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Home My WebLink AboutWell New 658 Foster Street WELL DRILLING BOARD 'STATE O�NNECTICUT PST NUMBER wosa 11 9 WELL DRILLING PERMIT 26135 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 t - LOCATION OF WELL (Town) (Street) (Lot Number) I DATE SOUTH WINDSOR 658 FOSTER ST. 10j23/74 OWNER OF WELL ® INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) JOHN PO.TYRA OWNER'S ADDRESS 658 FOSTER ST. , S. WINDSOR PROPOSED Y❑ DOMESTIC ❑ ESTABBUSNMLISHMENT ❑ FARM ❑ WELL People Wing USE OF served. WELL ❑ OTHER SPUBLIC AD Y ❑ INDUSTRIAL ❑ CIONDITIONING ❑ (Specify) 5 SKETCH OF WELL LOCATION ' Locate well with respect to at least two roads,showing distance from intersection and front of lot Location&F tot to at least two roads Well location on lot and to house Cd present) Indicate Norfh CAI 11� PST L) 7- Approximate,number of feet from well to nearest source of possible contamination: Sanitary 'Sewers • 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 AP r(S re) B� APPLICANT'S ADDRESS REGISTRATION N06 � LAKE ST. , VHRNON, CONN. 100 I BY(Tours Jf*aM Officer or Agent) DATE ---- Q`APPROVED CI REJECTED REMARKS . , I,a RETURN-THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETEON REPORT STATE OF CONNECTICUT DO NOT fill in WDB-5 12-69 .REV.9-71 WELL DRILLING BOARD STATE WELL NO. ps State Office Building HARTFORD, CONNECTICUT 06115 OTHER NO., OWNER NAME ADDRESS JOHN POTYRA 668 FOSTER ST. , ;3. W N SOR, CONK. LOCATION rr8- •(No.&Street) (Town) (Lot Number) U OF WELL FOSTER S'T• SOUTH WINO BUSINES PROPOSED ® DOMESTIC ❑ ESTABLS HMENT ❑ FARM ❑ TEST WELL USE OF { WELL PUBLIC AIR❑ OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DR:LL€€tips COMPRESSED CABLE OTHER Efz'EaILLINNT ® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? JCASING ( I 19.45 Z1 THREADED ❑ WELDED I ZI YES ❑NO ❑YES DETAILS 22 :EI NO HOURS YIELD(G.P.M.) TELD ❑ BAILED ❑ PUMPED FE] COMPRESSED AIR I 8 WATEMEASURE FROM LAND SURFACE-STATIC (Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL 20 ( 3r>0 I in feet below Land surface: 175 5 LEVEL MAKE (LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE I DIAMETER(inches) I IF GRAVEL I I GRAVEL SIZE(inches) FROM(feet) TO(feet) Diameter of well including 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 . 12 Bead & Gray`*". 175 Gray Bod ck oa If yield was tested at different depths during drilling;1€Mt.b&6w FEET GALLONS P_E-R 4iN6TE DATE WELL COMPLETED PERMIT NO. ; REGISTRATION NO. [DATE OF REPORT }, W! RILL gnature p DEPT. OF ENVIRONMENTAL PROTECTION WATER RESOURCES WELL COMPLETION REPORT ! _ STATE OF CONNECTICUr Do NOT fill in WDB_5 1?,69 REV. 9.71 WELL DRILLING BOARD- State Office Building STATE WELL NO. HARTFORD, CONNECTICUT 06115 OTHER NO. OWNER N�CM � I ADDRESS 003 ST• ! S. WnZ WOOS GQ&II• LOF WELL) 65 (N491street) SUII i�wir I DSt3R (Lot Number) BUSINESS PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF WELL ❑ OTHERPUBLIC AIR SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) COMPRESSEDDRILLING OTHER EQUIPMENT ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS 22 I 6 I �� I THREADED ❑ WELDED I]EYES [:]NO ❑YES C NO YIELDI.HOURS YIELD(G.P.M.) TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR �. MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) WATER 4 Depth of Completed Well LEVEL 20 l 154 ( in feet below Land surface: 175 MAKE I LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE ( DIAMETER(inches) I IF GRAVEL Diameter of I well including I GRAVEL SIZE(inches)_,FROM(feet) ITO(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. 0 12 Bond & Gmvol 12 175 Graq Bedrock If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE 40 DATE WELL COMPLETED I PERMIT NO. REGISTRATION NO. DATE OF REPORT Vy DRILL Rpignatur _-1012*Z7 26135 III '� "I` J LOCAL DIRECTOR OF HEALTH WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER WD" .11-69 WELL DRILLING PERMIT 26135 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 LOCATION OF WELL (Town) (Street) (Lot Number) I DATE SOUTH WINDSOR 658 FOSTER ST. 10/23/74 OWNER OF WELL E INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) JOHN oOWNER'S ADDRESS a 658 POSTER ST. , S. WINDSOR PROPOSED BUSINESS TEST Est.No.of DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being USE OF PUBLIC AIR OTHER served. WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) 5 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) Indicate North Et L PAS 710(jJ-C X roslcR Approximate number of feet from well to nearest source of possible contamination: Sanitary Swers The undersigned is aware that upon completion of the well,a'Well Completion Report" containing constriction 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. AP T(S ructuTo) APPLICANT'S ADDRESS I REGISTRATION NO. T-A ST. 9 VMN019 COM.- 100 BY Town Health Officer or Agent) I DATE APPROVED ❑ REJECTED !O REMARKS f- y✓.9//� �t/ NEC/( O{!O, 1+914 DIRECTOR Of HEALTH