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1 Well Driller Report Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports /S-3 Y/ Well Driller Please specify work performed: Hew Well Please specify well type: Monilonng Number Of Wells: 11 Well Location Address at well location: Street Number: Street Name'. 1 DAMON ROAD Building Lot#: Assessor's Map It Assessor's Lott ZIP Code: City/Town: NORTHAMPTON In public right-of-way: GPS (GPS for the deepest well) r Yes r No Subdivision/Property/Description: Property Owner: Engineering Firm: WJF GEOCONSULTANTS North: West. 4220445 72.38338 Mailing Address: F click here if same as well location addres Street Number. Street Name: 2789 BOSTON ROAD City/Town: State'. WLBRAHAM MASSACHUSETTS ZIP Code: 01095 Board of health permit obtained: r Yes M Not Required! Permit Number: Date Issued: Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(Monitoring) Well Driller - Monitoring Form DRILLING METHOD Overburden (Direct Push I Bedrock [-Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment _• _1 I10 I Medium Sand - I Brown PERMIT INFORMATION DEP 21E RTN# DEP Groundwater Discharge# ADDRIONAL WELL INFORMATION Drop in drill Extra fast or Loss or addit stem slow drill rate fluid r YES C NO 1 : r Fast r Slowl C Loss r Developed r yes G w! Are these wells nested? Surface Seal Type Cement Area of group(sq.ft) Total Well Depth 10 Depth to Bedrock r Yes r W• CASING ,r Is Casing above groundH From To Type Thickness Diameter O 'i 1 I Polyvinyl Chloride I-Schedule 40 2 SCREEN IF No Screed From"> To Fo WATER-BEARING ZONES From To ANNULAR SEAL/FILTER PACK Type Slotted PVC Yield(gpm) From To Material 1"> Weight Material 2 Weight Slot Size Diameter Water (gal) -0 1101. I Sand . '., I, I--Choose Material-- WATER LEVEL Batches Method Of Place I Gravity Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(Monitoring Date Measured Static Depth BGS(ft) Flowing Rate(gpm) 11/04/2015 i5 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations, and this report is complete and accurate to the best of my knowledge. Driller BRETT BALYK Registration# 606 TECHNICAL DRILLING Firm SERVICES,INC. Rig Permit# 66 Monitoring IMI Supervising Driller Signature Date Job Complete NOTE.Well Completion Reports must be filed by the registered well driller within 30 days of well completion. NEWSHA PETER,W '.11/042015