HomeMy WebLinkAboutWell New 577 Barber Hill Road WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
WDB•S 1249 REV.9-71 WELL DRILLING BOARD
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 061.15
OTHER.NO.
NAME ADDRESS
OWNER JNJ MIKE JACQUES CONSTRUCIION CO. 626 ELLINGTON RD. , S. WINDSOR, CT.
LOCATION (No.3 Street) (Town) (Lot Number)
OF WELL 82 BARBER HILL ROAD SOUTH WINDSOR
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF AIR OTHER
WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (specify)
DRILLING ROTARY ❑ COMPRESSED
PER PERCUSSION ElP PERCUSSION ❑ (OTHER EQUIPMENT AIR (Specify)
CASING LENGTH(feet) DIAMETER'(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 40 I 6 � 19.45 I a THREADED ❑ WELDEDI OYES NO ❑YES (:3NO
YIELD ❑ ❑ PUMPED HOURS YIELD(G.P.M.)
TEST BAILED ® COMPRESSED AIR 4 l5
WATER
MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet)
• Depth of Completed Well
LEVEL 30 80 in feet below land surface: 100
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN i
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches)FROM(feet) TO(feet)
PACKED: I gravel pack(inches):
DEPTH FROM LAND SURFACI FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
0 10 Sand & Gravel
10 30 Clay
30 100 Bedrock
/Ci
If yield was tested at different depths during drilling,list below Vt�
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF kLPORT WgR{L R(S' nature)
10/25/78 145887 I 100 ( 10/31/?8I`
BOARD
WELL DRILLING BOARD STATE of cb44iiCTICUr PERMIT NUMBER
1N054 1149 WELL DRILLING PERMIT 4 5 8 8 7-
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (rown) (Street) (Lot Number) DATE
SOUTH WINDSOR 62C—ET!,T,1 82 BARBER HILL RD. 9/29/78
OWNER OF WELL
❑ INDIVIDUAL ® BUILDER ❑ OTHER(specify) JNlJ MIKE JACQUES CONSTRUCTION CO.
OWNERS ADDRESS
626 ELLINGTON ROAD, S. WINDSOR, CONN. 2 7 l y7-
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT '� ❑ FARM ❑ W� People being
USE OF
served.
WEU ❑ SUPPLY ❑ INDUSTRIAL ElCOMMON(UG ❑ ((SSppeecifify) 4
SKETCH OF WELL LOCATION
Locate well with respell 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 Coif present)
Indicate
1-14vaxL
r
�11i�JDso12 ( xs
r/
11 90
eA
Approximate number of feet from well to 80 T
nearest source of possible contamination:
The undersigned 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.
APP ipnatum) APPLICANT'S ADDRESS REGISTRATION NO.
LAKE ST. , VERNON, CONN. I loo
BY Toro»Irian 0M.- r or Ago") DATE
APPROVED ❑ REJECTED I /o—
REMARKS
Via ' it— 2Li 5 ct
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD