HomeMy WebLinkAboutWell New 202 Abbe Road 20Z. P"Wmd
WELL DRILLING BOARD STATE OF;CONNECTICUT ' PERMIT NUMBER
B-a wD "�9 WELL DRILN VG PERMIT 12120
STATE OFFICE$UILDING,HARTFORD,CONNECIICW 06115
ci
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
SOUTH WINDSOR ABBY ROAD .1- 9/1/72 -
OWNER OF WELL
❑INDIVIDUAL ®BUILDER OTHER(Specify) JAAN LAINE'
OWNER'S ADDRESS
44 HENRY ST. , MANCHESTER9 CONN.
PROPOSED BUSINESS TEST Est.No.of
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑'yyELL People being.
USE OF served.
WELL ❑ PUBLIC THER
SUPPLY INDUSTRIAL ❑ CONDITIONING El AIR Specify) 5
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot
Location of lot to at least two roads Well location on lot and to house(if present)
Indicate North /tRK
�0jq
WEw
e-xT, J4a13y / 0/1 D
Approximate number of feet from well to
nearest source of possible contamination: 80
The undersigned is.aware that upon completion of the well;a"Well Completion Report"containing construction details and information.required under Section 25-13,
of the 1.969 Supplement to the General Statutes must be sent to the owner,the Board and the Water Resources Commission an the form provided by the Board:This
permit is not valid until all information is filled in and it has been countersigned by the Director of Health or his agent.
APPU ) APPLICANT'S ADDRESS REGISTRATION NO.
LAKE ST. , VERNON CONN. 100
own Health Officer or Agent) DATE
IAl APPROVED ❑ REJECTED 09-0�/" L
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
_WELL COMPLETION REPORT` STATE.oF.CONNECTICUT. Do NOT fill in
WDB-5 12.69 REV.9-71 WELL DRILLING;BOA_RD STATE WELL NO.
State Office Building
.HARTFORD,CONWECTICUT'06115
: OTHER NO. .
OWNER
NAME .. ADDRESS
• •
JAAN LAINE ( ' 44 HENRY ST. , MANCHESTER, •-CQNN.
LOCATION _ (No.&Street) (Town); :(Lof Number),
OF WELL ABBY ROAD SOUTH .WINDSORBUSINESS
1
PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL :
USE OF.
WELL•'.. ❑ PUBLIC- AIR OTHER
SUPPLY*." :❑ INDUSTRIAL ❑'CONDITIONING T' ❑ .(Spe ify)
EQUIPMENT ® ROTARY (_J ARM PERCUSSION, ❑ PERCUSSION ❑ (Specify)
CASING
LENGTH(feet) _ DIAMETER.(inches) WEIGHT'PER FOOT DRIVE SHOE WAS CASING-GROUTED?
2O I 6 I 19 a 45 C� THREADED -❑.WELDED I @ YES' ❑NO DETAILS: ❑YES NO
HOURS YIELD-(G.P.M.)•
TEST ❑ BAILED ❑'PUMPED ® COMPRESSED-AIR` 4 1.0
MEASURE FROM-LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST-(feet).
WATER 2 I Depth of Completed Well
0 80
LEVEi in feet below Land surface: 100
MAKE (LENGTH OPEN TO AQUIFER(feet)
SCREEN .DETAILS'..., SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including
(GRAVEL SIZE(inches)FROM(feet). 'TO(feet)
PACKED- -gravel 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 10 SbLnd &•Gravdl
10 100 Reddish Rock'-
ay_
If yield was tested at different.depths during drillitig,list below,
FEET GALLONS PER MINUTE Y�r,
• �DATE WELL COMPLETED': .PERMIT
NO212 REGISTRATION NO..' 1DT9El2 R5EP�RT :I•W R(Sig
T ?20 100 • , -.
BOAR® '
L WE'LC OMPLETSON"REPORT STATE OF CONNECTICUT
WDB-5 12.69 REV. 9-71 WELL DRILLING BOARD DO NOT fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTI NO.
OWNER-
NAME ADDRESS .
A L ICE ) HUNRY S s ,, MANCT. , � o
LOCATION (No.&:Street) (Town)
_ (Lot Number)
OF WELL { B � SOU WINS,.
BUSINESS
PROPOSED 1 1 DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPP Y ❑ INDUSTRIAL
❑ CONDITIONING ❑ (Specify)
DRILLING
EQUIPMENT E0 ROTARY ❑ APRESS RM ERCUSSSION ❑ED CABLE OTHER
PERCUSSION ❑ (Specify)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT
� DRIVE SHOE WAS CASING GROUTED?
DETAILS I I ` ( THREADED ❑ WELDED I [EYES ❑NO ]YES �NO
YIELD - ( HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED IN COMPRESSED AIR 4 i
MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet)
WATER Depth of Completed Well
LEVEL 20I I in feet below Land surfacer100
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including I GRAVEL SIZE(inches)(FROM(feet) ITO(feet)
PACKED: I gravel pack (inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
10 Sond & Gravel
10 100 ReddishRook
fig
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 WE IyyER(Sig atur
s v Gr✓ fly% i
DEPT. OF ENVIRONMENTAL PROTECTION