• Date well completed
• Date of report
• Permit number
• Registrant number
• State well number
• Other number

Owner Info

• Owner First Name
• Owner Last Name
• Address

Well location

• Well Street Number
• Well Street Name
• Town
• Zip code
• Lot number
• GPS coordinates
  Latitude Longitude
• Location relative to three permanent landmarks
• Use DOMESTICBUSINESS ESTABLISHMENTFARMTEST WELLPUBLIC SUPPLYINDUSTRIALAIR CONDITIONINGOTHER
• Drilling equipment ROTARYCOMPRESSED AIR PERCUSSIONCABLE PERCUSSIONOTHER

Casing Details

• Length feet
• Diameter inches
• Weight per foot lbs/feet
• Threaded Welded
• Drive shoe yes no
• Was casing grouted yes no

Yield Test

• Method Bailed Compressed Air Pumped
• Test duration hours
• Yield gallons per minute
• Yield test notes

Water Level

• From land surface feet
• During yield test feet
• Depth of complete well feet

Screen Details

• Make
• Length open to aquifier feet
• Slot size
• Diameter inches
• Gravel Packed Unpacked
• Diameter including gravel pack inches
• Gravel size inches
• Gravel pack location feet
  to
  feet

Other Notes