HomeMy WebLinkAboutWell New 00 Foster Street (2) STATE OF CONNECTICUT WELL COMPLETION REPORT DO NOT FILL IN
WATER COMMISSION
317 STATE OFFICE BUILDING This report must be completed and submitted to STATE WELL N0. .z.. .;• ....
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO.
............................
after completion of well.
WELL AZI,
OWNER
WELL Name f Street Addres
DRILLER ' _ City or TowAf
t
i
Name Street Address s ity or Town —
PROPOSED USE OR USES (check):
# �Vj Domestic Ej Irrigation ❑Stock a Munici l
P ❑ Industrial ❑Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: FEET DURATION: HOURS STATIC: FEET MAKE:
SLOT
DIAMETER: i INCHES PUMPING RATE: G.P.M. WHEN PUMPING: FEET LENGTH: FT. SIZE
KIND:
DIAMETER: IN.
WELL LOG
1 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 G FT.
j
FT.to 06FT.
FT.to FT.
FT.to FT.
FT.to FT. ��p 56
FT.to FT. STATE WATER COMMISSION
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.
iATE WELL WAS COMPLETED:. P DATE OF REPORT r S
f Y WELL DRILLER
(Signature) ---
CERTIFICATE NO. --
f �
LOCATION 0 WELL: TOWN OF riot s �Y dLl
SKETCH ING LOCATION OF PREMISES IN TOWN:
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD: