HomeMy WebLinkAboutWell New 1344 Main Street W ELL-DRILLING BOARD STATE of coNNEalcur PEST NUMBS
1ND" 11-69 WELL DRILLING PERMIT 5 7 0 2
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 /
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
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OWNER OF WELL
to INDWIDUAL ❑ BUILDER ❑ OTHER(Specify)
OWNBVS ADDRESS J/ /p
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PROPOSED BUSINESS TEST Est.No.of
USE OF
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
served.
WEII PUBLIC AIR❑ SUOTHER
PPLY ❑ INDUSTRIAL ❑ ONDI TIONING El (Specify)
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
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Approximate number of feet from well to
nearest source of possible contamination: (0
The undersigned is aware that upon completion of the well,a"Well Completion Report'containing construction details and-information required under Section 6 of.
Public Act 659 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 informa-
tion is filled in and it has been counter-signed by the Director of Health or his agent.
CANE(Signofurej APPLICANT'S RESS REGISTRATION NO.
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OF ir DATE
�--� BY(TownV7g
ent)
L✓J APPROVt� El r
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
WDB-S 1249 WELL DRILLING BOARD
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER MARTIN G. PANDUCCI. SOUTH WINDSOR '
LOCATION (No.d Street) (Town) (Lot Number)
OF WELL 798 MAIN STREET:
BUSINESS
PROPOSED I/sMOMESTiC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT ❑ ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) HAND DUG
CASING LENGTH(feet) DIAMETER(inches) IWEIGHT PER FOOT VE SHOE S CASING OUTED?
DETAILS 28' 34' 2OO ❑ THREADED ❑WELDED rYES ❑NO YES LiNO
YIELD HOURS G.P.M. YIELD(G.P.M.)
TEST ❑BAILED ® PUMPED ❑ COMPRESSED AIR 5 18 18
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATER Depth of Completed Well
LEVEL _ 21' 24' in feet below Land surface: 28'
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(Inches) IF GRAVEL I Diameter of well including GRAVEL SIZE(inches) FROM(test) TO(feet)
PACKED: gravel pack (Inches): 1/4' 18, 28'
DEPTH FROM LAND SURFACE Sketch exact location of well with distances,to at least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
0 16 Find Sand
16 28 Coarse sand and light gravel
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If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
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DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT DRILLER(Signature)
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BOARD