HomeMy WebLinkAboutWell New 24 Judge Lane CPR-9 Rev.7/95 Do NOT fill in
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAMEj_d ADDRESS (�
//'(4 k '9� 21y 6j,U v
LOCATION No.6 Street) (Town) f ( t N be
OF WELL f :t In �_- a)(�� Sr e
DOMESTIC BUSINESS FARM TEST + �
PROPOSED ESTABLISHMENT ❑ WELL ev, O
USE OF WELL PUBLIC INDUSTRIAL AIR E�OTHER
❑ SUPPLY ❑ El CONDITIONING �--' (Sped )
DRILLING ROTARY OMPRESSED CABLE OTHER
EQUIPMENT ❑ LIJ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING LENGTH(feet) I DIAMETER(inches) WEIGHT PER 100T DR SHOE WAS C GROUTED?
DETAILS �� �,; } THREADED ❑ WELDED
t YES ❑ NO 111 "'YES ❑ NO
YIELD TEST BAILED PUMPED COMPRESSED HOURS YIELD(GPM)
❑ ❑ ❑ �' ' 1
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feel) Depth of Completed Well in f
LEVEL
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: including gravel pack
(inches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
r
�AJ NO
If yield was tested at different depths during drilling,list below -�
FEET GALLONS PER MINUTEL L ~p
v
DATE WELL COMPLETED PERMIT N0. REGISTRATION NO. ATE OF PORT Lj,DRILLER lure)
I-If
LOCAL DIRECTOR OF HEALTH