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STATE OF CONNECTI T Do NORM
DEPARTMENT OF CONSUMER PROTECTION STATE WELL O-.
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING COMPLETION REPORT OTHER NO.
165 Capitol Avenue,Hartford,Connecticut 06106
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ADDRESS
WEST VIEW R BAST WI tDSOR, GT
LOCATION ( o. ree) (Town) (Lot Number)
OF WELLONG RD S. WINDSOR 1
DOMESTIC BUSINESS a FARM TEST
PROPOSED ESTABLISHMENT LiWELL
USE OF WELL
PUBLIC ❑ INDUSTRIAL AIR OTHER
SUPPLY CONDITIONING (Specify)
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT � a AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT
DETAILS 135 1 7 O DRIVE SHOE WAS CASING GROUTED?
THREADED � WELDED t�
YIELD TEST x BAILED ❑ PUMPED ® COMPRESSED AIR HOURS ( YES ❑ NO• YES ❑ NO
YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) fe
LEVEL 5 40 5 Depth of Completed Well in feet
4O 5
MAKE lJ
SCREEN LENGTH OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO feet
PACKED: including gravel pack (feet)
(inches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION
Sketch exact location of well at least two
FEET TO FEET permanent landmarks with distances,to
O 130 Sand & Gravel i
�30 405 Granite
y� f
1
If yield was tested at different depths during drilling,list below a
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT"i REGISTRATION NO. DATE OF REPORT
*t �-20 9 7 19205 102 p WELLDRILLE Signetur
t 4/2i3I99
DEPT.OF ENVIRONMENTAL PROTECTION-WATER RESOURCES