HomeMy WebLinkAboutWell New 531 Griffin Road U/ b5l
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STATE OF CONNECTICUT WELL COMPLETION E OR DO NOT FILL IN
WATER COMMISSION
317 STATE OFFICE BUILDING This report must be completed and submitted to STATE WELL N0. : !�°. .3
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO. .........
after completion of well.
WELL � 7
OWNER ?.� ✓ ' �'�.?2C� / ' �;' I'. � r� x�>?/
WELL _ f �N e Sttrr et Address �C,aitf or Town
DRILLER 7`r
Name Street Ad 4ess r City or Town
PROPOSED USE OR USES (check):
j]Domestic 0 Irrigation ❑Stock (Municipal 0 Industrial ❑Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: FEET DURATION: HOURS STATIC: FEET MAKE:
SLOT
DIAMETER: INCHES PUMPING RATE: - G.P.M. WHEN PUMPING:: - FEET LENGTH: FT. SIZE
KBND: a%` DIAMETER: IN.
WELL LOG
DEPTH FROM Give details of formations penetrated, such as: peat,silt,sand, gravel,clay, hardpan,shale,stone,rock. Include size of gravel
GROUND SURFACE (diameter)and sand (fine, medium, coarse),color of material, structure (loose, packed,cemented, soft, hard)
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DATE WELL WAS COMPLETED: ^_f � } /!� /�` d DATE OF REPORT
WELL DRILLER
(Signature)
CERTIFICATE NO.^—
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
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i t j
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
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f ROUTEDIRECTIONS FOR REACHING WELL SITE FROM HARTFORD: ,
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