HomeMy WebLinkAboutWell New 291 Oakland Road CO �./�'
WATER RESOURCES COMMESSlON DO NOT FILL IN
223 State Office Building This report must be completed and submitted
Hartford, Connecticut to State Water Resources Commission no later State Well No,
than 30 days after completion of well.
WELL Other No..________
=
OWNER tin
WELL Name -
DRILLER street Address
y and wn
Name �
tract Address
PROPOSED USE OR USES (Check): Qity an T n
❑ Domestic ❑ Farm ❑ irrigation Business
P"tstablishment. ❑ Municipal ❑ Industrial ❑ Test Well
CASING DETAILS YIELD TEST
WATER LEVEL SCREEN DETAILS
ailed
Length: or 7- (measure from land su ace)
Feet ❑ Pumped Hours 1
l Static: Feet. Make.-
Diameter: Inches Yield: When Bailed
G.P.M. or Pumped Slot
Feet . Length
Kind: DRILLING Ft. Size
� � QUIPMENT
Cable Tool ❑ Other (Specify) Diameter:❑ Rotary n.
TOTAL DEPTH OF WELL
-��-a—cam--FEET
WELL LOG
Depth From Give description of formations penetrated, such as:
Ground Surface granite, etc. Include size of gravel (diameter) and sand (fine, m dium, coarse), color of material, struct
(loose,packed,cemented soft hard). For example:0 ft.to 27 ft.fine, gravel, clay, hardpan, shale,sandstone,
granite. p packed,yellow sand;27 ft,to 134 ft. grayFT.to X6/1
FT.to
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
G.P.M.
FT. G.P.M.
FT. G.P.M.
FT. G.P.M.
Date Well Was Completed:
�---� -9 — Date of Report
Well Driller
(Signature)
Certificate No.
1 F
LOCATION OF WELL: TOWN OF.-
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:-
(Show distance and direction from road intersection or other landmark.)
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
k1-
a
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM NEAREST CITY OR VILLAGE CENTER:
S TA T�EWA TE RS
commiSS1014
R 1 0 1904
ANSWERx:D
REFERRED --------------
FILED ............