HomeMy WebLinkAboutWell New 8 Collins Lane 8o11i► 1--Q1r LC�Ct� � li�ct ,
WELL COMPLETION-REPORT STAJ-QF CONNECTICUT
'Do NOT fill in
WOB 5 12-69 •REV.9-n. WELL DRILLING BOARD STATE'WEu No.
1,. State•Oftice Building
HARTFORD,'CONNECTICUT 06115 .
OTHER N0.
NAME : ADDRESS
O1N" PORTER. COLLINS I COLLINS LANE, WAPPING, CONN.
LOCATION (No.&,Street) ;"(Town) _ (Lot Number)
OF WELL COLLINS LANE SOUTH WINDSOR
PROPOSED ® DOMESTIC ❑ BUSINESS
ESTABLISHMENT .• ❑ ❑-TEST'WELL
.FARM
USE PUBLIC AIR OTHER
WELLL" ❑.SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)'
DRILLING ROTARY ❑ AIR MP R SSED N PERCUSSION (Specify)
- ECABLE OTHER
QUIPMENT
-LENGTH(feet) DIAMETER(inches_) ..WEIGHT.-PER FOOT • ''� • DRIVE SHOE WAS CASING GROUTED?
CASING
DETAILS.' ?0 l 6,• I 19 a 45. 'I THREADED ElWELDED I YES: [:]NO ❑YES [ NO
HOURS YIELD(G.P.M.) _
YIELD ❑''BAILED ❑'PUMPED' ® COMPRESSED AIR
TEST .,I A.. 25
WATER "MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed'Well-
LEVEL' -30 I. 120 in feet below Land surface: 150
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)
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 25 SaAd & Gravel
25_ -60 Hardpan
60 150 Reddish Rock
fir,-
If yield was tested at'd)fferent depths during drilling,list below
FEET GALLONS PER MINUTE V
v IX
O��, 11 NC
DATE WELL•COMPLETED- PERMIT'NO. REGISTRATION NO. J.DATE OF'REPORT'' WELL' L R.(Sig atur }
WELL DRILLING BOARD STATE VF cONNECTICUT _ PERMIT NUMBER
WDB-4 11-69 WELL DRILLING PERAl11T. 12267
STATE OFFICE BUILDING,HAR1'fORD,CONNECTICUT 06115 z
t
LOCATION OF WELL(Town) (Street' (Lot Number) DATE
SOUTH WINDSOR COLLINS LANE 9/8/72
OWNER OF WELL _
®INDIVIDUAL ❑BUILDER ❑ OTHER(Specify) PORTER COLLINS
OWNER'S ADDRESS
COLLINS LANE, WAPPING, CONN.
PROPOSED BUSINESS TEST Est.No.of
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
WELL ❑ OTHER UPPLY ❑ INDUSTRIAL ❑ CONDITIONINGAIR (Specify) 5
SKETCH OF WELL LOCATION
Locate well with respect to of least two roads,showing distance from intersection and front Of lot
Location of lot to of least two roads Well location on lot and to house(if p ent)
1�
7 _
a
Indicate North
o tL
ANT
�R�� �� V
G�rdR - - � Q
x �N.1 5
• 3 . �
fi4N0 ��,�C 1�0
Approximate number of feet from well to $0
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 counter-signed by the Director of Health or his agent.
NT :gnature) APPLICANT'S ADDRESS REGISTRATION NO.
LAKE ST. , VERNON, CONN. 100
wn Health Officer or Agent) DATE
X APPROVED ❑ REJECTED
R/I ''EMAWS
No s ffPrfd, A-*=01C b 1L CW TNiS IVQ0 AV,47',
RETURK THIS COPY TO CONNECnCUT WELL DRILLING BOARD : '
WELL COMPLETION REPORT STATE OF CONNECTICUT DO NOT fill in
WDB-5 42-69 REV.9-71 WELL DRILLING BOARD STATE WELL NO.
State Office Building l j�
HARTFORD, CONNECTICUT 06115 5
• OTHER NO.
C f�
NAME ADDRESS _
OWNER PORT -GOL � I GGIL �NS LANK g. APJ .i NG 0 .
LOCATION (No.& Street) (Town) (Lot Number)
OF WELL ���a L � ����� 4I
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT
BUSINESS El FARM TEST WELL
USE OF PUBLIC AIR
WELL ❑ SUPPLY .❑ INDUSTRIAL ❑ OTHER
DITIONING ❑ (Specify)
COMPRESSED CABLE OTHER
DRILLING ROTARY ❑ AIR PERCUSSION ElPERCUSSION ❑ (Specify)
EQUIPMENT
LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT I DRIVE SHOE WAS CASING GROUTED?
CASING I I THREADED ❑.WELDED EYES ❑NO ❑ [I NO
NO
DETAILS # # I 60
HOURS YIELD(G.P.M.)
YIELD ❑ BAILED ❑ PUMPED COMPRESSED AIR I TEST 25
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
WATER
LEVEL 0 I 120 in feet below Land surface_ 150
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) I IF GRAVEL Diameter I of well including I GRAVEL SIZE(inches) FROM(feet) TO(feet) -
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.
25 Land & Grayal
25 60
0 1 r10 Reddish Ronk
m
tA
VC
c�a
U
07 Juy- a✓�r� J
If yield was tested at different depths during drilling, list below �7 �
FEET GALLONS PER MINUTE C� 1L- r
g
DATE WELL COMPLETED I PERMIT NO. (REGISTRATION NO. (DATE OF REPORT WELL R(Sig; tur
r
DEPT. OF ENVIRONMENTAL PROTECTION
V�
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4 OW N Se
�- 700 olle so� ?d&U&01t
1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
f�Osoe•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 0f1> racf NJ
Robert De Vito at 860-644-2511, extension 248.
Water service:
Circle the appropriate service: sou-rHwuyup�r.
ENGeNEERjNG
WELL MDC CT WATER
WELL USE: DOMESTIC LAWN & GARDEN AGRICULTURAL
Well Location : c
FQ R--
C7hevl'nlc/eo/gs BACK DRAWING:
40 FT
tA' FRONT B �rMt five
30 F 14 FT
WELL �► - 7+ f�`C ighl
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