HomeMy WebLinkAboutWell New 1281 Main Street state of c:onnecticut VVMLL COMPLETION REPORY DO NOT FILL IN
WATER RESOURCES COMMISSION This report must be completed and submitted
317 State Office Building
Hartford Of Conn. to State Water Resources Commission no later State Well No.�_? _7L
than 30 days after completion of well.
Other No.
WELL
OWNER
WELL Name Stre Address
DRILLER City dTown
Name Street Address ell",`
¢ity and Town
PROPOSED USE OR USES (Check):
�°Domestic ❑ Farm ❑ Irrigation Business
9 ❑ Establishment ❑ Municipal ❑ Industrial ❑ Test Weil
CASING DETAILS YIELD TEST WATER LEVEL
SCREEN DETAILS
❑ Ba®rd (measure from land su ace)
Length: Feet or
:2—Hours Static:
Feet Make:
Diameter: Inches Yield: hen Bailed
G.P.M.GP or Pumped Feet Length Ft Slot
Size
Kind:
Diameter: In.
TOTAL DEPTH OF WELL—cig _FEET
WELL LOG
Depth From Give description of formations penetrated, such as:Ground Surface peat, silt, sand, gravel, clay, hardpan, shale,sandstone,
granite; etc. Include size of gravel (diameter) and sand (fine, medium, coarse), color of material, structure
(loose,packed,cemented,soft,hard). For example:0 ft.to 27 ft.fine,packed,yellow sand;27 ft.to 134 ft.gray
granite.
FT:to FT.
FT.to$P/ FT.
1 FT.td�6FT.
FT.to FT.
FT.to FT. anCkesfr'r- !
FT.to FT.
FT.to FT.
FT. to FT.
FT. to FT.
yk
Si ��Gi�� '
FT. to FT. 1 ...... q
FT. t0 FT. pf ? S U 3
FT. to FT. t l�`� ...........I
Date Well Was Completed: „ I�t� �a f Date of Report f
f
Well Driller
(Signature)
Certificate No.
i
J k, 3
LOCATION OF WELL: TOWN OF y G
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
(Show distance and direction from road intersection or other landmark.)
t•
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
60vey-vtor-5 If��h "}� S ro,� Road
-1/1.1 Mile
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM NEAREST CITY OR VILLAGE CENTER:
C +cf�r
CX-
y":r trs3f,.;gin 1V'�y'�C.,