HomeMy WebLinkAboutWell New 00 Scantic Road WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV. 9-71 WELL DRILLING BOARD D® NO fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER-NO.
OWNER NAME ADDRESS
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL
BUSINESS
[� `6OMESTIC ❑ ESTABLISHMENT ❑,FARM PROPOSED ❑ TEST WELL
USE OF
WELL PUBLIC AIR ❑ OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING
(Specify)
DRILLING C PRESSED CABLE
EQUIPMENT ❑ ROTARY f AIR PERCUSSION ❑ PERCUSSION ❑ OTHER
(Specify)
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE
s WAS CASING GROUTED?
CASING ( I s I THREADED ❑ WELDED I ❑NO ES ❑NO
DETAILS � ��. OYES
YIELD HOURS YIELD (G.P MM.)
TEST ❑ BAILED ❑ PUMPED P—COMPRESSED AIR I
WATER
MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD?EST (feet)LEVEL Depth of Completed Well •�
I in feet below,Land surface: J
MAKE —
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including�. — I GRAVEL SIZE (inches)—FROM(feet) TO(feet)
.
PACKED: gravel pack (inches):
DEPTH FROM LANDSURFAC "—
FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET to FEET two permanent landmarks.
.5
/ =
I
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF RLPORT WE (Signature)
f I f �P3�dEGrICUT VALLEY ARTESIAN WELL CO, (NG:
DEPT. OF ENV)RIONK11_P;TAL rPOTE�T,D;�i I�;r�:i'E� PESDUP.DES