HomeMy WebLinkAboutWell New 1445 Main Street WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
1aDB-4 a 69 WELL DRILLING PERMIT 57051
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) - (Street) (Lot Number) DATE
South Windsor 1445 Main St. I 12/1.9/78
OWNER OF WELL
a INDIVIDUAL ❑ BUILDER ❑ OTHER apacify)
OWNER'S ADDRESS
Lee & Paula Harrington 1445 Main St. South Windsor
TEST PROPOSED X❑ DOMESflC ❑ ESTABLISHMENTS'NUS ❑ FARM El y PescP
USE OF served.
WELL PUBLIC INDUSTRIAL AIR OTHER
❑_ SUPPLY ❑ — ❑ CONDITIONING ❑ (Specify) 1 family
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: 75 t +
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.
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JAPW"Y
NT fgnature) APPLICANT'S ADDRESS REGISTRATION NO.
Dufford Drilling Co.
0111
4peAp , 4f BY( own Health Officer or Agent) DATE
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RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
Do NOT fill in
WDB-5 12-69 REV. 9-71 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER
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LOCATION (No.&Street) Y(Town) (Lot Number)
OF WELL
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X�;--j BUSINESS
PROPOSED EXJ DOMESTIC ~ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE WELLL PUBLIC AIR OTHER
W ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING ❑ COMPRESSED CABLE OTHER
ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
LENGTH LENGTH (feet) I DIAMETER (inches)I WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
CASING I ❑ ® WELDED I ❑YES ❑NO ❑YES R NO
DETAILS THREADEDC
HOURS YIELD(G.P.M.)
YIELD ❑ BAILED ❑ PUMPED 50 COMPRESSED AIR }
TEST I ` c)
WATER
MEASURE FROM LAND SURFACE—STATIC (Specify feet)I DURING YIELD TEST(feet) Depth of Completed Well LEVEL in feet below Land surface:
� L
MAKE I
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE ( DIAMETER(inches) IF GRAVEL Diameter of well including
I I GRAVEL SIZE(inches)(FROM(feet) ITO(feet)
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
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61
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT ff MLL DRILLER(Signature)
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