HomeMy WebLinkAboutWell New 73 Griffin Road WATER RESOURCES� "'G�COMMISSION MILL COMPLETION REPORT DO NOT FILL IN
223 State Office Building This report must be completed and submitted �C Hartford, Connecticut � —
to State Water Resources Commission no later State Well
than 30 days after completion of well, ---
Other No.St-1 37
_
WELL irSn�x
OWNER . -� `�— L
® r
Name I � J
WELL street A d eea
DRILLER y / CRY and Town
Name �/J �r
Street Addreq
tatty area awn
PROPOSED USE OR USES (Check):
�-Domestic ❑ Farm Business
❑ Irrigation ❑ Establishment ❑ Municipal ❑ Industrial
fJ Test Well
EKind
YIELD TEST
WATER LEVEL SCREEN DETAILS
abed
or {measurefrom land su ace)
et ❑ PumpedHoursStatic: ( Feet Make:
ches Yield: When Bailed G•P•rvi. or Pumped Feet Length Slot
Ft. Size
E-C DRILLING EQUIP ENT
able Tool ❑ Other (Specify) Diameter:
❑ Rotary t n. i
.............................
TOTAL DEPTH OF WELL _FEET
WELL LOG
Depth From Give description of formations penetrated, such as:
Ground Surface granite, etc, include size of gravel (diameter) and sand(fine, medium, coarse), color of material, structure
gravel, clay, hardpan, shale, sandstone,
(loose,packed,cemented,soft,hard). For example:0 ft.to 27 ft.fine
(�i� vv�� granite. ,packed,yellow sand;27 ft.to 134 ft.gray
FT.too�v`�FT.
FT.t
,17v FT.to/� . --------------
if FT.t T.
FT.to
FT. to
FT.to FT.
FT. to FT.
YIELD TEST DATA IN G.P.M.
Give Depths At Which Yield Was Tested And Yield
G.P.M. /
FT. G.P.M. �l
FT. G.P.M.
FT.. G.P.M.
Date Well Was Completed:
Date of Report
Well Driller
(Signature
Certificate No.
LOCATION OF WELL. TOWN
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:-
(Show distance and direction from road intersection or other landmark.)
!V --� =
•a
a�
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
In
D ,
A'
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM NEAREST CITY OR VILLAGE CENTER:
'hLATER RCI�
� M� I�
R�CEI D
�Vtfli� 1 0 193
AINISW:R..D
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