102 JACKSON STREET /o.Z Sac kson *.54-ree+
t Massachusetts Department of Conservation and Recreation163483
-
Office of Water Resources V/ �/_ G 16 3 4 8 3 S
TYPE OR PRINT ONLY Well Completion Report
IfWELL'LOCATION„'s GPS (Required) North -0—. .West - 02 -&L-3— l�l—
Address at Well Location: L L Property Owner/Client: G/1
Subdivision Name:_��/�O� �JG�tp �L_L� Mailing Address: mryy� /L/ ,Q�
City/Town: l/Lm �/7 CitylLown:_� OJOlJf�70dY17�_�`� U/
1K Aw
Assessors Map Assessors Lot# NOTE: Assessors Map and Lot#mandato'ry if no streetaddress available
Board of Health permit obtained: Yes ❑ Not Required CA Permit Number Dafe•lssued
2:WORK PERFORMED`aaf 3.-WELL TYPE rte'%�<— ,,' 4 DRILLING METHOD Tii 6:CASING a sci„;; `" a x • ': w =
Overburden Bedrock From(ft) To (ft)-, „Type' Thickness Diameter
53 WELL LOG' OVERBURDEN Water Loss or DExtra ❑Q❑
rop in - - _
LITHOLOGY Bearing- Addition Drill Fast or .0❑1:1
Zone of Fluid Stem Slow 7 SCREEN`!Ehn -21- 1 '^ � W`f
From (ft) To (ft) Code Calor Comment Drill Rate
Y / N Y / N F / g From (ft)"iT6'MO , Type Slot Size Diameter
t t Yea M•&, . p'
Y / N Y / N F ❑❑❑ • - -
L Y / N Y / N F / S Aft�, ❑❑❑ . -
- -
Y / N Y / N F / S K*ANNULAR SEAL/FILTER PACK/ABANDONMENT MTLv
Y / N Y / N F /;•Sj From(ft) To (ft) Material Description Purpose
m Y / N Y F /is o 0 1l�J—
a.
Y / N Y F9�S� �" El El
Y / N Y / N, 'F.%
Well Completion Report Codes
Section 2 •' _ Section 3-- _ Section 4
Work A Well Drilling
Work ;� Performed �T Type Method
PerformedNi CodeV*N • ^ ZWell Type Code Y ) A . 'Drilling Method Code
Decommissib yCC n, �, BCathodic Protection CTPR Air k0me):v,;
Deepen DP" Domestic DMST Air Rotary-N 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 r MONT Dug � DG
.k, j Public Water Supply b PBWS f, Mud Rotary MR ,
elRecovest ry RCVRSTW RevSonerse Rotary FIR
SN
SEP 27zott
6�1 <J FI€i�eh6n.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 1 Cera-Lok CTL Schedule 5 �*,
Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 ,r Nx`*
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 PHv
Cobbles C '. Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 n`
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 v
Medium Sand MS Marble MA SDR 26
Organics 0 Quartzite OZ SDR 325
Sand&Gravel SG _ Rhyolite PH SDR 40
Silt r SI Sandstone SS 17#
Silly Clay , SICL Schist SC 19#
Silty Sand SIS Shale SH
Silty Sand&Gravel SISG Slate/Phyllite SL/PH
Till IT Pegmatite PM
Section 7 Section 8 Section 10
Annular Seal/Fitter
� 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.' ,^ --7. Bentonite Grout BG — Filter FT Air Lift AL
Galvanized Wire Wrapped GWWr Cement/Bentonite Grout CB Seal AS Bailing BL
_ Perforated Pipe' PFP `"` Concrete CT Constant Rate Pum CR
P P
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
t-.
t _
Section 12 Section 13
Pump
Description Well Seal
Pump Description Code Horsepower Surface Seal Type Type Code
t 3 Wire Variable Speed Submersible 3WVS 1!2 20 z 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 1 112 40 None NO
. Constant Speed Submersible Turbine CSST 2 50 &;
a 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" °,` ;