HomeMy WebLinkAboutWell New 1165 Sullivan Avenue WELL COMPLETION REPORT ' STATE OF CONNECTICUT
CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WeLL NO. -
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME 49
OWNER ADDRESS
t:TTJT'�.�y.1.S AiMS 11 SULLIVAN AV.E i T
S`. WZNI�t�30.�# �`i t
LOCATION -g (No. & Street)7 n) �}7�p (Lot Number)
Of WELL 1165�.�a:3' t�i.#MU AVE.t's 3, 1f€.►..NDSU.
❑ BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM
USE OF
❑ TEST WELL
(��
WELL AIR OTHER
U SUPPLY ❑ INDUSTRIAL
❑ CONDITIONING ❑(Specify)
DRILLING COMPRESSED CABLE� ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION (Spec EQUIPMENT
(Specify)
VE CASING LENGTH(feet) DIAMETER inches WEIGHT PER FOOT
DETAILS ) e THREADED ❑ WELDED AYESSH❑NO ®ESOE ING GRou❑TE NO
EL
TIEST ElBAILED ❑ PUMPED COMPRESSED AIR HOURS YIELD(G.P.M)
25
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
LEVEL Depth of Completed Well ��
✓ .150 in feet below Land surface:
MAKE
LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) well i GRAVEL SIZE (inches) FROM TO(feet
IF GRAVEL Diameter of wencluding
(feet)
PACKED: gravel pock(inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION Sketch exact location of well with distances, to of least
FEET TO FEET two permanent landmarks.
0 6 Topsoil Sand
6 Clay
5 165 Bete.ook
! / f
�f i
If yield was tested of different depths during drilling, list below
FEET GALLONS PER MINUTE
z"_ / o I .
DATE WELL COMPLETED PERMIT NO:, EREGIST:RAT;15�NNO. DATE OF REPORT WEl ER(Signature)
DEPT. OF ENVIORNMENTAL PROTECTION-WATER RESOURCES
WELL COMPLETION, REPORT STATE of GONNECTIcuT -- —
CPR-9 REV.11_82 DEPARTMENT OF CONSUMER PROTECTION _Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
165 CAPITOL AVE.
CLIP TEE COMPLETION C0 HARTFORD, CONNECTICUT 06106 OTHER NO.
NAME ADDRESS
AVE.
OWNER JUKNIS AX4 .i:16SULLIVAN' S. �,�?`T1:}aC�,d� Cis
LOCATION #- (No. 8 Street) (Town)
OF WELL SULLIVAN AVE. S.WINDMi (Lot Number)
n rBUSINESS
PROPOSED (�( DOMESTIC ESTABLISHMENT FARM TEST'WELL USE OF Farm Use
WELL L--4 SUPPLY INDUSTRIAL AIR OTHER Only
CONDITIONING 11(Specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT L!!�j ROTARY El AIR PERCUSSION PERCUSSION (Specify)
LENGTH(feet) DIAMETER.(inches)— WEIGHT PER FOOT
DETAILS
AiLS '190 THREADED WELDED �IYES H NO a YES
GaouEITE NO
YIELD BAILED ��
HOURS YIELD (G.P.M.)
TEST PUMPED L`=J COMPRESSED AIR i 5
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) —
LEVEL 5 Depth of Completed Well
✓0 in feet below Land surface:
MAKE
SCREEN LENGTH OPEN TO AQUIFER (feet)
DETAILS SLOT SIZE DIAMETER(inches) GRAVEL SIZE (inches) FROM (feet) TO(feet
IF GRAVEL Diameter of well including
_ PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION Sketch exact location of well with distances, to of least
FEET TO FEET two permanent landmarks.
6 55 01aX
�e
� dJ
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE '
�U
s
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT RiLLER (Signotur
DEPT. OF ENVIORNMENTAL PROTECTION-DATER RESOURCES