HomeMy WebLinkAboutWell New 00 Avery Street .III11i VI" WELL COMPLETION REPORT
WATER RESOURCES COMMISSION DO NOT FILL IN
317 STATE OFFICE BUILDING This report must be completed and submitted STATE WELL N0.<.69.'
HARTFORD 15, CONN. to State Water Resources Commission no
later than 30 days after completion of well. OTHER
WELL
OWNER
WELL
r Name Ar
Stre7,tAdress
DRILLER City or Town
NOme Street Address
City or Town
PROPOSED USE OR USES (check):
omestie ❑irrigation ❑Stock
[]Municipal ❑ Industrial ❑Test Well
CASING DETAILS PUMPING TEST WATER LEVEL
SCREEN DETAI9SL
r (measure from Iona surface)
LENGTH: FEET DURATION: HOURS STATICS
FEET MAKE:
IAMETER: INCHES PUMPING RATE: —
--__ 3 —G.P.M. WHEN PUMPING: FEET SIZE
— � �,$ FEET LENGTH: FT.
KIND: �
DIAMETER: IN.
WELL LOG
DEPTH FROM Give details of formations penetrated, such as, at silt d
' Pe r , sand, clay, hardpan,shale,stone,rock. Include size of gravel
GROUND SURFACE (diameter)and sand (fine, medium,coarse),color of material, structure (loose, packed,cemented, soft, hard)
FT.to ✓, FT. -° /�✓ '_Y
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT,to FT.
FT.to FT.
FT,to FT.
FT.to FT.
A
WATER n','�. _
FT.to FT. --' REQE° [N/
FT.to—_FT. U J li s
-- - --- r -- Q 1,4u4 _
FT.to FT. ptNSWLRr_D..........
FT.to FT. --- -- --- LE
FT.to FT.
FT.to FT.
DATE WELL WAS COMPLETED: 3'"—6DATE OF REPORT
WELL DRILLER � �
( Ignatur.T
FORM WRC-4 �e
CERTIFICATE NO.—__._
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:` -
I
4
t `
E
1
f
s
i f
t
i
f
fi
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
1
f /
' e
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD: