HomeMy WebLinkAboutWell New 2022 John Fitch Boulevard WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
11-69 WELL DRILUNG PERMIT 55313
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 i
LOCATION OF WELL (Town) Mreet) (Lot Number) DATE
SOUTH WINDSOR 2022 JOHN PITCH BIND. 7 I 10/16/79
OWNER OF WELL
® INDIVIDUAL ❑ BUILDMt ❑ Onm{Specify) JOHN ROMAN
OWNER'S ADDRESS
114 G NEW STATE RD. , MANCHESTER, CT.
PROPO Q DOMEmq El EST
USE OFF ESTABLISHMENTS
ElRM FA ❑ vau People being
PUBLIC AUt OTHER served.
0 ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITLONING ❑ (Specify) 4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distanoe from intersection and front of lot
Location of lot to at least two roads Well location on lot and to house(if present),, I, tr
/ e A
Indicate North
Lir7tj
7 I
i
Approximate number of feet from well to S
nearest source of possible contamination: 1501
The undersigned is aware that upon completion of the well,a'Will 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 1s not valid until all information is filled in and it has been countersigned by the Director of Health or his agent.
AP +e) (APPLICANT'S ADDRESS REGISTRATION NO.
T,A10 ST., VERNON, O.T. 100
By(Town aaatth Offlaer or Agent) DATE
APPROVED ❑ REJECTED
REMARKS
r
z06 SS
RETURN THIS COPY TO .CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
WDB-S 12-69 REV. 4-71 WELL DRILLING BOARD
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME {� �� ADDRESS
OWNER esi+ _01 t��di`.ti.3'i 114 CT n INMW STATE RD.
) iGIMS EEIRI CT.
LOCATION (No.&Street) _ !� t� Crown) T� 7 q (Lot Number)
OF WELL 20222 e1 i 1 ITCH BRs�.l t€ . S. I d1.a�'.isrc..�0.15;. �-
❑ ESTABLISHMENT ❑ FARM
BUSINESS
PROPOSED DOMESTIC ❑ TEST WELL
USE OF
WELL ❑ PUBLIC AIR OTHER
SUPPLY ❑ INDUSTRIAL
❑ CONDITIONING ❑ (Specify)
DRILLING ROTARY COMPRESSED CABLE
❑ AIR PERCUSSION ❑ PERCUSSION ❑ OTHER
EQUIPMENT (Specify)
CASLENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS ��. ( , 1p - I THREADED ❑ WELDED I YES ❑NO ❑YES �NO
YIELD
HOURS YIELD(G.P.M.)
I TEST El ❑ PUMPED � COMPRESSED AIR 20
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATER I I Depth of Completed Well
0
LEVEL 150 in feet below Land surface:
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) I IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: I gravel pack(inches):
DEPTH FROM LAND SURFACEFORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET to FEET - - two permanent landmarks.
0 2 S=d 834 f -�",-el
6 156 CiaY
156 2-
>0 Bedrock
(L)
If yield was tested at different depths during drillinq, list below S
FEET GALLONS PER MINUTE `�-
Q c_/y .
DATE WELL COMPLE�T�7ED PERMIT NO. REGISTRATION NO'. DATE OF REPORT W-Ej1�2(S
,pin ature)
55�
DEEP T. 0: "9J;_,ii(.?tJil;r_;t!._,c. P;:,JcE Cii0IN, V-tt-::t.{i fir._J0 si;..(�"v