HomeMy WebLinkAboutWell New 880 Foster Street Extension WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
WDBS 12-W REV.9.71 WELL DRILLING J1QARD STATE WELL NO.
State Office Build.ing
HARTFORD,CONNECTICUT 06115
OTHER.NO.
OWNER NAME I ADDRESS
Bruce Wi11an3
LOCATION (No.&Street) Crown) (Lot Number)
OF WELL Foster St., Ext. South WindsorBUSINESS i
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM
❑ TEST WELL
USE OF
WELL PUBLICAIR OTHER
ElSUPPLY 1-1INDUSTRIAL
❑ CONDITIONING. ❑ (Specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT ❑ ROTARY ❑ A R PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT ! DRIVE SHOE I WAS CASING GROUTED?
DETAILS — 20 6 I ® THREADED ❑ WELDED I ❑YES [:]NO IX]YES ❑NO
HOURS YIELD(G.P.M.)
YIELD TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR I 4 15
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATER I Depth of Completed Well 05
LEVEL 20 i4q I in feet below land surface: 1
MAKE t LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) I IF GRAVEL Diameter of well including I GRAVEL SIZE(inches)FROM(feet) TO(feet)
'PACKED: gravel pack(inches): i
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET - two permanent landmarks.
O7 Sand
7 i5e Granite
O�
z� S`' s
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. `REGISTRATION NO. DATE OF RL•PORT WE L DRILLER(Signatvre)E&E) rnMQv0a
Alpany
ii I. 60 4 I I 16 I
BOARD
WELL DIUWNG BOARD STATE OF CONNECTICUT PERMIT NUMBER
wise.~ 1149 WELL DR1LUNGa`-�PI0 MIT 60824
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (Street) (Lot DATE
E
�'o v7Zf h/lNnU'd JCafii �s'r" r," / 17�`S�7�
OWNER OF WELL
INOMDUAL ❑ BUILDER ❑ OTHER(Specify) /
OWNER'S ADDRESS
PROPO$ED DOMESTIC ❑ 6U ABILI S ❑ FARM ❑ WELL Pe pbeing
EsrABusHItIENT
USE OF AIR OTHER served.
WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Spedfy) '
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 Cif present)
Indicate North
0 1 S Jaw �s
Approximate number of 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 1%9 Supplement to the General Statutes must be sent to the owner,the Board and the Water Resources Commission on the form provided by the
Goan .This a �_.yyJJC. not vai /until/all information is filled in and it has been countersigned by the Director of Health or his.agent.
./V!` �_/_ESL f�i.. C-0, - -
APPLICANT(Sionatxre) APPLICANT'S ADDRESS II REGISTRATION NO.
aG 41o6 i 3
By(Town Health Of&er or dpont) DATE
APPROVED WECIED
REMARKS
76Ft
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD