HomeMy WebLinkAboutWell New 00 Miller Road (2) VTELL COMPLETION REPORT DO NOT FILL IN
WATER RESOURCES COMMISSION This report must be completed and submitted
223 State Office Building to State Water Resources Commission no later State Well No.
Hartford, Connecticut than 30 days after completion of well.
Other No.
WELL
OWNER ° J
Name
WELL Street Add Clty a Town
DRILLER �7 ,
Name c�
Street Address Clty and Tn '
PROPOSED USE OR USES (Check):
Business
("Domestic ❑ Farm ❑ Irrigation
❑ Establishment ❑ Municipal ❑ Industrial ❑ Test Well
CASING DETAILS YIELD TEST WATER LEVEL
W-BSCREEN DETAILS
f aord / (measure from an su ace)
Length: Feet ElPutn Pumped / �..
P Hours Static: Feet Make:
Diameter: Inches Yield: When Bailed
G.P.M. or Pumped Feet Len th Slot
g Ft.. Size
Kind:
DRILLING EQUIPMENT
l -� / able Toot
V/ / �C ❑ Other(Specify) Diameter: In.
Rotary
TOTAL DEPTH OF WELL -0� _FEET
WELL LOG
Depth From Give description of formations penetrated, such as: peat, silt sand ,
Ground Surface granite, etc. include size of gravel (diameter) and sand (fine,'medium, coarse),,color of materia,sandstone
l structure'
(loose,packed,cemented,soft, hard). For example:0 ft.to 27 ft.fine
granite. / ,packed,yellow sand;27 ft.to 134 ft. gray
FT.is j FT.
FT.to FT. �
FT.to FT.
FT.to FT.
FT.to FT.
FT,to FT.
FT.to FT.
FT. to FT.
YIELD TEST DATA IN G.P.M.
Give Depths At Which Yield Was Tested And Yield
FT. . G.P.M.
FT. G.P.M.
FT G.P.M.
FT. G.P.M.
Date-Weil Was Completed:_ — / f Date of Report l ( / ✓' 3s
Well Driller
(Signature)
Certificate No.
8
LOCATION OF WELL: TOWN OF
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:-
(Show distance and direction from road intersection or other landmark.)
t
\4
DIAGRAM SHOWING LOCATION OF WELL ON PREMISES:
t
t
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM NEAREST CITY OR VILLAGE CENTER:
STATE L
NIARI
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