HomeMy WebLinkAboutWell New 130 Buckland Road WELL COMPLETION REPORT STATE OF CONNECTICUT Da NOT fill in
WDB-5 12-69 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115 [ / -S V�'j
OTHER NO.
OWNER
NAME ADDRESS
LOCATION (iJo. Street) (Town) (Lot Number)
OF WELL
BUSINESS
PROPOSED I DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL ❑ PUBLIC ❑ ❑ AIR El
SUPPLY INDUSTRIAL CONDITIONING (Specify)
DRILLING �] COMPRESSED CABLE OTHER
EQUIPMENT D ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 1 r { � THREADED ❑WELDED ❑YES ❑NO ❑YES ❑NO
YIELD HOURS G.P.M. YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED 11�1 COMPRESSED AIR ;)
MEASURE FROM LAND SURFACE—STATIC(Specifyfeet) DURING YIELD TEST(feet)
WATER Depth of Completed Well
LEVEL r in feet below Land surfacer
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(Inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
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If yield was tested at different depths during drilling,list below I ) I
FEET GALLONS PER MINUTE I bam I ' , 1J tm f af, ,1
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DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) r},-
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WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
WDB-5 12.69 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
OWNER
NAME / ADDRESS
LOCATION (All.d treat) (Town) (Lot Number)
OF WELL
BUSINESS
PROPOSED DOMESTIC ❑ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL ❑ PUBLIC AIR
OTHER
PLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILUNG COMPRESSED EQUIPMENT ROTARY CI AIR PERCUSSION ❑ PERCUSSION ❑LE OTHER
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS r YIELD �y�fs2lei THREADED ❑WELDED ❑YES ❑NO ❑YES ❑NO
TEST ❑BAILED ❑ PUMPED 1" COMPRESSED AIR HOURS G.P M. YIELD(G.P.M.)
MEASURE FROM LAND SURFACE—STATIC(Spec/ly loot) DURING YIELD TEST(feet)
WATER Depth of Completed Well
LEVEL in feet below Land surface: j '
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(toot) TO(toot)
PACKED: gravel pack (Inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances,to at least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
Lc
L
L
If yield was tested at different depths during drilling,list below ❑
FEET GALLONS PER MINUTE
DATE WELL COMPLETED IPERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature)
BOARD