HomeMy WebLinkAboutWell New 00 Kelly Road (2) STATE OF CONNECTICUT WELL COMPLETION REPORT DO NOT FILL IN.
WATER COMMISSION
317 STATE OFFICE B-UILDING This report must be completed and submitted to STATE WELL NO. . ......�=
HARTFORD 15, CONN. State Water Commission no later than 30 days OTHER N0. ` .......�'. f...
after completion of well. 1Cr^
WELL --••�C
OWNER '
WELL I Na_ Street Address City or Town
DRILLER
Name Street- ddress City or Town
PROPOSED USE OR USES (check):
mestIc Ej Irrigation ❑Stock ❑Municipal Industrial Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: FEET DURATION: HOURS STATIC: FEET MAKE:
�,i SLOT
DIAMETER: INCHES PUMPING RATE:. �� .P.M. _WHEN PUMPING: (® _FEET LENGTH:-- �FT. SIZE
KIND: e �v d� ----- _—�
DIAMETERS--- 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 10 FT. ,� -
1-0 FT.to (-FT. 5� .
FT.to FT.
FT.to FT.
FT.to FT.
FT.to FT.
FT,to FT.
FT,to FT.
FT.to FT. t
— — i
FT.to FT. —_-- ---
FT.to FT.
FT.to FT. C744
r , —
FT,to FT.
FT,to FT.
FT.to FT.
DATE WELL WAS COMPLETED: f
DATE OF REPORT
WELL DRILLER
(Signature) —
CERTIFICATE NO.
LOCATION OF WELL: TOWN OF 44�
SKETCH SNOWING LOCATION OF PREMISES IN TOW
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DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD: