HomeMy WebLinkAboutWell New 2019 Ellington Road WELL COMPLETION REPORT STATE of CONNECTICUT CPR-9 REV.11_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 PAM MCIMOS 2019 EdSiiWO-1I RD s, S• Wy.'nSOR g L T s
LOCATION (No. &Street) , n p t� ((Taown)�r e (Lot Number)
OF WELL 2019 K.3�tT14TT01i RD. S• W I•�;DSORBUSINESS
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PROPOSED AI DOMESTIC ESTABLISHMENT � FARM � TEST WELL
USE OF
WELL OTHERPUBLIC AIR
SUPPLY INDUSTRIAL CONDITIONING (Specify)
OTHERDRILLING COMPRESSED CABLE
EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT RIVE SHOE WAS CASING GROUTED?
DETAILS � 19,45 THREADED WELDED YES NO ®YES NO
YIELD ❑ D COMPRESSED AIR HOURS r YIELD(G.P.M.)
TEST BAILED PUMPED � 7,Lj
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL 30 100 in feet below Land surface: 130
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 pock(inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET TO FEET two permanent landmarks.
O 12 Saiid Ct1a
apt
1
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If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DA=REPORTWEL LER (Signature)
two
DEPT. OF ENVIRONMENTAL PROTECTION—WATER RESOURCES