HomeMy WebLinkAboutWell New 580 Foster Street tVVELL COMPLETION REPORT STATE OF CONNECTICUT DO NOT fill in
WDB-5 12-69 REV.9.71 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD, CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
.OWNER t f
LOCATION sac) (No. &Stree~ (Town) (Lot Number)
OF WELL 4W
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❑ BUSINESS
ESTABLISHMENT El FARM PROPOSED DOMESTIC El TEST WELL
USE OF
WELL ❑ OTHERPUBLIC AIR
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING E�OMPRESSED CABLE OTHER
EQUIPMENT ❑ ROTARY III AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING
CASING GROUTED?
DETAILS I yil. , I -►"'7 THREADED ❑ WELDED I `rYES ❑NO �ES El NO
YIELD
HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR
MEASURE FROM LAND SURFACE—STAT C(Specify feet) DURING YIELD TEST(feet)
WATER I Depth of Completed Well
LEVEL "2 T <: -e 7 I J G in feet below Land surface: 31 ,
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MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) I IF GRAVEL ) Diameter of well including GRAVEL SIZE(inches)FROM(feet) TO(feet)
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances,To at least
FORMATION DESCRIPTION
FEET to FEET two permanent landmarks.
f fill-
If yield was tested at different depths during drilling,list below '(
FEET GALLONS PER MINUTE
DATE WELL OMPLETED PERMIT NO. REGISTRATION NO. DAT��F OF REPORT W RIktER(Sign u ) jt f
LOCAL DIRECTOR OF HEALTH