HomeMy WebLinkAboutWell New 17 Deming Street State of Connecticut WELL COMPLETION REPORT DO NOT FILL IN
WATER RESOURCES COMMISSION This report must be completed and submitted �,va
317 State Office Building to State Water Resources Commission no later State Well No. _ _
Hartford 15, Conn. than 30 days after completion of well. Other No.
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WELL
OWNER ' . _ _ ,� - ✓�(•
f�a S reet Address A�i
WELL .• City and Town
DRILLER42k
Name g F'
A Streetress City and Town
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PROPOSED USE OR USES (Check):
Business
( j Domestic Farm El Irrigation ❑ Establishment ❑ Municipal ❑ Industrial ❑ Test Well
CASING DETAILS YIELD TEST WATER LEVEL SCREEN DETAILS
❑ Bailed (measure from land sur ace)
or
Length: Feet [ Pumped Hours Static: Feet Make:
When Bailed Slot
Diameter: Inches Yield: G.P.M. or Pumped Feet Length Ft. Size
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Kind: Diameter: In.
TOTAL DEPTH OF WELL L—_FEET
WELL LOG'
Depth From Give description of formations penetrated, such as: peat, silt, sand, gravel, clay, hardpan, shale, sandstone,
Ground Surface granite, etc. Include size of gravel (diameter) and sand (fine, medium, coarse), color of material, structure
(loose,packed,cemented,soft,hard). For example:0 ft.to 27 ft.fine, packed,yellow sand;27 ft.to 134 ft. gray
granite.
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FT. to FT.
Date Well Was Com letod: Cyr 1 1
p _ Date of Report
Well Driller` - b F r
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Certificate No.— �Z J
LOCATION OF WELL: TOWN OFf � �� �"
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
(Show distance and direction from road intersection or other landmark.)
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DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
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ROUTE DIRECTIONS FOR REACHING WELL SITE FROM NEAREST CITY OR VILLAGE CENTER:
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