HomeMy WebLinkAboutWell New 29 Brookfield Street WELL COMPLETION REPORT STATE of coNNEcncur
CPR-9 REV.11_82 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD srATE WELL NO.
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
OWNER. NAME ADDRESS
LOCATION (No. & Street)
OF WELL (Town) (Lot N ber)
BUS
PROPOSED � DOMESTIC ESTABLISHMENT 29
I FARM
USE OF TEST WELL
WELL PUBLIC SUPPLY INDUSTRIAL OTHER
AIR
CONDITIONING �(Specify)
DRILLING ® AR PERCUSSION COMPRESSED _ CABLE OTHER
ROTARY
EQUIPMENT PERCUSSION (Specify)
CASING :LEN:G:T:H(:feet) DIA;�TIR(Inch`e, VVEI:�GHTPERFOOT DRIVE SH EtE
TED?
DETAILS 5 �THREADED WELDED YES NO
YIELD HOURS
TEST BAILED PUMPED 13 COMPRESSED AIR
WATER
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) E
LEVEL Depth of Completed Well
"' 7 —ft in feet below Land surface:
MAKE _
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER (inches) =GRAVELIZE(inches) FROM feet
=GRAVEL Diameter of=ellinclud=ing ( ) TO(feetgravel pack
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET TO FEET two permanent landmarks.
Send
_ e
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER (Signature)
DEPT. OF ENVIRONMENTAL PROTFrTIONI_%A/ATrD Dccni tore