= a 11 ADDITIONAL WELL INFORMATION _Nam-.,
Developed? ❑ Yes ❑ No
From (ft) To (ft) Material Description Purpose Fracture
Qt P t, I ( Enhancement? ❑ Yes ❑ No
Method- �.
Disinfected? ❑ Yes ❑ No
12.WELL TEST DATA'(PRODUCTION WELLS) ' = e yy N . - _r 13.'-'STATIC WATER LEVEL(ALLY WELLS)»
Yield `NTime Pumped Drawdown to Time ' Recovery to Depth Below
Date Method (GPM) (hrs'&min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT)
( S6
14. PERMANENT PUMP (IF AVAILABLE) 4 . sr a ,: `x , 15.NAMEIADDRESS'OFPUMP INSTALLATION COMPANy-.
Pump Description LIHorsepower
Pump Intake Depth -� ,i+ (ft) Nominal Pump Capacity (gpm)
MM
16.COENTS'" /S I&I011e J
17.WELL DRILLER'S STATEMENT ,mow. This well was drilled and/or abandoned under my supervision, according to applicable rules
`� *J((e11 � and regulations, and this report is compl and c r ct to the best of my knowledge. '
Driller:� � 1 v��l ha Supervising Driller Signature: �� Registration #:L I� P l
Firm: T . t *tal U -7-04. Date: 6154 — RigPermit#: I I I 1 I
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
",BOARD OF
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Gi 1Y OF SALE-o
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