HomeMy WebLinkAbout1972-3-2 - 105 Ident Road - Well Completion ReportBOARD
STATE OF CONNEC‘I’ICUT
WDBf 12-69 WELL IIRILLING WARD
Side O$ce Buiiding
HARTFORD,CONNECTICU‘I'061 15
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STATE WELL NO.
OTHER NO.
OWNER NAME
tIE RR§‘B u x L oE .
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LOCATION
“WE“
'(No.&Street)(Town)(Lot Number)
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USE OF
WELL
E/DOMESTIC
EUSINESS D mm D TEST WELLESTABLISHMENT
PUBLIC B INDUSTRIAL
'AIR
CONDITIONING OTHERSUPPLY(Specifv)
DRILLING
EQUIPMENT D ROTARY AIR
OMPRESSED
PERCUSSION
CABLE
PERCUSSION OTHER(Specily)
CASING
DETAILS
LENGTH (feel)l o é DIAMETERUnchEs)
é
WEIGHT PER FOOT
I 9 ETHREADED DWELDED
DRIVE 5HOE
YES NO
‘TWA CASING ROUTED?
YES NO
YIELD
TEST
HOURSaBAILEDDPUMPEDE’COMPRESSED AIR .1
G.P.M.7 //2 YIELD (G.P.M.)7 kz
WATER
LEVEL
MEASURE FROM LAND SURFACE—STATICISP8CII)’I99!)I3C3
DURING YIELD TEST (lee!)
1 8K /Deplh
in fee!
cf
below
Complefed
Land surfnce:
Well
/8 8 I
SCREEN
DETAILS
MAKE LENGTH OPEN TO AQUIFER (lee!)
SLOT SllE DIAMETER (inches)IF GRAVEL
PACKED:
A”A”
Diameier of well including
gravel pack (inches):
’GRZVEI SIZE (inches)ROM (teat)Io (rem)
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketchtwo permanen:
‘exact IocatloIandrgagzge II with distal-was,to at leastFEETInFEET
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If yield was tested at diHerenf depihs during drilling,Iist below
FEET GALLONS PER MINUTE
DATE WELL COMPLETEDa~3 "7 R
PERMIT NO.»
f)9 3 O
REGISTRATION NO.
9‘1 ?
DATE OF REPORT
.3~2 ‘7Q WELL DRILLER (Slgnamm)
CONNEcrICUT VALLEY ARTEsIAN‘wELL co.t &--
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 WELL DRILLING BOARD Do NOT fill in
Sw‘te Office Building
HARTFORD,CONNECTICUT 06115
STATE WELL NO.
§m/3"r;
OTHER NOT
OWNER NAME’Ffa‘w Es‘m x gia5 ‘3:Ni.
ADDRESS
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LOCATION
OF WELL
(No.&Street)(Town)(Lot
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Number)
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FROPQSED
USE OF
WELL
BUSINESS
OMESTIC ESTABLISHMENT FARM TEST WELL
PUBLIC AIR OTHERSUPPLYINDUSTRIALCONDITIONING(Specify)
DRILLING
EQUIPMENT I OMPRESSED CABLE OTHERROTARYI“AIR PERCUSSION PERCUSSION (Specify)
GROUTED?
NO
CASING
DETAILS
LENGTH (fee?)g g,é?
DIAMETER(/'nches}
f‘L’W
WEIGHT PER FOOT
i Li E’THREADED D WELDED
DRIVE SHOE
YES NO
WAS CASING
YES
YIELD
TEST
HOURSBBAILEDDPUMPEDIt}_.COMPRESSED AIR ‘}(”x
G.P.M.
“'?Kiri;,xx
YIELD (G.P.M,)zy z 54‘”2
WATER
LEVEL T
SCREEN
DETAILS
MEASURE FROM LAND SURFACE~STATIC{SpeCify feet)DURING YIELD TEST (feef)
K
f 5’5
Depth
in fee?
of
below
Complefed
Land surface:
Well
’
i’8‘g z
MAKE LENGTH OPEN To AQUIFER (fEeU
SLOT SIZE DIAMETER (inches)IF GRAVEL
PACKED:
Diameler of well including
gravel pack (inches):
GRAVEL SIZE (inches)FROM (feet)TO (feet)
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of we/I with distances,to at leasttwopermanentlandmarks.FEET to FEET
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If yield was tested at diRerent depths during drilling,Iisf below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED
g:...$§:-“h;PERMIT NO.”Wis Ta ”a.r ;C-.A a“;
REGISTRATION NO.a faf}...A.
DATE OF REPORT
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WELL DRILLER (Signature)L “Ii-‘4’}w
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