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WELL COMPLETION REPORT STATE OF CONNECTICUT
CPR-9'REV. Sae DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
20 GRAND STREET
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME yyd e5 [��74<;)
OWNER Fl.S.Kt NT+t.�;Z3.W�Rs mo. 7j3 ��tt �t �r �Y�T�
LOCATION #�vv y (No. & btt�reet) t # (Town) p (Lot Number)
OF WELL ROS�.•,- i i�.Y LARE ir'f s Y+t IRDSO Z 1
BUSINESS
PROPOSED a DOMESTIC ESTABLISHMENT FARM El TEST WELL
USE OF
WELL PUBLIC AIR OTHER
SUPPLY INDUSTRIAL
El. CONDITIONING �(Specify)
DRILLING ROTARY ARMPRESSED CABLE PERCUSSION PERCUSSION ❑ (Specify)
Sp cif
EQUIPMENT y)
CASING LENGTH(feet) DIAMETER(inches) _ WEIGHT PER FOOT D I HO WAS CASIt-GROUTED?
DETAILS _ jt i, :THREADED ❑ WELDED YES El NO a YES a NO
YIELD _J° HOURS YIELD (G.P.M.)
TEST BAILED PUMPED COMPRESSED AIR L' 10
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
Depth of Completed Well
LEVEL 1 2 in feet below Land surface: *�
MAKE y
LEN50
GTH OPEN TO AQUIFER(feet)
SCREEN_
DETAILS SLOT SIZE DIAMETER(inches�:���er
GRAVEL SIZE(inches) FROM(feet) TO(feet
of well including
pack (inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET TO FEET two permanent landmarks.
0 7 S ,sue Gra-vt:e'
31 Clay
31 250 Bedrock
0161 ,(,'L1 Y
If yield was tested at different depths during drilling, list below `
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL LER�iure
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