HomeMy WebLinkAboutWell New 1486] Main Street WELL COMPLETION REPORT STATE OF CONNECTICUT
CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WELL NO
165 CAPITOL AVE.
HARTFORD, CONNECTICUT 06106 OTHER NO.
OWNER NAME ADDRESS t —
No. & Street ( ) (Lot Number)
LOCATION � )� Town
OF WELL
PROPOSED
DOMESTIC ESTABLISHMENT BUSINESS FARM TEST WELL
USE OF 1 9-7
PUBLIC AIR Fl.
WELL SUPPLY Ej INDUSTRIAL CONDITIONING a(specOTHEify)
DRILLING
EQUIPMENT � ROTARY ❑ AIR PERC
USSION SDSION � PERCUSSION L=Specify)
CABLE OTHER
CASING LENGTH(feet) :J�� DIAMETER�(inches) [WEIGHTPER FOOT�E]
IV H WAS CASING Ga0 TED? -
DETAILS READED WELDED I YES NO 'YES i NO
YIELD HOURS YIELD (G-PM.)I
TEST I_( BAiI.ED � UMPED �COMPRESSED AIR
WATER MEASURE FROM SURFACE—STATIC(Specify feet)DURING YIELD TEST(feet) —
Depth of Completed Well
LEVEL in feet below Land surface:
MAKE /�. LENGTH OF
AQUIFER (feet)
SCREEN
J
DETAILS SLOT SIZE DIAMETER(inches) GRAVEL SIZE (inches) FROM(feet) TO(Feet
/ - IF GRAVEL Diameter of well including
¢ s PACKED: grovel pack (inches):
DEPTH FROM LAND SURFACE --_
FORMATION DESCRIPTION Sketch exact location of well with distances, to of least
FEET TO FEET — two permanent landmarks.
L� '
I
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
.2; --
D E WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT L ILLER i notur
" -'- 7/
DEPT. OF ENVIORNMENTAL PROTECTION-WATER RESOURCES