HomeMy WebLinkAboutWell New 00 Graham Road (3) STATE OF CONNECTICUT WELL COMPLETION REPORT DO NOT FILL IN
WATER COMMISSION STATE WELL NO. `.... y
317 STATE OFFICE BUILDING This report must be completed and submitted to
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO. .. .........
after completion of well.
WELL '
OWNER
WELL Name --�. Street Address City or Town
DRILLER
Name Street Address/ City or Town
PROPOSED USE OR USES (check): G
D Domestic Irrigation [I Stock [:]Municipal C] Industrial ❑Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: e FEET DURATION: . HOURS STATIC: FEET MAKE:
- -- ------ ----- SLOT
DIAMETER: INCHES PUMPING RATE: Jr G.P.M. WHEN PUMPING: FEET LENGTH: FT. SIZE
KIND: � � _ -- -- —^.---- ----- —
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 m
GROUND SURFACE (diameter)and sand (fine, medium,coarse),color of material,structure (loose, packed,cemented, soft, hard)
FT.to 14(-FT.
!! /FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT,to FT. "'T + V
FT.to FT.
i�
FT.to FT. -- _ - q COt�1i4"FISSION
FT.to. FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
/3 ep
DATE WELL WAS COMPLETED: i� DATE OF REPORT -Y--M -- 1--- -
WELL DRILLER
(Signature)
CERTIFICATE NO.
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
�E
sl
a
1
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTF.ORD:
rP ��
u
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 NO.
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO. .................„.........
after completion of well.
WELL
OWNER
WELL NOn16 Street ddressp City or Town
DRILLER .6O�e/ w ! /i�� ��
Name Street Address City or Town
PROPOSED USE OR USES (check):
0 Domestic 0Irrigation ❑Stock []Municipal 0 Industrial ❑Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from lana surface)
LENGTH: FEET DURATION: HOURS STATIC: FEET MAKE:
SLOT
DIAMETER; INCHES PUMPING RATE: G.P.M. WHEN PUMPING _-- —FEET LENGTH — FT. SIZE
KIND: 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, medium,coarse),color of material, structure (loose, packed,cemented, soft, hard)
FT.to FT.
FT.to , FT. _
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT. RECEIVED
FT.to FT. r: {{ {1 i7 1 F q"e ti
FT.to FT. — E 1YVLTE( COP-11MESSION
FT.to FT.
FT.to FT.
FT,to FT.
FT.to FT.
FT.to FT.
FT.to FT.
Ile
DATE WELL WAS COMPLETED DATE OF REPOR,���
.s e
WELL DRILLER X" (Signature)
CERTIFICATE CERTIFICATE NO.----------------------------------
Ato6— .,
LOCATION OF WELL: TOWN OF '' ��'"•
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
�i
t
DIAGRAM SNOWING LOCATION OF WELL ON PREMISES:
t -
4
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
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 NO. .3;�?............
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO. ...
after completion of well.
WELL
OWNER
WELL Name a Street Add res City or Town
DRILLER r i arrsr' � � ram.j � ,0J"i. .f,try 3.�?ytr
Name Street Addrss / City or Town f,
Ir
PROPOSED USE OR USES (check): D Domestic g 0 p LI
Irrigation ❑Stock Munici al industries! Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: / FEET DURATION: HOURS STATIC: FEET MAKE:
-- --------- --- SLOT
DIAMETER: INCHES PUMPING RATE: G.P.M. WHEN PUMPING: FEET LENGTH: FT. SIZE
KIND: d, 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, medium,coarse),color of material, structure (loose, packed,cemented, soft, hard)
FT.to,)--/ FT.
FT.to z�, FT. A j
FT.to FT.
FT.to FT.
FT,to FT.
FT,to FT.
FT.to FT.
E a Imo.
FT,to FT.
FT.to FT.
— -- STATE WATER c0�����iSsiaN
FT.to FT.
FT,to FT.
FT,to FT.
FT,to FT.
FT,to FT.
FT.to FT.
DATE WELL WAS COMPLETED: 4P DATE OF REPORT
Irk
WELL DRILLER - �_— —.---
(Signature)
CERTIFICATE NO. —.---------------------_---_—_--
�v
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
S
1 r
x
f
f
k
DIAGRAM SHWING LOCATION OF WELL ON PREMISES:
� / 4
O
ROUTE DIRECTIONS FOR REACHING WEL SITE FROM?HARTFORD:
ly
/. c
STATE OF CONNECTICUT WELL COMPLETION REPORT
WATER COMMISSION DO NOT FILL IN
317 STATE OFFICE BUILDING This report must be completed and submitted to
HARTFORD 15, CONN. STATE WELL NO. . 1
State Water Commission no later than 30 days
after completion of well. OTHER NO.:............„.
WELL A ............
OWNER f
t
WELL � ame
DRILLER `
Street Address
�w P City or Town
No me 7-
Street Address
City or Town
PROPOSED USE OR USES (check):
Domestic Irrigation
L]Stock ❑Municipal [1 Industrial
El Test Weli
CASINGfDETAI PUMPING TEST
WATER LEVEL SCREEN DETAILS
LENGTH: T DURATION: p ® (measure from Iona surface)
� H�URS STATIC: FEET MAKE:
DIAMETER: HES PUMPING RATE: -- - ----
G.P.M. WHEN PUMPING: SLOT
- ---- FEET LENGTH: FT. SIZE
—_---
KIND: - -
DIAMETER: IN.
WELL LOG
DEPTH FROM Give details of formations penetrcted,such as: peat,silt sand GROUND SURFACEpan*shale,
SURFACE (diameter) and sand (fine, medium,coarse),color of material, structurel(Poose, packed,cemented, soft, Include size of gravel _
har
FT.tt�FT.
-
r
FT.to FT..
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
i
FT.to
FT.
ED
FT.to FT. - --
-- 7 i�
FT,to FT. ,
STATE VVA�t t� ;'y?i is i0N
FT.to FT: ---__---_.._-
FT.to FT. _ ---- ------- ----
FT.to FT. —_`_--- ---------
i
i
FT.to FT. - - — -----
E WELL WAS COMPLETED: �-� ----- __ ---------------
DATE OF REPOR —
"s
WELL DRILLER
(Signature)
CFRTIFIrA-re
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
45
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
o
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
17
-rA—
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. ::�.�°U,",,jto
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER N0. ............._.
after completion of well.
WCLL I y
OWNER / j"Z
f f
WELL — Name Str et Add
DRILLER (/ / Address
@ y or Town
�' o^ Nome tfeet Add re s` —----`—
s¢ City or T
PROPOSED USE OR USES (check): �s/
Domestic 0 Irrigation (]Stock Munici al
❑ P [] Industrial El Test Well
CASING DETAILS PUMPING TEST
WATER LEVEL SCREEN DETAILS
LENGTH: FEET DURATION: (measure from Tana surface)
_4HOURSTATIC:_ _ FEET MAKE:IAMETER: INCHES PUMPING RATE; � HEN PUMPING: SLOT
FEET LENGTH: FT. SIZE
KIND: � — ----
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, medium,coarse),color of material, structure (loose, packed,cemented, soft,hard)
FT.tom FT.
A
FT,to FT. �q
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. ------- - ---- STATE WATER COivfi0[SSiON
FT.to FT. ------ -----
FT.to FT. --------- ------ --
FT.to FT. ------------ -----
4TE WELL WAS COMPLETED: _ V
DATE OF REPOR/T/ _ � -
WELL DRILLER
(Signature)
CERTIFICATE NO.
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
e;
4
1,
t
ggY
f
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
a
t E
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 NO. .37
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO.
after completion of well.
WELL 7
OWNER
WELL Name Street Address city Town
DRILLER % t�
Name Street AddresF City or Town -
e
PROPOSED USE OR USES (check):
E]Domestic E7 Irrigation C1 Stock []Municipal ❑ Industrial ❑Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
/ (measure from Iona surface) i
LENGTH: t FEET DURATION: - HOURS STATICS FEET MAKE:
----------- - --- — SLOT
DIAMETER: INCHES PUMPING RATE: G.P.M. WHEN PUMPING: FEET LENGTH: FT. SIZE
[KIND.
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, medium,coarse),color of material, structure (loose, packed,cemented, soft, hard)
FT.to r FT.
FT.to � FT. t
® _
AL
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT,to FT.
FT.to FT. �q
FT.to FT. t�E D
FT.to FT. AUG I
STATE WA1-ER coltq t)ISS10Pd
FT,to FT.
FT.to FT.
FT,to FT.
FT,to FT.
FT.to FT.
IATE WELL WAS COMPLETED: DATE OF REPO T
WELL DRILLER s 11
(Signature)
CERTIFICATE NO. �_-
LOCATION OF WELL: TOWN OF f '�
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
� d
f
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
`mod
ROUTE D RECTIONS FOR REACHING WELL SITE FROM HARTFORD:
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 NO.S jWY.'., ..
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO.
after completion of well.
WELL
OWNER , a ✓.
WELL ame Street Address
t > ------ — City or Town --
DRILLER
Name Street Address f City or Town
PROPOSED USE OR USES (check):
}]Domestic M Irrigation El Stock E]Municipal ❑Industrial []Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
ll, (measure from land surface)
LENGTH: FEET DURATION: HOURS STATIC: FEET MAKE:
SLOT
DIAMETER: INCHES PUMPING RATE: G.P.M. WHEN PUMPING_ FEET LENGTH: FT. SIZE
KIND: DIAMETER: 1N.
WELL LOG
DEPTH FROM Give details of formations penetrated, such as: peat,slit,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.toT.
r
Y-T.to /FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT. RECEIVED
FT.to FT. A
s f 7 _ In
FT.to FT. _ — STATE WATER CN''•INISS10N
FT.to FT.
FT.to FT.
FT.to FT.
FT,to FT.
FT.to FT.
L�:F�toFT.
DATE WELL WAS COMPLETED: DATE OF REPORT '" %1 �0
WELL DRILLER ---
(Signature)
CERTIFICATE NO.----- ------------------------------
LOCATION OF WELL: TOWN OF _L_ Z ✓
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
s'
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
i.E`f
STATE OF CONNECTICUT
WATER COMMISSION WELL COMPLETION REPORT
317 STATE OFFICE BUILDING DO NOT FILL IN
This report must
HARTFORD 15, CONN. be completed and submitted to State Water Commission no later than 30 da s STATE WELL N0.
i
WELL after-completion of well. y OTHER NO.
OWNER /WELL ! Name
DRILLER Street Ad4dress '�
City or. awn
Name
Street Address'/ - -
City - Town
PROPOSED USE OR USES (check): Ol
(_J CASING DETAILS Domestic ElIrrigation
❑Stock []Municipal
industrial j]Test Well
PUMPING TEST
WATER LEVEL SCREEN DETAILS
LENGTH: FEET DURATION 1 (measure from land surface) Mal: r- _ HOURS STATIC: ----
DIAMETER: �
FEET MAKE:-_—
INCHES PUMPING RATE: — '
G.P.M. WHEN PUMPING: SLOT
FEET LENGTH: FT. SIZE
KIND: — ---____._____
WELL LOG DIAMETER: IN.
DEPTH FROM �
Give details of formations penetrated, such as; -~_ ^� r `--
Peat,slit, sand,gravel cla -__.______"-'^ ovel
GROUND SURFACE (diameter)and sand (fine
medium,coarse),color of material, structure (loose, packed,cemented,ales osoft,ohard)
r Include size of grave( _
FT,to 412 FT.
D FT.to rU'FT. fy
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. STATE VV TERi n;i'}'/n�{ :
�VIP17�t lRSSROR�
FT.to FT. -------- ----
FT.to FT. - --
FT.to FT. -----
FT.to FT. ----
' WELL WAS COMPLETED:
DATE OF REPORT
IS
WELL DRILLER
(Signature)
CERTIFICATE NO.___—
LOCATION OF WELL: TOWN OF _
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
tj
r
r'
k.
d
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
STATE OF CONNECTlCUT WELL COMPLETION REPORT
WATER COMMISSION DO NOT FILL IN
317 STATE OFFICE BUILDING This report must be completed and submitted to
HARTFORD 15, CONN. STATE WELL NO. .�Sw'„
State Water Commission no later than 30 days
after completion of well. OTHER NO. ..._........„..
WELL
OWNER
WELL 4L&-
Qlame a
DRILLER % > -�- Street Address
r f NCity 0,r,Town ay
Name 0 -f � � f� -• J
Street Addresses_�-
t ) City or Tawn
PROPOSED USE OR USES (check):
CI Domestic Irrigation Ll Stock
[]Municipal [� Industrial
❑Test Well
CASING DETAILS PUMPING TEST
WATER LEVEL SCREEN DETAILS
LENGTH: Z (measure from Iona surface)
FEETEDURATION: HOURS STATIC:
s FI
IAMETER: INCHES- AT-E: — - SLOT_ G.P.M. WHEN PUMPING: F SIZE
KIND: , ��, --- —
IN.
F_NDSURF
__ _ WELL LOG
Give details of formations suc
at, slit,
,clay, hardpan,
CE (diameter)and sand (fine, coed um coarse)hcolorof materialosdtructurel(loose, packed,cementedo e,rock. Include size of gravelT.
FT.FT.FT.FT.
FT:to FT.
FT,to FT.
FT,to FT.
FT.to FT. E a ,
FT,to FT. i( 9 Iasi
F---? t� FT. STATE WATER GUMNIISSION
FT.to FT. --------`__- -- --
FT.to FT. ---'-- -- ------ -- - --
FT.to FT. --- ------------------- -
FT.to FT. ---
TE WELL WAS COMPLETED:__-c.2
— f
r DATE OF REPORT
WELL DRILLER � �"'"� -A 7
(Signature) —
CERTIFICATE NO.-_--__
LOCATION OF WELL: TOWN OF-,,
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
1
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
Oi
r
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
�' _. -- r
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. .................
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO.
after completion of well.
WELL / �OWNER .��L-t� fk2�j ('U
WELL Name Street Address City o Town
LI
DRILLER '
Street Addres City or Town � �
PROPOSED USE OR USES (check):
E]Domestic Irrigation (]Stock ❑Municipal C] Industrial []Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: FEET DURATION: �� HOURS STATIC: FEET MAKE:
�� - --------- ---- SLOT
DIAMETER: w INCHES PUMPING RATE: G.P.M. WHEN PUMPING: FEET LENGTH: FT. SIZE
KIND: DIAMETER: IN.
WELL LOG
DEPTH FROM Give details of formations penetrated,such as: peat, snit,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)
r 8
FT.to ' FT. - �•`'
r e� �®- -
3 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.
----- -- — - STATE WATER CQdYM11-JIC�i�V
FT,to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT. ^�
DATE WELL WAS COMPLETED DATE OF REPORT s �~�
i WELL DRILLER
(Signature) _
LOCATION OF WELL- TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
r -
y
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE�RECTIONSACHING WELL SITE FROM HARTFORD• E
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
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER N0:.............„„„....„...
after completion of well.
WELL
OWNER
WELL �Na -Street Address � City r TownDRILLER � i
Naf° aF S4reet Address
�� ,,s City or Town
Lee-
PROPOSED USE OR USES (check):
D Domestic 0Irrigation ❑Stock Municipal [] Industrial ❑Test We If
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: FEET DURATION: _- HOURS STATIC: FEET MAKE:
-- -------- ---- SLOT
DIAMETER: ® INCHES PUMPING RAT G.P.M. WHEN PUMPING: -----FEET LENGTH: FT. SIZE
KIND: 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, medium,coarse),color of material, structure (loose, packed,cemented,soft, hard)
FT.to -0 FT.
FT.to 1-. FT. 8 � P
FT.to FT.
FT.to FT.
FT.to FT.
FT,to FT.
FT.to FT.
FT.to FT.
F.T.to FT. _ VED
FT.to FT. AUG' 1-
FT.to FT.
_— -- STATE titdA,Ttl2 COMMISSION
FT.to FT. "
FT,to FT.
FT.to FT.
FT.to FT.
)ATE WELL WAS COMPLETED:f ` DATE OF REPORT '� E
WELL DRILLER
(Signature)
w
ho-
LOCATION OF WELL: TOWN OF `ter / - � �
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
_g
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
F
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
t
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 NO.
HARTFORD15, CONN. - State Water Commission no later 'than 30 days OTHER NO.
after completion of well.
WELL /7
aR
OWNER
WELL Name%
'
Y f 4� 4
�7
DRILLER Street Address I�y
" W �� C!t Town
Name nie_ Street Ad4:r,;Ss City or Town
\4
PROPOSED USE OR USES (check):
Domestic 0 Irrigation E]Stock L]Munic ipal C] Industrial []Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
CASING
FEET DURATION: HOURS STATIC:-------- FEET MAKE: 9
SLOT
DIAMETER: INCHES PUMPING RATE: G.P.M. WHEN PUMPING: FEET LENGTH: FT. SIZE
LKIND: r F
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, medium,coarse),color of material, structure (loose, packed,cemented, soft, hard)
A
/—FT.to_1? FT.
FT.to/PPFT.
liew
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
—FT.to FT.
FT.to FT.
ST TE VVIWER G91;--1
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
)ATE WELL WAS COMPLETED
DATE OF REPORT
WELL DRILLER
(Signature)
Ar-
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD;
41
All
f I
STATE OF CONNECTICUT WELL COMPLETION REPORT DO NOT FILL IN
WATER COMMISSION q4,
317 STATE OFFICE BUILDING This report must be completed and submitted to STATE WELL N0.��!�!�`..:
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER N0. ...»............„.........
after completion of well,
-WELL t
OWNER
WELL _ Name Street Address C�t�y or Town 4_DRILLER r /� � � ...--'°
s`�•fm s_
Name Street Address City or T
PROPOSED USE OR USES(check):
_]Domestic 0Irrigation ❑Stock (]Municipal Industrial []Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
� ? r (measure from land surface)
LENGTH: V FEET DURATION: HOURS STATIC: FEET MAKE:
� ------------ —_— SLOT
[DIAMETER: INCHES PUMPING RATE: c G.P.M. WHEN PUMPING: FEET LENGTH: FT. SIZE
[KIND: j
� — —_ — -- --.---- --------
DIAMETER: IN.
WELL LOG
DEPTH FROM Give details of formations penetrated, such as: peat,slit, 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)
f FT,to J-� FT. F /
FT.to 1/4)FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT. RECEIVED
FT.to FT.
FT.to FT. — — -- - I lATTC t6VAT E R n 0;'JI I ICLN —
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
DATE WELL WAS COMPLETED: DATE OF REPOR V
`` a
t
WELL DRILLER
(Signature) -----
CERTIFICATE NO. -------------T_____--_—__—___—_---
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF. PREMISES IN TOWN:
.6
4 - „__--
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
b i �
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
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. . �
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO. ... ........_.. .........
�{ after completion of well.
WELL
OWNER W 1 r
WELL `-Name Address City
DRILLER e e� Street f al ,,Town
N°R P City y or Town
—
� own
PROPOSED USE OR USES (check):
❑Domestic ❑Irrigation ❑Stock Munici al
❑ P Cl Industrial El Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
o (measure from land surface)
tENGTH: �L FEET DURATION: _ —HOURS STATIC: FEET MAKE:
SLOT
DIAMETER: }� INCHES PUMPING RATE: f G.P.M. WHEN PUMPING: _ -- —FEET LENGTH: FT. SIZE
KIND: , -F ,,,�
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, medium,coarse),color of material, structure (loose, packed,cemented, soft, hard)
P
FT.to _J FT. � �--
r f !
FT.to / g FT. s
FT.to FT.
FT.to FT.
FT.to FT.
FT,to FT.
FT.to FT.
FT.to FT.
�— � _
FT,to FT. r
FT.to FT.
i i vA I l i FT.to FT. C0i Ile] aiG��V FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
SATE WELL WAS COMPLETED: DATE OF REPOR y t H
WELL DRILLER
(Signature)
CERTIFICATE NO.—__--____—__—_-- ------ ----
LOCATION OF WELL: TOWN OF = '
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
1
i
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROgTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
of- A p
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
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO. ............................
after completion of well.
WELL
OWNER 4r�,
WELL Name "✓°" +� �� o
DRILLER / f f greet Address f City r Town
Street Address
� ���,��.� ✓ �%" ;� r � City or Town.
PROPOSED USE OR USES (check): b
0 Domestic ❑Irrigation ❑Stock
❑Munici Pal ❑ Industrial E3 Test We if
FLENGTH
SING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
� p Y FEET DURATION: ;'-- HOURS STATIC: FEET MAKE:
IAMETER: � INCHES PUMPING RATE: may' G.P.M. WHEN PUMPING: FEET LENGTH: SLOT
—`---- ' --- ----- FT. SIZE
KIND: r` ^
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,medium,coarse),color of material, structure (loose, packed,cemented,soft, hard)
d
J FT.to"I
FT.
� . FT.to ' AFT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT. —
FT.to FT.
FT.to FT. �
r IG a I
FT.to _FT. --- _ 'TAT
FT.to FT, x
FT,to FT.
FT.to FT. —
F.T.to FT. -_--
FT.to FT.
ATE WELL WAS COMPLETED:— DATE OF REPORT' % _ �X- —
\ _ a
WELL DRILLER
Signature)
CERTIFICATE NO.
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
t�a�s
STATE OF CONNECTICUT WELL COMPLETION REPORT DO NOT FILL IN
WATER COMMISSION 11
317 STATE OFFICE BUILDING This report must be completed and submitted to STATE WELL NO.4}...'t.`s'`.........
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER NO. ,..»..........
after completion of well
WELL
OWNER " f t '�'"' t Q
WELL Name t freet Address -
City or wn
DRILLER - _Name Street Address City or Town
PROPOSED USE OR USES (check):
omestic Irrigation ❑Stock ]Municipal 0 Industrial []Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: FEET DURATION: I-��HOURS STATIC- FEET MAKE:
`- ---- ------ SLOT
DIAMETER: INCHES PUMPING RATE: � ' G.P.M. WHEN PUMPING: FEET LENGTH: FT SIZE
KIND: .,a'
DIAMETER: IN.
WELL LOG
DEPTH FROM Give details of formations penetrated, such as: peat,silt, sand, gravel,clay, hardpan,shale, stone,rock. Includjofgravel
[GROUND SURFACE (diameter)and sand (fine, medium,coarse),color of material,structure (loose,packed,cemented,soft, hard)
FT.to FT. � e
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.
FT.to FT.
FT.to FT. ja a fia4
FT.to FT.
FT,to FT.
1ATE WELL WAS COMPLETED: DATE OF REPORT ,1—
WELL DRILLE
--
i g nature)
CERTIFICATE NO, --_--_---_— _--- — —_—
I nCATIQN OF WELL; TQWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
l
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
r'
e,
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
t '
-�
r
' -