Loading...
HomeMy WebLinkAboutWell New 676 Clark Street -7 WELL COMPLETION REPORT STATE OF CONNECncuT CPR-9 REV. I1-82 DEPARTMENT OF CONSUMER PROTECTION - Do NOT fill in STATE WELL NO. WELL DRILLING BOARD 165 CAPITOL AVE. HARTFORD, CONNECTICUT 06106 OTHER NO. NAME ADDRESS OWNER QN MIkK-e6ON !60 e clvlee. ST LOCATION (No. & Street) (Town) (Lot Number) OF WELL tOln© �T �Q. 11161FU�' BUSINESS PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF PUBLIC AIR WELL SUPPLY INDUSTRIAL CONDITIONING (Specify) Sp OTHER DRILLING PRESSED �ABLE EQUIPMENT ® ROTARY ARM PERCUSSION PERCUSSION (OSpecR fY) CASING LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT D IV HO WAS CASING GROUTED? DETAILS , "Y ® THREADED WELDED YES1:1 NO YES NO YIELD l� a HOURS ` YIELD (G.P�M.) TEST j� COMPRESSED AIR BAILED PUMPED d WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST (feet) Depth of Completed Well V LEVEL s —?CIO in feet below Land surface: 1?0c3 MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN 7 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. Taxrk- If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED �ERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) PZ DEPT. OF ENVIORN ENTAL PROTECTION WATER RESOURCES - — WELL COMPLETION REPORT STATE OF CONNECTICUT CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION - Do NOT fill in WELL DRILLING BOA_ RD STATE WELL NO. 165 CAPITOL AVE. HARTFORD, CONNECTICUT 06106 OTHER NO. NAME ADDRESS OWNER LOCATION (No. & Street) (Town) (Lot Number) OF WELL 4: 60 afT BUSINE PROPOSED DOMESTIC a ESTABLISHMENT ❑ FARM TEST WELL USE OF PUBLIC AIR WELL SUPPLY INDUSTRIAL CONDITIONING ❑(Specify) cy) COMPRESSEDDRILLING F;:;l,EQUIPMENT I!fN ROTARY AIR PERCUSSION PERCUSSION El (Spec i ) CASING LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT �- FyDRIV SHOE WAS CASING GROUTED? DETAILS / �� THREADED WELDED /AYES �NO YES NO TEST --- YIELD F�7 HOURS YIELD (G.P.M.) I BAILED � PUMPED �COMPRESSED AIR CJ WATER MEASURE FROM/�AND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL .JQd 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 of least FEET TO FEET two permanent landmarks. fie! Tank-. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT NO. G REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) {� 61 +5� ------------- DEPT. OF ENVIORNMENTAL PROTECTION WATER RESOURCES