HomeMy WebLinkAboutWell New 141 Beelzebub Road WELL COMPLETION REPORT 'STATE OF CONNECTICUT Do NOT fill in,
WDB-5 12-69 REV.9-71 WELL DMLLfWd'BOARD STATE WELL NO. •
State Office Building
HARTFORD,CONNECTICUT 06115
f/ OTHER NO.
OWNER
NAME /{ ADDRESS � T g.fig
JOHN �IGZA I BOX 54A9 W. WIL,ZRGTORS CONK.
LOCATION (No. &Street) �(TTown) (Lot Number)
OF WELL SM7.Fr' B ROAD SOUTH WINWOR 141
BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR❑ SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING ❑ ((THER
Specify)
COMPRESSEDDRILLING OTHER EOU PMENT ® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 23 I 6 I 19,45 I F] THREADED ❑ WELDED I EYES ❑NO [:]YES '�NO
HOURS YIELD(G.P.M.)
YIELD ❑TEST BAILED ❑ PUMPED COMPRESSED AIR 50MEASURE FROM LAND SURFACE—STATIC (Specify feet) DURING YIELD TEST(feet)
WATER Depth of Completed Well
LEVEL 13 I 75 I in feet below Land surfacer 110
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches)(FROM(feet) ITO(feet)
PACKED: I gravel pack(inches):
DEPTH FROM LAND SURFACEI Sketch exact location of well with distances,to at least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
f O 3 TspsOil ¢
3 13 Gra"l
13 110 Radish RMk
i ��3✓ �f�-
If
If yield was tested at different depths during drilling, list below G+jr1
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT LE Signatur )
LOCAL DIRECTOR OF HEALTH
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
1ND8 4 11-6' WELL DRILLING PERMIT
STATE OFFICE BUILDING,t4tARTFORD fiCONNECTICUT 06115 20605
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
SOUTH WINDSOR BMMZBWB ROAD I 12/10/73
OWNER OF WELL
INDIVIDUAL ❑ BUILDER ❑ OTHER(specify) JOHN WU TENCZA•:.
OWNER'S ADDRESS _
PINNEY HELL RD. , R.F.D. # It BOX 54At- W. WILLINGTON, CONN.
PROPOSED a DOMESTIC ❑ BUSINESS fiMENr ❑ FARM ❑ rye People being
USE OF PUBLIC AIR 07M served.
WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (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 Cif present)
Indicate North
X N f �►�sR
DRjj
yam' r f�A�
1V
T7-
.
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
25.131 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
CANT ) APPLICANT'S ADDRESS REGISTRATION NO.
v
1 T. VTRNON CONN. 100
own S Officer or dp DATE
APPROVED' ❑ REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUi Do NOT fill in
WDB-5 12-69- REV. 9-71' WELL MILLING BOARD
STATE WELL NO.
State Office Building
HARTFORD, CONNECTICUT 05115 S jj(f
_ OTHER NO.
OWNER NAME I ADDRESS
'JOHNITEN. atBOX 54AS
t.
. WILLI11TGT0X, . (N
LOCATION (No. &Street) (Town) (Lot Number)
OF WELD , -L 1 UB D H IND 41
BUSINESS
DOMESTIC_ ❑ E TABL SHMENT ❑ FARM
PROPOSED 77—
❑ TEST WELL
USE OF �(WELL 1-1 THER
SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)PUBLIC AIR (
DRILLING
IPMENT 7 ROTARY ': ❑ ARM EPRESSED RCUSSION ❑ PERCUSSION ❑ ((Specif
CABLE
EQUIPMENT y)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS I" I I THREADED ❑ WELDED I ®YES ❑NO ❑YES El NO
YIELD ❑ BAILED HOURS YIELD(G.P.M.)
TEST ❑ PUMPED COMPRESSED AIR I 50
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet) I Depth of Completed Well
LEVEL 1 5 in feet below Land surface: 11
MAKE I
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) I IF GRAVEL Diameter of well including I I GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACEI Sketch exact location of well with distances,to at least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
Topsoil males cka-I r
13 Grave
13 110 Reddish lZoak
i
4 If y
(f3t9
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT W LER Signatur n
DEPT. OF ENVIRONMENTAL PROTECTION — WATER RESOURCES
SOWN Se
y x �
To� O-Psou� ?d
G U
w� 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
f�Osox•co TELEPHONE (860) 644-2511
Dear Homeowner:
The Town of South Windsor Health Department's goal is to keep you informed about the
status of water quality throughout the town whether you are served by and individual well
or by a public water source.
In an attempt to better serve you, we have reviewed our files to ensure we have the
most recent and accurate information possible. Our review has revealed that we do not
have any information regarding how your residence receives its water.
We are hopeful that you will take a moment to help us keep our records current. Please
indicate the type of water service by circling the appropriate entry below and return this
letter no later than in February 27, 2009, in the self addressed stamped envelope
provided.
If you receive your water from a private well, please let us know the location as it relates
to your home by providing two measurements from the foundation to the well in the
space provided and let us know if the well is used for domestic, lawn and garden, or
agricultural use. See example below.
Thank you in advance for your cooperation.
Any questions can be addressed to the South Windsor Environmental Health Officer,
Robert De Vito at 860-644-2511, extension 248. l /NPW^-710'1 /S "�
Water service: S
Circle the appropriate service:
WELL MDC CT WATER
/ ll BLZ�� uL3 � Q .
�/�� �C-os2( C T
WELL USE: DOMESTIC LAWN & GARDEN AGRICULTURAL � 0- -71
Well Location :
BACK DRAWING:
40 FT
A FRONT B RECEIVED
30F 14FT
WELL FEy I /MIN
STREET
ENG'NEERING oER