HomeMy WebLinkAboutWell New 610 Clark Street WELL DRILLING BOARD STATE OB.';:ONNEOCUT PERMIT NUMBER
"ID&4 11-69 WELL DRILLING PERMIT 61066
STATE OFFICE BUILDING,HARTFORD,CONNECTIM 06115
LOCATION OF WELL (Torun) (Strad) (Lot Number) I DATE
SOUTH WINDSOR 610 CLARK ST. 7/20/79
OWNER OF WELL '
® INDMDUAL ❑ BUILDER ❑ oT�fETL(Specify) MERLE D:INSE
OWNER'S ADDRESS
610 CLARK ST. , SOUTH WINDSOR, CONN.
PROPOSED TEST
Est.No.of
a DOMESTIC ❑ EST BUSINESS
❑ F� ❑ WELL People being
USE OF served.
WELL ❑ R 0711ER
SUPPLY ❑ INDUSTRIAL ❑ CIONDITIONING ❑ (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)
g I �r
l ut I
Indicate North '~�' .� +>
r tJ
_
x
Approximate number of feet from well to
nearest source of possible contamination; 9oi'
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 (S' ore) i APPLICANT'S ADDRESS I REGISTRATION NO.
3T.11 VERNON, COIVN. 100
ae BY(Tow(n�Heaitia Officer or ent) DATE !�
ErAPPROVED ❑ REJECTED I !K- ag C 7
REMARKS Q Q
RETURN THIS COPY TO CONNECTICUT'WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF.,CONNE0ICUT
WD&S 12.0 REV.9.71 WELL DRILLING BOARD DO NOT fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
O1N"� MERLE .DINSE 610 CLARK ST., S. F,MSORq C.T.
LOCATION (No.6 Street) Crown) (Lot Number)
OF WEu 610-,MA RK ST SOUTH WINDSOR-. _
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM
BUSINESS
PROPOSED ❑ TEST WELL
USE OF
WELL ❑ SUPPLY ❑ INDUSTRIAL
AIR OTHER
❑ CONDITIONING ❑ (Specify) .
DRILLING ® CABLE ROTARY COMPRESSED ❑ ❑ (Specify)
EQUIPMENT AIR PERCUSSION PERCUSSION CASING
LENGTH(feet) DIAMETER(inches) WEIGHT..PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 101 6 I 1 47�`t5t THREADED ❑ WELDED YES [:]NO ❑YES ®NO
HOURS /� YIELD(G.P.M.)
YIELD ❑ BAILED ❑ PUMPED COMPRESSED AIR 4 lO
TEST 1
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATER Depth of Completed Well
LEVEL 20 125• I in feet below Land surface: 150
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL GRAVEL SIZE(inches)FROM(feet) TO(feet)
I, � Diameter of well including
I I- 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 18 Sand & Gravel
18 91 Clay
91 150 Bedrock s
10, 13 .
l�orJs �
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 �Rgnalur
2 ( 6 1009/6179
BOARD