HomeMy WebLinkAbout1986-3-25 - 1575 Main Street - Well Completion ReportWELL COMPLETION REPORT STATE OF CONNECTICUT
CPR—9 REV.11‘82 DEPARTMENT OF CONSUMER PROTECTION
WELL DRILLING BOARD
165 CAPITOL AVE.
HARTFORD,CONNECTICUT OéIOb
Do NOT fill ih
STATE WELL NO,
OTHER No4
OWNER “if gyf‘rvr‘§i:zx:EHE‘DQL:‘*Tm 4..“3‘Eb:«If?
ADDRESS
BOax yr G§$(-31-4;.kt TL
LOCATION
OF WELL
F (No.&Slree!)(Town)(L01 Number)l§?§1%Ea?3?.3 .iagiéEfa‘GR
PROPOSED
USE OF
WELL
E DOMESTIC
'BUSINE$S
ESTABUSHMENT TEST WELLFARM
PUELIC AIR OTHER
SUPPLY INDUSTRIAL CONDITIONING (Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE OTHER
ROTARY AIR PERCUSSION PERCUSSION D <Specify)
CASING
DETAILS
LENGTH (feei)
1 "
J.’a'u
DIAMETER (inches)
é
WEIGHT PER FOOT
1E;4;:@ THREADED B WELDED*;¢(J
DRIVE SHOE
YES NO
WAS CASING GROUTED?
—YES NO
YIELD
TEST D BAILED
V HOURS
PUMPED COMPREssED AIR
I
YIELD (G.P.M.)
U
WATER
LEVEL
MEASURE FROM LANDrSLiJrR'FACE—STATIC (Specify fee!)
gig
DURING YIELD TEST:)(Iee:)“QC?Depth of Completed Well
in fee?below Land surface:
SCREEN
DETAlLs
'MAKE LENGTH OPEN To AQDIFER (feet)
SLOT SIZE DIAMETER (inches)IF GRAVEL
PACKED:
Diameter of Well including
gravel pack (inches):
GRAVEL SIZE (inches)FROM (feel)To (fee:
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION I Sketch exoc'Iocation of well with dislonces,to c?Ieosltwopermanemlandmarks.FEET TO FEET
fxv
2’”!yd 121%m1;w”1V"?.,
If yield was tested of different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED
$f§2f8§
PERMIT NOL
ELDEEEEED
REGISTRATION NO.
EDD
DATE OF REPORT
WEE/8%