HomeMy WebLinkAboutWell New 1744 Ellington Road STATE OF CONNECTICUT WELL COMPLETION REPORT DO NOT FILL 6N
WATER COMMISSION
1 317 STATE OFFICE BUILDING This report must be completed and submitted to STATE WELL NO..�".,,i-'j.......
HARTFORD 15, CONN. State Water Commission no later than 30 days f�,/ OTHER NO.
after-completion of well.
WELL r e
OWNER
WELL Nam �� / ! Stre t ress it r T,.*4n
DRILLER j
Name / Street Addres�'
�� City or Town
PROPOSED USE OR USES(check):
14 Domestic Ej Irrigation Stock Municipal❑ p Industrial (Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
/d r (measure from Tana surface)
LENGTH: FEET DURATION: OURS STATIC:- -_ FEET MAKE:
IAMETER: INCHES PUMPING RATE: SLOT
(f G.P.M. WHEN PUMPING, SIZE
-- — ----- __-_FEET LENGTH: FT.
KIND: �� �S� DIAMETER: IN,
WELL LOG
-6---- - ----- -- --------------__-_-____
DEPTH FROM Give details of formations penetrated, such as: peat, silt, sand,gravel,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.
FT,to FT.
6 FT.to ,2 FT.
FT.to P-d FT.
FT.to FT.
FT.to FT. ✓� �� L����(.�
FT.to FT. 7
FT.to FT.
FT,to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
1ATE WELL WAS COMPLETED: X 0 J—.� DATE OF REPORT cSr�
WELL DRILLER
(Signature)(
CERTIFICATE NO.
i
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
4 .ir .'r ✓
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES: � ��f
li
I /
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
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