HomeMy WebLinkAboutWell New 479 Clark Street CPR-9 Rev.7/95
Do NOT fill in
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
WOOD CONSTRUCTION CO. 223 WOOD ROAD, SOMERS, CT.
LOCATION (No.BStreet) (Town) (Lot Number)
OF WELL 479 CLARK ST. S. WINDSOR
BUSINEST
PROPOSED � DOMESTIC � ESTABLISHMENT ❑ FARM 11 WELL
USE OF WELL
PUBLIC INDUSTRIAL El AIR OTHER WELT, ABANDONED
SUPPLY CONDITIONING (Specify)
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT AIR PERCUSSION F. PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS THREADED❑ WELDED""❑ ❑ YES ❑ N0 ❑ YES ❑ NO
YIELD TEST F]BAILED PUMPED a COMPRESSED AIR HOURS YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: including gravel pack
(inches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
EXISTING DRILLED ELL
ABANDONED ACCORDI G TO
r
STATE Pr a.=
` J
If yield was tested at different depths during drilling;list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED REGIS4R2TION NO. 4AI E109 T L DR aR( ature)
�f15I99
DEPT.OF ENVIRONMENTAL PROTECTION -WATER RESOURCES