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Home My WebLink About148 Oakland Road CPR-9 Rev.7/95 i Do NOT fill in STATE OF CONNECTICUT STATE WELL NO. DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO. WELL DRILLING COMPLETION REPORT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION (No.&Street) (Town) (Lot Number) OF WELL OWNER NAME ADDRESS EST PROPOSED DOMESTIC BUSINESS❑ ESTABLISHMENT FARM ❑ WELL USE OF WELL SPUBLIC UPPLY INDUSTRIAL CAIR ONDITIONING OTHER COMPRESSED EQDRILLING UIPMENT ROTARY ❑ CABLE OTHER AIR PERCUSSION El PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOTDRIVE SHOE WAS ASING GROUTED' DETAILS -T a THREADED� WELDED ,© YES ❑ NO © YES NO YIELD TEST ❑BAILED ❑ PUMPED ❑ COMPRESSED AIR HOURS YIELD(G ) 1 1 WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet LEVEL MAKE LENI E (feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of we L inc es (feet) ee PACKED: including gravel pack (inches) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET permanent landmarks t .��-7 �d) EO '"c. If yield was tested at different depths during drilling,list below FEE1 —�5TLEEWS PER MINUTE I I i DATE WELL COMPLETED PERMIT NO. REGISTRATION NO DATE OF REPORT % WELL DRILLER(Sign") t/ LOCAL DIRECTOR OF HEALTH