HomeMy WebLinkAboutWell New 1629 Main Street WRL DRIWNG BOARD STATE OF CONNECT16T - PERMIT NUMBER
UVDB4 1149 'r WELL DRILLING PERMIT 55807
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (Straey (Lot Number) DATE
SOUTH trIINDSOR 1629 MAID ST. 4 ( 8/7/79
OWNER OF WELL
❑ INOMDUAL ® BUILDER ❑ OTHER(specify) QUATTROPANI & COOLEY
OWNER'S ADDRESS
57 RIDGEWOOD ROAD, E. HARTFORD, CT.
PROPOSED ® DOMESTIC ❑ IrEft Est.No.of
ESTABLLISHMEM ❑ fARM ❑ WELL People being
USE OF PUBLserved.
WELL ❑ SUPPLIY ❑ INDUSTRIAL ❑ CIONDITIONING ❑ (S�)
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(f present)
Indicate North
I Qe
0-77
Approximate number of feet from well to
nearest source of possible contamination. Sanitary Sewers
The undersigned is aware that upon completion of the well,a'_'Well Completion Report" containing construction details and information required under Sec ion
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 countersigned by the Director of Health or his agent.
ICAN ( tynatu ) APPLICANT'S ADDRESS REGISTRATION NO.
LAKE ST. VERNON, CT. ' . 100
BY(Tome K."Officer or ent DATE
APPROVED ❑ REJECTED
REMARKS
CAI . 27 O S'V
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
ELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV.9-71 WELL DRILLING BOARD aO NOT fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME
OWNER t fif i A. ADDRESS _
57
LOCATION _ r St(No. &Street) Crown) �y (Lot Numher)
d`1�s
OF WELL IN T s a i�rINID O 4
BUSINESS
❑ ESTABLISHMENT ❑ FARM
PROPOSED DOMESTIC ❑ TEST WELL
USE OF
WELL PUBLIC AIR❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ O(Specify)
DRILLING ❑ COMPRESSED CABLE ❑ OTHER
ROTARY
EQUIPMENT AIR PERCUSSION ❑ PERCUSSION (Specify)
LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT
CASING ; DRIVE SHOE WAS CASING GROUTED?
DETAILS I _ If`t THREADED ❑ WELDED I YES ❑NO ❑YES NO
YIELD HOURS YIELD(G.P.M.)
- TEST ❑ BAILED ❑ PUMPED 1 COMPRESSED AIR 15
MEASURE FROM LAND SURFACE—STATIC (Specify feet)I DURING YIELD TEST(feet) ( Depth of Completed Well
WATER
LEVEL 7� t'7 in feet below Land surface: 5
� 5
MAKE (LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER (inches) I IF GRAVEL I Diameter of well including (GRAVEL SIZE (inches) FROM(feet) TO(feet)
gravel l pack (inches):
DEPTH FROM LAND SURFAC
FEET to FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
.
two permanent landmarks.
0 . Gravel
33 187 Clay
187 250Bed-rock
�..�' C
-76
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
---�e-- t
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT DRI ER Signature)
DEPT. OF ENVIRONMENTAL PROTECTION-WATER RESOURCES