34-006 (8) Massachusetts Department of Environmental Management b O
Office of Water Resources O
PE OR PRINT ONLY (p Well Completion Report
cress at Well Location: ' 7-4,. 4 64roperty Owner: j-e-A,-x-:. rP
division Name: Mailing Address: A-&.
'frown: ��_�.�.. �+-„_ ---2,-Q_0i,01?7.CityMwn:
;essors Map Assessors Lot#: NOTE: Assessors Map and Lot#mandatory if no street address available
trd of Health permit obtained: Yes ❑ Not Required X Permit Number Date Issued
�
New Well ❑ Abandon astic ❑ Irrigation Cl Cable Anger
Deepen ❑ Recondition ❑ Monitoring ❑ Municipal U-Ai Hammier: : y Direct Push
Re lace ❑ Other ❑ Industrial ❑ Other ❑ Mud,Aasa"...,',:❑ Other
eC Unconsolidated Consolidated
Q m c >
From(ft) To(ft) r High Low e' U Omer Rock Type
k '
I
,.�"''w« wy u/
d a nu aU, l l`: bi i J�i7C'.4>C F. rPx. w� •W 6 �e�+:wi w aJ a 'y Ley •'' G
Total Depth Drilled From (ft) To(ft) Casing Type and Material Size O.D. (in) Well Seal Type
Date Drilling Complete _5� t =.r
',��y� 0
. ryJ' u'�i'�+ ih�•'�y,{�,F�� .N�'.•�tj' 'b'' ��yyl�u�i,e a.� ';i{u�,J�rii,',. '.i iis,p:4.; nr"y ,J'a.. j ,P.: �a w��, �!$yy�vJ{y" )�",,N ��`d¢a.yyk}y,
.5�71i9'1Y" ,Y'h [?�`bi•�_'}.35t.1'P..
From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter
An ij!��1 ��vv shy'.�v wY,� �t �y k�` } ���pyn +I� C..y ■�a� ,i
YOU . i; yi
From (ft) To(ft) Material Description Purpose Developed? Yes El No Fracture
Enhancement? ❑ Yes ❑ No
Method
Disinfected? j Yes ❑ No
r1F,)?l �rW 9 M. r(
Yield Time Pumped Drawdown to Time Recovery to Depth Below
Date Method (GPM)''':'- (hrs& min) (Ft. SGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT)
r, g- lw � .
9
Pump Description - Horsepower
Pump Intake Depth� _ (ft) Nominal Pump Capacity (gpm) RT. 12N
KEENE,NH 03431
This well was drilled and/or abandoned under my supervision, according to applicable rules
and regulations, and this ref Grt' compnnZ1 to the hest of my knowledge.
Driller: �I Supervising Drilier Signatur Registration#,15 G'
L.G.'CUSHING & ^' *'G.
Firm: Date: a Rig Permit
NOTE: Well Completion Reports must be•filed by the registered well driller within 30 days of well completinn.
jl
FALL MOUNTAIN WATER TES i NG, INC.
P.O.flQx 939 30 F wimsm Dimm
CHARLESTOWN, NH 03603
603265032
60382&3378(FAY)
Pxpart#-. X�89�7744�� g cc,,��w.�,,�� E-MAIL vmwrQFMts.uu7r
a�uabim& 7Yns
Cwt Naatt: $Bond
XA=606 of Sample: M-1w)m Hill Rd Noth Iiampton,NSA(well hUM
Data ale'nm Suwkd: Me 9__2„OU2
Dade of Sample Rec6pt: Mme''14,20if22:30 am
PMM SMOMM DM WbAmt
-W- vr4r
14�trbc: water
"Total Colifotm 5/10/02 10:10 am AbWM Absent SM-18 9223
"Frcoli 5/10/02 10:10 am Absent Absmt SM-18 9223
PH 5110/02 10:12 am 7.09 6.5-8.5 SM-18 4500-H B
Tutbkk 5110/02 10:12 am 36.E nw 5 tttu SM-18 2130 B
Colon 5/10/02 10.15 am 202 units 15 emits HACH 8025
'/ton 5/13/02 2:37 pm 4,-1 Mo 0.30 mg)1 SM-18 3111E
"Manganese 5/13/02 2:48 pm 0.112 X11 0.050 m@A SM-18 3111E
*Nitrate 5/10/02 11:00 am <0.5 MAn 10 r>a SM-18 4500 NO3 D
Chimwe 5/10/02 10:22 am 3.6 n 11 250 won HACH 8113
1lardness 5/10/02 10:32 am 6f?! /) 250 we HACH 8226
*Copper 5/13102 2:29 pm U:1 1.3 n* SM-18 3111 B
Your Bacteria Test Passed NHf VT/EPA Standards for Potability
Note From Well Drifter: `Q High turbidity- creed to run because it is a new well"
krnd.
earl!—millig ms per liter XCL-Maxdmum Contmmnant Lxvel <-less it=
n4—wicrog rafts pt7 liter NTU,nepWonwtic Turbidity Units
pM—picmuries per liter >-Gremer Than
*NM State Certified#31402.1
*VT State Approved 4/17/02
11/1' - , 0
Pap 1 Of I
a''Y so the T R"M CvltapWM as 3113/02 3;32 8M
MAY 13 182 15:46 6038265032 PAGE.02
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