HomeMy WebLinkAboutWell New 278 Lawrence Road WELL COMPLETION REPORT STATE OF CONNECTICUT - Do NOT fill in
WOB-S I2.69 'REV.9.71 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
ADDRESS
Ovem N BERNA RD KA.RLIN l 278 LAWRENCE RD. , S., WINDSOR, CONN.
OF WELELL 278 LAWRENCTION (No.E tree ROAD -S. WINDSOR (Lot Number)
PROPOSED ® DOMESTIC ❑ ESTABLISHMENTBUSINESS ❑ FARM ❑ TEST WELL
USE OF PUBLIC AIR
WELL ❑ OTHER
SUPPLY ❑ INDUSTRIAL ❑— CONDITIONING ❑ (Specify)
DRILLINEQUIPMENT
® ROTARY AIR ER USSIPRESSED ON IJ PERCUSSION ❑ (Specify)
CABLE OTHER
EQUIPMENT
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS ( I f ❑ THREADED ❑ WELDED ❑YES [:]NO [:]YES ❑NO
HOURS YIELD(G.P.M.) .
YIELD ❑TEST BAILED ❑ PUMPED ® COMPRESSED AIR u
MEASURE FROM LAND SURFACE--STATIC(Specify feet) DURING YIELD TEST(feet)
WATER - Depth of Completed Well
LEVEL 20 150 in feet below Land surface: 190
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) J IF GRAVEL 1 Diameter of well including GRAVEL SIZE(Inches)FROM(feet) ITO(feet)
11'PACKED: I gravel pack(inches):
DEPTH FROM LAND SURFACI FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
We did not do any drill'
on .this well. We just
cleaned it and blew it.
.ale .
If yield was tested at different depths during drilling,list below '1}
FEET GALLONS PER MINUTE E`er
DATE WELL COMPLETED I PERMIT NO.
52O I REGISTRAtTIONNO. �DATE OF REPORT LL DR LLER(S gn e)
9/13/76 1 99
BOARD
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
WDB4 11•b9
WELL DRILLING PERMIT 3 6 5 ZO
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (60669) (Lot Nurxbsr) DATE
SOUTH WINDSOR 278 IAWRENCE ROAD i 9/9/76
OWNER OF WELL
a INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) BERNARD KARUN
OWNER'S ADDRESS
278 1AMENCE ROAD, 8. WINDSOR, CONIC.
PROPOSED x BUSINESS TEST Est.No.of
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF
served.
WELL ❑ SUPPLY AIR OTHER
❑ INDUSTRIAL ❑ CONDITIONINO ❑ (Specify)
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of tot
Location of lot to at least two roads Well location on lot and to house(if present)
Auk r <S t
Indicate North //
LU
>IQT #b'3
Approximate number of feet from well to
nearest source of possible contamination: 75
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 Resouices 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.
CA (S ndurch APPLICANT'S ADDRESS REGISTRATION NO.
IA KE ST., VERNON, CONN. i 100
• ( BY( n s h offlosr or I DATE
+APPROVED ❑ REJECTED
REMARKS
Deepening E34sting Well*
y
RETURN THIS COPY TO 'CONNECTICUT WELL DRILLING BOARD