HomeMy WebLinkAboutWell New 541 Miller Road State of Connecticut WAVELL COMPLETION REPORT DO NOT FILL IN
WATER RESOURCES COMMISSION This report trust be Completed and submitted State Well No.z2Lt 73
223 State Office Building to State Water Resources Commission no later
Hartford, Connecticut �� than 30 days a er ompletion of well. Other No. _
WELL t"e
OWNER `
'Name StraetPAdrau WELL CI. and Town
DRILLER n
Name Street Acldrew rItY d own
PROPOSED USE OR USES (Check):
Business
ga-6omestic ❑ Farm ❑ Irrigation ❑ Establishment [-].Municipal ❑ Industrial ❑ Test Well
CASING DETAILS YIELD TEST WATER LEVEL SCREEN DETAILS
c ❑ Balled (measure from land su ace)
or
Length: Feet ❑ Pumped Au; Static: L1la Feet Make:
When Bailed 4011 Slot
Diameter: Inches Yield: G.P.M. or Pumped Feet Length Ft. Size
DRILLING EQUIPMENT
Kind: _ f 0-Cable Tool ❑ Other (Specify) Diameter: In.
❑ Rotary
. ..............................
TOTAL DEPTH OF WELL 0 --FEET
WELL LOG
Depth From Give description of formations penetrated, such as: peat, silt, sand, gravel, clay, hardpan, shale, sandstone,
Ground Surface 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. Jf
w� FT.tgljlgT.
FT.to FT.
FT.to FT.
FT.to FT.
FT. to FT.
FT.to FT.
FT. to FT.
YIELD TEST DATA IN G.P.M.
Give Depths At Which Yield Was Tested And Yield
.FT. 6 G.P.M.
FT. /-�G P.M.
FT G.P.M.
FT G.P.M.
Date Weil Was Completed: V ,/ / 6- Date of Report
f
Well Driller, 2EZ4-1-4—e�4c
(Signature)
Certificate No.