3-27 PARADISE ROAD a o7 7 �.9/1/fc�%Se �Gcngr �Lvel/5)
♦' �' Department of Environmental Management/Division of Water Resources
11 " WELL COMPLETION REPORT
WELL LOCATION O Y: 3e l GEOGRAPHIC DESCRIPTION -
Address
3 ]to �'1 GIYA iStC iP00. N S E W of
.� � M- (reed ', lcirNel
City/Town /„ A
tr A/civicAt
(read) '
Address !rA CA N/e f• _r7'NYC l— N S E W OI
L '�.b f-1 /AT�' AIA yf
I' intersect. w/al Xl Md..M 1.001.00 (circle)
/— ine
Board of Health permit obtained: yes ❑ no❑ - (rad)
WELL USE WELL DATA
Domestic ❑ Public❑ Industrial ❑ Total well depth D 0 ft.
Monitoring Nr Other Depth to bedrock - ft.
Water-bearing tock/unconsolidated material:
Method drilled�f C
Date drilled .� //1 /& Description
Water-bearing zones:
Type
CASING 1) From To
PVG
21 From To
Length l-!'L._R. Dia(l.D.) in. -
31 From To
Length into bedrock—ft. Gravel pack well: ,dia.
Protective well seal: Screen: dia.
Grout.❑ Other&n:bt� Sloth /0 length.01from.l2r to124�
STATIC WATER LEVEL(all wells
Static water level below land surface—LG-ft. /Dal /96 —
WELL TEST(production wells)
,,
Drawdown ft. after pumping—Ill.—min.at - gpm
How measured Recovery - ft. after—hr.—min.
0
LOG of FORMATIONS COMMENTS a
n
Materials Fram To A
Drillers M• �o S- j,1AIn -
FirmriddD'/ffittel rn, N6 ._
Address /rJD watty Sfrrr�
City/Town FJ�VI dyI1C{ �, r• O�
Supervising Drflier RegA d7f VS
Sin ure al err ervrtfn hfemdwel/dr(i)er
P111cwenmlr BOARD OF HEALTH COPY