HomeMy WebLinkAboutWell New 112 Deming Street _ ION REPORT STATE OF CONNECTICUT
DEPARTMENT OF.CONSUMER PROTECTION Do NOT7in
WELL DRILLING BOARD r5TATEWELL NO.165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 NO.
OWNER NAME ADDRESS
LOCATION (No. & Street) (Town)
OF WELL (lot Number)
sr
BUSINESS
DOMESTIC;' ESTABLISHMENT FARM
PROPOSED �-TEST WELL
USE OF
PUBLIC AIR F1
WELL SUPPLY INDUSTRIAL CONDITIONING ❑(Specify)
Sp CRy)
DRILLING
EQUIPMENT ® ROTARY � COMPRESSED A R ERCUSSION PERCUSSION (Specify)
(Specify)
LENGTH (fee (t) DIAMETER inches WEIGHT PER FOOT
CASING ) ®THREADED WELDED DRIVE
IYESSHOE—[]NO
WAS CASING GROUTED?
DETAILS fR YES NO
TESTYIEL � BAILED PUMPED COMPRESSED AIR HOURS 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: -; 1
MAKE
LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(.inches) GRAVEL SIZE(inches) FROM(feet) TO(feet
IF GRAVEL Diameter of well including
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET TO FEET two permanent landmarks.
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If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
+� d
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature)
DEPT. OF ENVIORNMENTAL PROTECTION-WATER RESOURCES