HomeMy WebLinkAboutWell Correspondence 20 Pierce Road JUL-10-2008 03 :43 PM EASTERN DRILL CO. 860 870 9377 P. 02
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STATE OF CONNECTICU'T STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION _
REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO.
WELL DRILLING COMPLETION REPORT
1BSCapltal Avenue,Hartford,Connecticut 061091 w�
(OWNER NAME ADDRESS
.. LOCATIbN (No.Astrsal) ( ownt mdsr) +
OF`WELL �;k 0 , LA.>1 i^8. eef
DOMESTIC BUSINESS FARM TEST
PROPOSED 0 ESTABLISHMENT 0 WELL
USE OF WELL ❑ PUBLIC ❑ INDUSTRIAL AIR OTHER
SUPPLY u CONDITIONING S
... DRILLING AOTARY COMPRESSED ❑ CABLE OTHER
EQUIPMENT AIR PERCUSSION PERCUSSION (Sp")
CASINQ LENGTH(feel) DIAMETER pnahes) WEIGHT PER FOOT N WAS CABIN' OUTEIP
DETAILS sn ® THREADED ❑ WELDED
Ytw6 Q ND• YES NO
• ....�.r
"YIELD TEST VAILED PUMPED DOMPRE9 ED AIR HOURS IELD(GPM)
— WATER MEASURE FROM LAND SURFACE-STATIC(Spftify 1a01) DURING YIELD TEST()eel) --repthof lan at Il in Nat
Lt'=YYEL
E t r
MAKE LEN13TH OPEN TO AGUWER ")
SCREEN
DETAILS $L T SIZE DIAMETER lhd"&) I L iamelsr wall ) FROM(Net) (eNrj
PACKED: immalnp gravel
(h+chap
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION SKftch exact Iocapon of well with dtatamm,to st least two
FEET TO FEET permanent landmarks _..
. 25
m
� f
` o
1G , 1
p to
P6
It yield war,tested at different depths during ddIllnq,Ilet below 1
ALL NS PER MINUTE `
DATE LL CdMPIETL•ID P MIT NO I TRATION NO DATE OF REP WELL J*11 I .
• ,w+ w
f�f1Af7C7A^Tr'S l7
Propane Gas Service INVOICE
v 420 John Fitch Blvd., P.O. Box 239
South Windsor, CT 06074 10432
S;nee1941 Phone::860-289-0267 • Fax: 860-289-5368
Equipment Service and Appliance Sales are provided by Inergy Services
CUSTOMER NAME ACCOUNT NUMBER DATE
JACQUES CONSTRUCTION 03429 06/20f08 '11:47
STREET ADDRESS PHONE NUMBER TAKEN BY
20 FIERCE RD (880)305-1861 (HBO
CITY.STATE&ZIP PROMISED
S. WINDSOR CT 0E074 With:
DIRECTIONS.: WILL CALL FOR --18T FILL ARRIVALTIME
C/O TANK
FINISHED JDE
REGULATOR TEST TERM CODE: CR 3
Flaw Pn.awa Uixicr Lund Lock Up Prnann PRODUCT CEDE STEP RATE:- - 05 f TO"rALTIME
Integral Twin Stage IN.W.C. IN.W.C. #OF TANKS/TANK CAPACITY: 001 f 0 1000
EQUIPMENT INSTALLED/REMOVED
Two Stage ri Pru,,uru Ua&r una Luck uP P r„ure ITEM CAP.OR MODEL NO. SERIAL NO.
st Stage PSI" PSI CYL/PANK
2nd Stage IN.W.C. IN.W.C. CYL/I'ANK
LEAK TEST ;;. REG.
Integral Twin Stage Start Pressure End Pressure Time Held Sniff Test REG.
Tank PSI PSI Psi APPLtXNCES RANGE f WATER f CENTRAL
IN.W.C. IN.W.C.
Two Stage %:OF L P�1N REMOVEDTANK,
Tank PSI PSI PSI I EST.ANNUAL USAGE-HEAT
I st Stage PSI PSI NON HEAT
2nd Stag& IN.W.C.
SINS ; NS
1000 GAL FOR F' RCHASE TANK $2850, A 2 ,
180, , LINE $150 RMIT '$E5 , LABOR $250, 5 + TAX
RK:PERFOR
QTY DESCRIPTION COST QTY DESCRIPTION COST SUMMARY P.C. AMOUNT
APPLIANCE "
TRIP 2
INSTALLATION
SALES TAX
PERMITS
PARTS/FITTINGS
SALESTAX
LABOR
SALES TAX
MISC.
SALES TAX
PROPANE
SALES TAX
Customer received safety information YES TOTAL BILLING
Operation of System explained to Customer YES
Customer received MSDS'for Odorized Propane YES AMOUNT RECEIVED$
Checked Equipment Operation YES
-Gas Line Pressure Tested YES
.CUSTOMER SIGNATURE DATE
SERVICEMAN, DATE
CR03A-PGS