HomeMy WebLinkAboutWell New 555 Griffin Road STATE OF CONNECTICUT WELL COMPL 90 EPORT 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.
after completion of well.
WELL f�q
OWNER 'eJ l + J i'/� f>!s'{�_ �' Ems+ %V's 1.. i fs �'et0e
WELL ppa�y Name /� -yStreet Address City or Town
DRILLER 11/G 0 11/ . J, C_ // f ems` E`er sS '� s✓`� � `�� `s� }
Name
c�c ] Si-Ijl/ / Street Address City or Town
Ii X.J a°S G1 2 �r
PROPOSED USE OR USES (check):
omestic irrigation Stock ❑Municipal 0 industrial ❑Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: ,e FEET DURATION: �`- HOURS STATIC: FEET MAKE:
ft -_ ------- _--
SLOT
IAMETER: INCHES PUMPING RATE: _ G.P.M. WHEN PUMPING: FEET LENGTH: FT. SIZE
[KIND:---Cl — 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 grave[
GROUND SURFACE (diameter)and sand (fine, medium,coarse),color of material, structure (loose, packed,cemented,soft, hard)
FT.to FT.
FT.to//djj r
'FT. � t7
FT.to FT.
FT.to FT.
FT.to FT. S �j ) coma I'L•
FT.to FT. lot. sL o f ,
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT. —"-"--
FT.to— FT. ----- - ----- —�11 FT.to FT.
FT,to FT.
FT,to FT.
FT.to FT.
?ATE WELL WAS COMPLETED: ! `�- �-� f - ��� DATE OF REPORT
WELL DRILLER Lsj1 _y �c�2
(Signature)
i
CERTIFICATE NO.---------�'�_ -------------------------
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
�y
§ 5
DIAGRAM SHOWING LOCATs10N OF WELL ON PREMISES:
a
i
�? 1
6
ROUTE DIRECTIONS FOR REACHING WELL SITE FRAM HARTFORD:
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