HomeMy WebLinkAboutWell New 44 Doria Lane WELL DRIWWG► BOARD STATE OF C014NEMCUT PERMIT NUMBER
WD8.4 11-69 WELL DR•ILVNC� PERMIT 55288
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STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
SOUTH WINDSOR DORIA LANE 10 T10/2/79
OWNER OF WELL
❑ INDIVIDUAL 91 BUILDER ❑ OTHER(Specify) CECIL CONSTRUCTION -CO. , INC.
OWNER'S ADDRESS
80 AIITY ST. 9 HARTFORD CT. 06106
PROPOSED BUSINESS TEST Est.No.of
DOMESTIC ET
ESTABLISHA1IENT ❑ El WELL,ELL, People being
USE OF served
WELL OTHER
El 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 Of present) I
Indicate North
19
o rCI A
Approximate number of feet from well to r7
nearest source of possible contamination. !55.1
ilia 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.
APP ) APPLICANT'S ADDRESS I REGISTRATION NO.
LAKE ST. VERNON CT. I 100.
BY(Twon0lficer ew DATE
PROVED ❑ REJECTED i �' YlJQai ' I `�t
REMARKS p
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
y
WELL COMPLETION REPORT STATE OF CONNECTICUT —
WDB-S 12-69 REV. 9-71 WELL DRILLING BOARD Do NOT fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER"NO.
NAME ADDRESS
OWNER NAME
_Nd8 Ai TT Off* , �qT '�.�#:D, CT.
LOCATION (No.&Street) (Town) v`
,yy�, _ (Lot Number)
i.
OF WELL DORI 1t£ . E S• ��Z r OR 1
BUSINESS
❑ ESTABLISHMENT
PROPOSED DOMESTIC ❑ FARM El TEST WELL
USE OF
WELL ❑ PUBLIC ❑
SUPPLY ❑ INDUSTRIAL
AIR ❑ OTHER
CONDITIONING (Specify)
DRILLING {�( COMPRESSED CABLE ❑ OTHER
EOUIPMENT ROTARY LJ AIR PERCUSSION ❑ PERCUSSION (Specify)
LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT CASING DRIVE SHOE WAS CASING GROUTED?
20 G I I El THREADED WELDED I NO
DETAILS I ❑ RYES ❑NO ❑YES
YIELD HOURS ,�� YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR `�s• I 20
I
MEASURE FROM LAND SURFACE—STATIC (Specify feet)I DURING YIELD TEST(feet) I Depth of Completed Well
WATER 10
LEVEL � g'5 in feet below Land surface:
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) I I GRAVEL SIZE 6i ches)�FROM(feet) TO(feet)
IF GRAVEL Diameter of well including
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFAC
FEET to FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
two permanent landmarks.
8 10
3
E
4
If yield was tested at different depths during drilling, Fist below
FEET GALLONS PER MINUTEPie
t: I
�0
DATE WELL COMPLETED i PERMIT NO. REGISTRATION NO. (DATE OF REPORT. iI WE tL ARF{HFtiR(S}�natvre) LL
L€pep2E5 E5=�)88 100 ? lf�_ J�V--,A J �n� '
DEPT. OF ENVIRONMENTAL PROTECTION-WATER RESOURCES