HomeMy WebLinkAboutWell New 547 Griffin Road STATE CO C MISSION ICUT WELL �OAAPLET N REPORT DO NOT FILL IN
WATER COMMISSION �
317 STATE OFFICE BUILDING This report must be completed and submitted to STATE WELL NO. , ......'...:..
HARTFORD 15, CONN. State Water Commission no later than 30 days ( OTHER NO. .................„.........
fl after completion of well.
WELLrt " �' 'E ,
OWNER . _may f
WELL dame Str et Address
i` -� City or own
DRILLER
--Name f Street dddress
City or Town
i
PROPOSED USE OR USES (check):
DDomestic Ej►rrigation ❑Stock E3Municipal 0 industrial E]Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from Iona surface)
LENGTH: ` FEET DURATION: HOURS STATIC: FEET MAKE:
SLOT
DIAMETER: INCHES PUMPING RATE: — G.P.M. WHEN PUMPING FEET LENGTH: — FT. SIZE
i
KIND:
LDIAMETER: 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)
FT.t1 3 J-- FT.
—?&FT.to,// FT. �
FT.to FT.
FT.to FT.
FT.to FT. trJi i) f`Vf
FT.to FT. Ont SC GL Gt { R._t�'• �� bff7 G>' ✓1� 1 hr--
FT.to FT. �
FE--"I- Er D
FT.to FT.
— 3
FT.to FT.
FT.to FT.
i ,Ssi'a'tO Via?di' � $Rt(iliuy I:s�litll3i �$�I
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT..
)ATE WELL WAS COMPLETED:—l'..:'n_/ - � m '� DATE OF REPORT
, f
WELL DRILLER "
(Signature)
CERTIFICATE NO.------- ------------- ------ ------
LOCATION OF WELL: TOWN OFdt '"v�
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
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DIAGRAM SHOWING LOCATION OF ELL ON PREMISES:
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ROUTE DIRECTIONS FOR REACHING
rWELL SITE FROM HARTFORD: