HomeMy WebLinkAboutWell New 00 Kelly Road (3) STATE OF CONNECTICUT WELL COMPLETION REPORT DO NOT FILL IN
WATER COMMISSION _
317STATE OFFICE BUILDING This report must be completed and submitted to STATE WELL NO,
HARTFORD 15, CONN. State Water Commission no later than 30 days OTI-IER NO.
after completion of well. 6�
WELL / /ems
OWNER f-F l� ' f/ 1(jr A03e,, r
DRILLER / Ir WELL ams Street Address �^ City or�Town /
`� �51 B/ 1.t7 f E,+ms. &AJA
Name Street Address City or Town
PROPOSED USE OR USES (check):
jP/Domestic Ej-jrrigation ❑Stock El Municipal (] Industrial 0 Test Well
CASING DETAILS PUMPING TEST WATER LEVEL SCREEN DETAILS
(measure from land surface)
LENGTH: FEET DURATION: _ -_ HOURS STATIC:-- FEET MAKE• A 6 t�
SLOT
IAMETER: �i INCHES PUMPING RATE: G.P.M. WHEN PUMPING: ��� FEET LENGTH: ( pT, SIZE
[KIND: - — -
DIAMETER:,1AJe4CIN.
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)
s FT.to f 0 FT. ' (✓ 9' �7AJ
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FT.to FT.
T*4
FT.to FT. C�
FT.to FT. r is 4
FT.to FT. -
FT,to FT. --- Cn
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FT,to FT.
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DATE WELL WAS COMPLETED:_ DATE OF REPORT
WELL DRILLER
(Signature)
CERTIFICATE NO. _—.__--____,-------`---------------
LOCATION OF WELL: TOWN OF L)l6` tit AJL)Sb
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD: