HomeMy WebLinkAboutWell Repair 198 Smith Street WELL COMPLETION REPORT STATE OF CONNECTICUT
CPR-9REV.11-e2 DEPARTMENT OF CONSUMER PROTECTION 7STATEWELL
o NOT fill 7i.n
WELL DRILLING BOARD NO.
165 CAPITOL AVE.
Wel.J. AbZundoiirr,1 t HARTFORD,CONNECTICUT 06106
NAME ADDRESS
OWNER Margaret98
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.C: S98 Street, s7".d• Y9�...x��.> w�`t�3f �� V7
LOCATION (No. & Street) (Town) (lot Number)
OF WELL 198 'L'Lth Street- ►S 3. Windsor
ESTABLISHMENT FARM
NESS
PROPOSED DOMESTIC
USE OF 11 TEST WELL
WELL PUBLIC I
THER
SUPPLY INDUSTRIAL CONDITIONING ((Specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT D PERCUSSION ROTARY AIR PERCUSSION Fl(Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT I H WAS rA ING G UiED?
DETAILS THREADED WELDED YES NO YES NO
YIELD ❑ ❑ HOURS F
TEST BAILED PUMPED COMPRESSED AIR YIELD(G.P.M.)
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
LEVEL Depth of Completed Well
in feet below Land surface:
MAKE
SCREEN LENGTH OPEN TO AQUIFER (feel)
DETAILS SLOT SIZE DIAMETER(inches) GRAVEL 512E(inches) FROM(feet) TO(feet
IF GRAVEL Diameter of well including
PACKED: gravel pock(inches):
DEPTH FROM IAND SURFACE
FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to of least
two permanent landmarks.
ry t`�.i�r.aA AU vjt:.
accordim to CTI state Statutes
G �I
(!`i-^6J
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. 31I Co.
REGISTRATION NO. DATE OF REPORT WE DRILLER(Signoture)
d # I-7 91
sf
DEPT.OF ENVIRONMENTAL.PROTECTION-WATER RESOURCES
ocdLe oT 1,onnecticut WV r.LL %VI rLt11VN REPORT DO NOT FILL IN
WATER RESOURCES COMMISSION This report must be completed and submitted
317 State Office Building
Hartford 15, Conn. to State Water Resources Commission no later State Well No. S '7
than 30 days after completion of well. �✓
Other No.
WELL
OWNER
WELL Name
cStreet Address DRILLER . ��. Cit and Town
— ' `''�
Name T ..
Street Addres L'
City and Town
PROPOSED USE OR USES (Check):
omestic ❑ Farm Business
❑ Irrigation ❑ Establishment ❑ Municipal ❑ Industrial ❑ Test Well
CASING DETAILS YIELD TEST
a WATER LEVEL SCREEN DETAILS
ord (measure from land surface)
Length: �� Feet ❑ Pumped Hours Static: 1
Feet Make:
Diameter: Inches Yield: When Bailed
G.P•M: or Pumped `�-- Slot
Fee f Length Ft. Size
Kind:.
Diameter: In.
TOTAL DEPTH OF WELL—p? FEET
WELL LOG
Depth From Give description of formations penetrated, such as: peat, silt sand
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' gravel, clay, hardpan, shale, sandstone,
granite. p , packed,yellow sand;27 ft.to 134 ft.gray
C" FT.to FT. `
�S FT.tom;7FT.
FT:to FT.
FT.to FT. (di�lGllGs
FT,to FT.
FT. to FT.
FT.to FT.
FT. to FT. ---
6Ys,
FT.to FT. I e,
FT. to FT. ..<
ia�kl IF'
FT. to FT.
REERRED
FT. to FT. ---- n S...........o�
.u.4d..._..�
FT. to FT. ----- _----
Date Well Was Completed:----___,/�
Date of Report--- r_
Well Driller
(Si nature)
Certificate No.