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WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-s 12-69 REV,9.71 WELL DRILLING BOARD DO NO7 fill in
State Office Building STATE WELL`NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAMEE;DDJUG ADDRESS
OWNER g� Tg { 69 aa�r { �.#t.fL,S 33U:ii..:�i Lt431 �.SLfs;.%�3 +:7. - 3i7s 3.-�. .L:t.e,. a.rJ.Ld'#. a g_ 7..s137L-,l,S� l
LOCATION (No.& Street)
OF WELL (Town) (Lot Number)
? 323 BY ROADe WITTIDSOR POU1INBUSINESS
PROPOSED ? DOMESTIC ❑ ESTABLISHMENT ❑
FARM ❑ TEST WELL
USE OF
WELL PUBLIC
❑ SUPPLY ❑ INDUSTRIAL AIR f? OTHER
❑ CONDITIONING ❑ (Specify)
DRILLING
PRESSED CABLE OTHE
EQUIPMENT DO ROTARY ❑ ARMPERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING LENGTH(feet) I DIAMETER(inches) WEIGHT PER FOOTf DRIVE SHOE WAS CASING GROUTED?
DETAILS 1 6 y 3 - - I RE THREADED ❑ WELDED YES
❑NO DYES NO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED El COMPRESSED r AIR I �.. �
WATER MEASURE FROM LAND SURFACE--STATIC(Specify feet)I DURING YIELD TEST(feet)
'� 5 1 I Depth of Completed Vr✓ac
LEVEL in feet below Land surface: 2
MAKE
SCREEN
I LENGTH OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL> f GRAVEL SIZE(inches)FRO feet'-, I Diameter of well including M( ) T O(feet)
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFAC
FEET to FEET
FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
two permanent landmarks.
8 Sand $s 'Gravel
S 60 Clay ALL
60200 Bedrock ;
. f
6U'j'�
If yield was tested at different depths during drilling, list below E f
FEET GALLONS PER MINUTE
0 /'94
DATE WELL COMPLETED PERMIT NO.
REGISTRATION NO. I DATE k@( 7 �WELL DRILLSa Signature)
CC3 17
DEPT. OF ENVIRONMENTAL PROTECTION-WATER RESOURCES