HomeMy WebLinkAboutWell New 635 Nevers Road State of Connecticut WELL COMPLETION REPORT DO NOT FILL IN
WATER RESOURCES COMMISSION This report must be completed and submitted � rr
317 State Office Building State Well No._ .E_,=_.__ f
to State Water Resources Commission no later
Hartford 15, Conn. than 30 days after completion of well. Other No.
WELL OWNER
A=reet
i dress
WELL /� City and Town
DRILLER
.17
Name Streef Address City and Town
PROPOSED USE OR USES (Check):
Domestic Farm Business
[ ❑ ❑ Irrigation ❑ Establishment ❑ Municipal ❑ Industrial ❑ Test Well
CASING DETAILS YIELD TEST WATER LEVEL SCREEN DETAILS
Bailed (measure from Ian surface)
or
Length: f Feet ❑ Pumped Hours Static: e;L S Feet Make:
When Bailed Slot
Diameter: Inches Yield: j G.P.M. or Pumped 'V1 Feet Length Ft. Size
Kind: Diameter: In.
TOTAL DEPTH OF WELL/OLD---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.
FT.to j� FT.
�17FT.toy//V FT. /
FT.to FT.
FT.to FT.
FT.to FT.
FT. to FT.
FT.to FT. --
FT. to FT.
FT. to FT.
FT.to FT. —
i
FT. to FT.
FT. to FT.
FT.to FT.
Date Well Was Completed: — --- — --- Date of Report—
e ,
Well Driller
(Signatur
Certificate No. _-
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OF
LOCATION OF WELL: TOWN
I
g �4 ; SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
(Sh�w distance and direction f om road intersection or other landmark.)
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DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
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ROUTE DIRECTIONS FOR REACHING WELL SITE FROM NEAREST CITY OR VILLAGE CENTER:
liv-
0y\ W. Site