HomeMy WebLinkAboutWell New 00 Ellington Road STATE OF CONNECTICUT WELL OOAi4�LE'�I01� REPORT � �. I
WATER COMMISSION R DO
317 STATE OFFICE BUILDING DO NOT FILL IN
HARTFORD 15 This report must be completed and submitted to STATE WELL NO. . :.. .e:...
CDNN• State Water Commission no later than 30 days
after completion of well.. /�� OTHER N0. ...»..„,,,,»»» „
WELL
l
OWNER
WELL Name ,
" Str
DRILLER t Addr s Cit rr n
Name
t Street Address
City or Town -
PROPOSED USE OR USES (check):
0 Domestic (j Irrigation
E]Stock ❑Municipal [] Industrial
[I Test Well
MD
PUMPING TEST
WATER LEVEL SCREEN DETAILS
DURATION: (mecsure from Iona surface)
HOURS STATIC:
--- �_---- F
EET MAKE:
PUMPING RATE: ---� Q� G.P.M.GP WHEN PUMPING: SLOT
--- —_.UMPI F LENGTH: FT. SIZE
—
DIAMETER: IN.
---- ----- ---------- WELL LOG
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, m edium, coarse), color of material, structure (loose, packed,cemented, soft, hard)
FT,to '—FT.
S FT.to i/r-t FT, -
FT,to FT,
FT.to FT. 5�i✓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.
FT,to
- j
-------------
FT.to FT.
TE WELL WAS COMPLETED: '
DATE OF REPORT -
i
4
WELL DRILLER
j (Signature` —
CERTIFICATE NO.
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
t
. ,t
'IrG
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
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-1 7
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
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76
STATE OF CONNECTICUT WATER COMMISSION WELL COMPLETION REPORT
317STATE OFFICE BUILDING STATE WELL N0 DO NOT FILL IN
HARTFORD CONN
15 This report must be completed and submitted to .
. State Water Commission no later than 30 da s .'sc'.: ::`.::,,
i after completion of well.. Y OTHER NO. ...WELL
OWNER .:, ..
�.
WELL
Name
DRILLER Street d ess �n
e l:� elf �tY or Town
Name L' �z9 .�tf' mil- lr
S reet Address -�" �-" t
City or Town -
PROPOSED USE OR USES (check)
Ix Domestic Irrigation [I Stock
CASING DETAILS
(Municipal [] Industrial
❑Test Well
PUMPING TEST
WATER LEVEL SCREEN DETAILS
LENGTH: FEET DURATION: (measure from lana surface) ,
HOURS STATIC: - J FEET MAKE:
DIAMETER: INCHES PUMPING RATE: `
--__ _✓�G.P.M. WHEN PUMPING: J-6 JSIZE
KIND:
-/ --- FEET LENGTH: FT.
� ---- --------
DIAMETER:
--- -�_ WELL LOG IN.
DEPTH FROM Give details of formations~ __..,.penetrated, such as:r -_--~�-�--���'---------- ___ _
GROUND SURFACE (diameter)and sand (fine peat,silt,sand,gravel,clay, hardpan,shale, stone rock. N
o medium,coarse),color of material, structure (loose,.pocked.,cemented, soft, hard)nclude size of gravel
d FT.to J FT.
FT.to FT, -- -
FT.to FT ------__
FT,to FT.
FT.to FT.
FT,to FT.
FT.to FT.
FT,to FT.
FT.to FT.
FT,to FT. -- -------
FT. to FT. —_--- f
FT.to FT. --- - --- ----------------_ -
FT.to FT.
—_----
FT.to FT. _.--_ ------- -- ------
FT.to FT. - --- ---___
.E WELL WAS COMPLETED:
,r I
��------ DATE OF REPORT cv4 tr ~� - '
f i
WELL DRILLER _
(Signature -- --
CERTIFICATE NO.
r
LOCATION OF WELL: - TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
� r
j
Cv &4C4-
y
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
fte v 41
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
STATE OF CONNECTICUT
WATER COMMISSION WELL COMPLETION REPORT
317 STATE OFFICE BUILDING DO NOT FILL IN
14ARTFORD 15, CONN. This report must be completed and submitted to State Water Commission no later than 30 days STATE WELL N0. . r�........' ,
after comp OTHER completion of well.. R NO.
• WELL - p ....:........_.._....
OWNER P /
WELL Name
DRILLER 4 Street dress �✓?
f '` a
ty or Town
ame 41-1
Stfeet Address _
City or Town -
PROPOSED USE OR USES (check):
Domestic
Irrigation [I Stock
El Municipal Industrial
CASING DETAILS El Test Well .
LENGTH:
PUMPING TEST
WATER LEVEL
� SCREEN DETAILS
DURATION:FEET (measure from land surface)
HOURS STATIC:
IAMETER:
FEET _MAKE:
D "�--69 ---__ _
INCHES- PUMPING RATE: 66'
KIND: SLOT
- -----, _-�•P•M• WHEN PUMPING:
` _- ----FEET LENGTH: FT SIZE
_
WELL LOG DIAMETER: IN.
�._--_____------ --
DEPTH FROM Give details of formations r--~�--- `--'--"--- _
penetrated, such as: peat, silt, sand, gravel clay, hardpan,
, medium,coarse),color of material, structure (loose, packed,cementedosoft,ohard)nclude size of gravel
GROUND SURFACE {diameter)and sand (fine -
shale,
stk. I
FT,to FT.
FT.to FT.
FT,to FT. _
FT. to FT.
---- _
FT.to FT.
to FT.
FT,to FT.
FT,to FT.
1
FT.to FT. -
�_ i
FT.to FT.
FT.to FT. -
FT.to FT. --- -------_.__-- I
FT.to FT. — - -__—___.-_- ----- ---------- --
FT.to FT. ----- -- _ I
-- i
FT,to T.
WELL WAS COMPLETED:
DATE OF REPORTv/'
WELL DRILLER
(Signature) ---
CERTIFICATE NO._-
LOCATION OF WELL: TOWN OFrr
r
SKETCH SHOWING LOCATION OF PREMISES IN TOWN-
DIAGRAM SHOWING LOCATI N OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD: