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HomeMy WebLinkAboutWell New 350 Abbe Road Extension WELL DRIWNG BOARD STAT0bF l'�iMBC;WLIT PERMIT NUMBER INDB 4 1149 WELL DRILLING PERMIT -5 5 514 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 0611S LOCATION OF WELL (70") (8tmet)- (Lot Nxmbar) I DATE S. WINDSOR 350 ABBY ROAD EXT. B 7/30/79 OWNER OF WELL 0 INDIVIDUAL ❑ BUILDER' ❑ OTHER(specify) JAl`'1.ES COTTON OWNER'S ADDRESS 350 ABBY- ROAD EXT.., aOUTH WINDSOR, CT. Est.No.of PROPOSED . © BUSINESS TEST DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being USE OF served. PUBLIC u ❑ AIR OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) . - 4 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) C r t Indicate North dor ��° P K x 2 �0A� zgRi 11(1P.. fin) Approximate number of feet from well to nearest source of possible contamination: .75 t 'The*undersigried is aware that upon completion of the well,a"Well Completion Report'containing construction details and Information required under Section . 25-131 of the 1969 Supplement to the General Statutes must be sent to the owner,the Board and the Water'Resources Commission on 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. AP NT fs I .LAHE APPLICANT'S ADDRESS REGISTRATIONNO. ST. * VERNON CONN. ( 100 Br(Tmn Health Of or Avert) DATE APPROVED ❑ REJECTED I I 7 REMARKS RETURN THIS COPY TO•CONNECTICUT WELL DRILLING BOARD KNELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in WMS 12.69 REV.4-71 WELL DRILLING BOARD STATE WELL NO. State Office Building HARTFORD,CONNECTICUT 06115 OTHER-NO. OWNER JAM AME JAM 00TTON ADDRESS 350 ABBY ROAD EgT. 9 S:. WINDSORt CT- LOCATION (No.A Street) (Town) tlot.Number) OF WELL 350 ABBY ROAD EXT. S. WMSOR B PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF PUBLIC AIR OTHER WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING ❑ COMPRESSED ❑ CABLE ❑ OTHER TH f EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS 21 - I 6 11(AX5 I y�� THREADED ❑ WELDED l 5d YES ❑NO ❑YES ®NO YIELD ❑ BAILED ❑ HOURS YIELD(G.P.M.) TEST PUMPED FKI COMPRESSED AIR 4 30 MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet)WATER Depth of Completed Well LEVEL 0 in feet below Land surface: 100 MAKE I 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): I I 1 DEPTH FROM LAND SURFACt FORMATION DESCRIPTION Sketch exact location of well with distances,to at least FEET to FEET two permanent landmarks. 0 8 Sand, Gravel & Clay 6- 8 100 Bedrock �o U"r If Yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE _____DATE-_WELL_COMPLETED P_ERMIT_NO. _ REGISTEAT-ION NO._ DATF-OF KP_ORT _. _ n RI R.(Si ture)__ 8/23/79 55514 100 9/6/79 � BOARD