The URL can be used to link to this page

Home My WebLink AboutWell New 360 Foster Road (:zk 'd z.WELk.pR1I 1 BOARD STATE OF CONNECTICUT PERMIT NUMBER WQB-4 11.6 WELL DRILLING PERMIT 28005 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 LOCATION OF WELL (Town) r (Street) (Lae xnvaer) DV-PlIh5- 0 .� u it /� J Oct Im OWNER OF WELL 11,4 INDIVIDUAL ❑ BUILDER �OTHER(Specify) S2t/C M F / OWNER'S ADDRESS f /,, e SS o� Q ti a PROPOSED ❑ BUSINESS TEST Est.No.of DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being USE OF R OTHER served. WELL ❑ SUPPLY El INDUSTRIAL' ❑ CPUBLIC IONDITIONING ❑ (specify) f� 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) 0 Indicate North r VIA A45 J d�v S ur 9 �(o 90 i F-o o ren J /�I f WC S�l�ao� C e� Approximate number 6f feet from well to 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. APPLI Biynatato I APPLICANT'S ADDRESS REGIST ATION NO. 17 B Mn Sean or ere DATE) APPROVED ❑ REJECTED REMARKS r RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD r - - YVELk{OMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in WDB•5 12.69 REV.9.71 WELL DRILLING BOARD STATE WELL NO. State Office Building HARTFORD,CONNECTICUT 0611.5 OTHER NO. OWNER NAME / ( ADDR P' .U0 O LOCATION (Nsu&,�reat) IT ) (Lot Number) OF WELL 117 OS/>o2 Cil�/ f"<� SON A e4 ❑ DOMESTIC ❑ ESTABLISHMENT FBUSINESS ARM TEST WELL USE OF PUPPY ❑ INDUSTRIAL ❑ AIR OTHER � ��WELL ' CONDITIONING ❑ (Specify) DRILLING r--j.,0& CABLE EQUIPMENT ❑ ROTARY A RMPRESSED PERCUSSION ❑ PERCUSSION ❑ ((Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT ��], DRIVE SHOE WAS CASING GROUTED? DETAILS I ,l I 7 I -(� THREADED ❑ WELDED I AYES ❑NO ❑YES aNO YIELD ❑ BAILED ❑ PUMPED �iOMPRESSED AIR HOURS YIELD(G.PM/�.)i47ee�.-.j f� S, TEST y ({J' .44 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet)? DURING YIELD TEST(feet) I Depth of Completed Well LEVEL 0 in feet below Land surface: 3 L MAKE I 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: I 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. LI 900 e . A li �};�a 0lV4 to If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE fatj>D%• t 60 DATE WELL C P ETE I PERMIT NO. I REGISTRATION NO. - I DATE OF EP T (WEL RILLER(Signature 3 0� Y 7� r BOARD i` ;x�: `t _`��t"'k ' .• ""' { .':r z. +y`"cse` k' `. €+. j'' 's-r. �L �A-`zs`n;�, `.- '�� 5":. s '�.Y;,^ ''_.,._"' "5 � ' �; =' „ a ;r • WELL COMPLETION REPORT STATE OF CONNECTICUr Do NOT fill in WDB-5 72-69 REV. 9.71 WELL DRILLING BOARD State Office Building STATE WELL NO. - HARTFORD,CONNECTICUT 06115 OTHER NO. OWNER NAME ..�. �€ r.... AD�DyRE S {/' p /p twa JJ F Arm+=- r!L.«/`. t, Aq., .r � � rM� (No.&Street) -7( Y (Town)) (Lot Number) r'r+` OF WELLBUSINESS PROPOSED ❑ DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF WELL (PUBLIC AIR OTHER G—I SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING r;;KCOMPRESSED CABLE OTHER EQUIPMENT ❑ ROTARY I—I AIR PER PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS ' I I I THREADED ❑ WELDED I '�YES [:]NO [:]YES �O YIELD HOURS YIELD(G.P.M,) ❑ BAILED ❑ PUMPED ,COMPRESSED AIR TEST v t.) ' • t-- WATER MEASURE FROM LAND_SURFACE—STATIC(Specify feet) DURING YIELD TESTT((feet) Depth of Completed Well LEVEL' I f S I in feet below Land surface: f MAKE I LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches)FROM(feet) TO(feet) I ' Iyl PACKED: gravel pack(inches): DEPTH FROM LAND SURFACEI Sketch exact location of well with distances,to at least FORMATION DESCRIPTION FEET to FEET two permanent landmarks. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE J v y-- DATE WELL O PLETED +PERMIT NO. y REGIS ATION NO. DATE OF REP RT WEL DRILLER( ' nature)' I sT f fi r 1I + Jr LOCAL DIRECTOR OF HEALTH 4: WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER WD&4 11-69 WELL DRILLING PERMIT 8 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 i LOCATION OF WELL (Town (street) (Lot Number) DATE OWNER OF WELL ❑ INDIVIDUAL ❑ BUILDER OTHER(Specify) ��'�(�/ti J� 4/ tjeA-,f C �Uo OWNER'S ADD616 RESS f�/e f�/ l• 0 7 �`/l N f�IJ J {j/? I- f1 PROPOSED �•❑ DOMESTIC ❑ TEST Est.No.of ESTABL BUSINESS ❑ FAQ ❑ WELL People being USE OF OTHER served. WELL SUPPLY*OSLIC ❑ INDUSTRIAL ❑ CONDAIR ITIONING ❑ (Specify) f V SKETCH OF WELL LOCATION III 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) Indicate North �5 .Approximate number of feet from well to h nearest source of possible contamination: v 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. APPLI (Signature APPLICAN ' DDREM �^ ��/I/ � REG RATLON,NO.7 / 67 BY own Health Officer or Agent) I DATE APPROVED ❑ REJECTED REMARKS DIRECTOR OF HEALTH