HomeMy WebLinkAboutWell New 160 Chapel Road WM DRILLING BOARD t STATE OF'CONNECTtCUTJ�u PERMIT NUMBER
1149 WELL DRILLING PERMIT 518 8 8-
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
SOUTH WINDSOR CHAPEL ROAD 8/4/77
OWNER OF WELL
❑x INDIVIDUAL ❑ BUILDER ❑ OTHER(specify) EUSEBIO SILVA CORDEIRO
OWNER'S ADDRESS
_ 111 HENRY ST. , HARTFORD, -CONN.
BUSININS TEST PROPOSED ® DOMESTIC ❑ ESTABLISHMENT '� ❑ FARM ❑ VILU Peeople being
USE OF served.
WELL
❑ SUPPLY AM OTHER S❑ INDUSTRIAL ❑ CCOONDMONING ❑ {pecify) 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 Of present)
UrJ �J'
t
- �QO
indicate North IR� -
ix
y'+
- .• �����L �d Esc-'•
Approximate number of feet from well to
nearest source of possible contamination: 1001
-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 musf be sent to the owner,the Board and the Water Resources Commission on the form provided by the
Board.T}ris permit is not valid until all inf mat or ion is filled in and it n Pe - has been owr teraigned•by the Director of Health or his agent.
T(S APPLICANT'S ADDRESS REGISTRATION NO.
ST. VERNON CO_IITTde
• B � er d0ent) I DA — r J
APPROVED ❑•RlelECfED I c 7
11
REAAARKS
RETURN THIS COPY TO- CONNECTICUT WELL DRILLING BOARD
' WEEL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 I2-69 REV.9aI WELL DRILLING BOAR® Do NOTfil( in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME y I ADDRESS OWNER 1;.`�.3 wS�.#-rB{0 -,SIL�`�'-.i �a .a`�.s,m.1R0- 1.11 M1111PIRY ST11• s {a R i IT 0.3-5.:D, t".0X1�
LOCATION (No.& Street) (Town) (Lot Number)
OF WELL GILA L
1 i D trt'`Fst{€ ro
BUSINESS
PROPOSED R DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL
{� (
❑ CONDITIONING ❑ (Specify)
DRILLING M
MENT � ROTARY LJ AIR PERCUSSION ❑ PERCUSSION ❑ (Specif
THE
EQUIP y)
CASING
LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?DETAILS 1L TREADED ❑ WELDED
I ]YES ❑NO ❑YES NO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR 6 20
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well ��
LEVEL 25 I .a ` in feet below Land surface: �5%
MAKE (LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including I GRAVEL SIZE(inches)FROM(feet) TO(feet)
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTI
T Sketch exact location of well with distances,to at least
FEET to FEET , ON two permanent landmarks.
4
0 °(
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 WL>LD LLEpRff(Signature)
10�
ye
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