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HomeMy WebLinkAboutWell New 320 Long Hill Road WELL COMPLETION REPORT STATE OF CONNECTICUT , WDB-5 72-69 REV.9-71 WELL DRILLING BOARD Do NOT fill in-_*,' . State Office Building STATE WELL NO. HARTFORD,CONNECTICUT 06115 OTHER NO. OWNER NAME ADDRESS .Tm I I LA" IST. , VMON9 COM. LOCATION (No.�&Street) (To ) c (Lot Number) OF WELL 320 LONGs ROAD SO H WIt*�! OR BUSINESS ❑ ESTABLISHMENT ❑ FARM ' PROPOSED DOMESTIC ❑ TEST WELL USE OF WELL PUBLIC AIR❑-SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ ((SSpeEfy) DRILLING COMPRESSED ERCUSSION El PERCUSSION ❑ OTHER EQUIPMENT ® ❑ AR ROTARY PERCUSSION CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS 4: 6 I 19.45 I © THREADED ❑ WELDEDI YES []NO ❑YES ENO YIELD I HOURS YIELD(G.P.M.) TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) _ Depth.of Completed Well LEVEL 20 I 175 I in feet below Land surface: 2W MAKE I LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE I DIAMETER(inches) ( IF GRAVEL Diameter of well including ( GRAVEL SIZE(inches)FROM(feet) TO(feet) PACKED: gravel pack(inches): DEPTH FROM LAND SURFACE Sketch exact location of well with distances,to at least FEET to FEET FORMATION DESCRIPTION two permanent landmarks. O 200 Red Beck t If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTEjj to DATE WELL COMPLETED II PERMIT NO. REGISTRATION NO. DATE OF REPORT LL '(Signa re 1 O 4 1 271.�0 1.0� � 12/27/74 t'. '',,.,, LOCAL DIRECTOR OF HEALTH : WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBEt1;_ . WDB-a 11-69 WELL DRILLING PERMIT 26140 A y� STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 LOCATION OF WELL (Town) (Street) (Lot Number) DATE SOUTH WINDSOR 320 LONG HILL, ROAD I 11/4174 OWNER OF WELL a INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) JOHN MYEgS OWNER'S ADDRESS LAID ST. , VERNON t CONN. PROPGSRI ❑ BUSINESS ❑ ❑ TEST Est.No.of DOMESTIC ESTABLISHMENT FARM WELL People being USE OF served. WELL PUBLIC AIR OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) 5 g 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 .. UAD �j t =te4 i 30 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 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. A (Sign tore) APPLICANT'S ADDRESS REGISTRATION NO. L ST. , "RION COS!'. I 100 BY own Heal, Officer or Age ) DATE, ❑ APPROVED REJECTED REMARKS 144, E AeAlw ire- o-4waaw7 r-/ECD I ts�+AT/o.J wlt'�D�a �NEciC Flo. l,F.g4�, DIRECTOR Of HEALTH