HomeMy WebLinkAboutWell New 00 Avery Street (3) STATE OF CONNECTICUT WELL COMPLETION REPORT
WATER COMMISSION DO NOT FILL IN
317 STATE OFFICE BUILDING This report must be completed and submitted to STATE WELL NO. .
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO.
..............
-after completion of well.
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OWNER VIP
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WELL Name
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DRILLER City or Town
Name
Street Address City or Town
PROPOSED USE OR USES (check):
D'Domestic ❑Irrigation []Stock Municipal ❑
❑ P � Industrial Test Well
CASING DETAILS PUMPING TEST WATER LEVEL
SCREEN DEJA
cp 1 (measure from Iona surface)
LENGTH: FEET DURATION: HOURS STATIC:
_ FEET MAKE:
DIAMETER: INCHES PUMPING RATE: G.P.M. WHEN PUMPING — FEET LENGTH;91,
KIND: DIAMETER:
WELL LOG
DEPTH FROM Give details of formations penetrated, such as eat silt sand _ � ���'^�,clay, hardpan, __s__M- __ ..__�_�___��_
13
GROUND SURFACE (diameter)and sand (fine, medium, coarse),colorpof material, structurel(loose, packed,cemented, soft,ohard)tnclude size of gravel
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SATE WELL WAS COMPLETED:_ F% ?� DATE OF REPORT__ -- --/--�' d—_ _ —_---
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WELL DRILLER — T_ � `
(Signature)
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CERTIFICATE NO. --------------- ------------------
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LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
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DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
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sROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFfORD: j�y {lp
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