HomeMy WebLinkAboutWell New 1299 Main Street State of Connecticut WELL COMPLETION REPORT DO NOT FILL IN
WATER RESOURCES COMMISSION This report must be completed and submitted
223 State Office Building to State Water Resources Commission no later state Well No, v cG)00
Hartford, Connecticut than 30 days after completion of well.
Other No.._.__,_
WELL``.
OWNER Mr. Fe►i' i.a insk s 1299 i-f
WELL „ Name Street Address DRILLER I" j`c tE.Z SuPPlies Inc. 75G Fuller St. Ludlow, C(tyandTown
ow, Mass.
Name
street Address City and Town
PROPOSED USE OR USES (Check):
Domestic [I Farm Business
❑ irrigation ❑ Establishment ❑ Municipal ❑ Industrial
❑ Test Well
CASING DETAILS YIELD TEST
WATER LEVEL SCREEN DETAILS
❑ Bailed I (measure from land su ace)
Length: 2 � Feet or ours Static: '�-Pumped [---'� -_H 1 Feet Make:
Diameter: 3' or i During Yield --
Inches Slot
❑ Compressed Airy G.P.M. Test: I`* Feet Length Ft. SIZE
.Kind: DRILLING EQUIPMENT
Cable Tool ❑ { p y) Diameter:
CBTT187�t Yield: �� to ��' G.P.M ❑ Other S ecif In.
❑ Rotary CAL?e......S �l.:..........
)TAL DEPTH OF WELL 2?_ _FEET
WELL LOG
Depth From Give description of formations penetrated, such as:Ground Surface granite, etc. Include size of gravel (diameter) and sand ('fine, medium, coarse), color ofnmaterial structure i
(loose,packed,cemented,soft,hard). For example:0 ft.to 27 ft.fine, packed,yellow sand;27 ft.to 134 ft. gray j
granite.
FT.toll FT. coarse sand
FT.to 22 FT. 1'cah.t grGvex
1
FT.to FT.
i
i
FT.to FT.
- i
FT.to FT. i,G 1 s- l
FT. to FT. 1a,
vLvv r�ccx 'F A0
FT.to FT. -
i
i
FT. to FT. j
YIELD TEST DATA IN G.P.M.
—_ If Yield Was Tested'At different Depths During Drilling, List Below
FT. G.P.M.
FT. G.P.M.
FT.
G.P.M. —------- ------ --- I
G.P.M.
,,.
l Was Completed: F Date of Report
'own Permit Number.
Well Drillers !
`'-(Signature)