HomeMy WebLinkAboutWell New 120 Maskel Road WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
'"D�' "�' WELL DRILOG PERMIT 10963
STATE OFFICE BUILDING,HARTFORD,CONNECTIC IT 06115
LOCATION OF WELL(Towai) (Street) (lot Number) DATE
SOUTH WINDSOR MAMM ROAD 6 -7/6/72
OWNER OF WELL "
❑INDIVIDUAL F BUILDER ❑ OTHER(specify) V JAAN LAINE
OWNER'S ADDRESS
44. HENRY ST-. , MANCHESTER CONN..
PROPOSED TEST
Est.No.of
® DOMESTIC ❑ EST'ABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
WELL ❑ PUBLIC AIR OTHER
SUPPLY ❑ INDUSTRIAL ❑ CONIMONING ❑ (Specify) 6
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
C.A.RNE`T 1 ENE �
x A
,fifv (�l
61 Y
• 1
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.
APPU ignoture) 1 APPLICANT'S ADDRESS REGISTRATION NO.
T,I1KF S _• , VEFtN0 , C.ONN.- 1.00
-- BY(Town Health Officer t) DATE
ELAIWOVED M ❑ REJECTED `=
REMARKS
RETURN THIS COPY TO CONNECiICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 92-69 REV.9-71 WELL DRILLING BOAR®
Do NOT fill in
STATE WELL NO.
State Office.Building
HARTFORD,CONNECTICUT 06115 {�
OTHER NO.
NAME ADDRESS
OWNER JAA ""IN-1-3I 4 -MRY ST* j MANCHE M y Goble
LOCATION (No.& Street) (Town) (Lot Number)
OF WELL a; .L..s ,.n SCIUITfl .WT P.,.s`'-.. 01P. 6
BUSINESS
PROPOSED ®DOMESTIC ❑ ESTABLISHMENT ❑-FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑_:CONDITIONING ❑ (Specify)
DRILLING COMP RESIED CABLEEQUIPMENT � ROTARY ElA R PERCUSSION ❑ PERCUSSION ❑ ((Spec fy)
CASING LENGTH (feet) DIAMETER (inches)( WEIGHT PER FOOT I DRIVE SHOE WAS CASING GROUTED?
DETAILS 4 , 10.45 I 1-7 THREADED ❑ WELDED YES ❑NO ❑YES F4NO
YIELD HOURS YIELD (G.P.M.)
TEST ❑ BAILED El PUMPED � COMPRESSED AIR
° C
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATER I I Depth of Completed Well
LEVEL 2 100 in feet below land surface: 150
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER (inches) IF GRAVEL Diameter of well including
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.
OPS0 i
Sand. Gravel
20 6 HarkpI .
2 5 € °
t
t
F-T
If yield was tested at different depths during drilling, list below glp
FEET GALLONS PER MINUTE
x
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT _ WE D tL (Sig )
DEPT. OF ENVIRONMENTAL PROTECTION
WELL COMPLETION REPORT STATE OF CONNECTICUr Do NOT fill in
WDB-5 12-69 REV.9a1 WELL DRILLING BOARD
. . State Office Building
STATE WELL NO.
HARTFORD, CONNECTICUT 061.15
OTHER NO.
NAME ADDRESS
OWNER aAAX LAM I 4 .HMY SST.# MA 1&3 .aR I, con.
LOCATION (No,.t&Street) (Town) �I�p (Lot Number)
M lt[�J:e
OF WELL M D S M WINDSORBUSINESS
S
PROPOSED lid DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
PUBLIC AIR
WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ ((Spec fy)
DRILLING ® OTHERCOMPRESSED CABLE
EQUIPMENT ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING
LENGTH (feet) DIAMETER(inches)I WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
. I THREADED ❑ WELDED I [AYES ❑NO
DETAILSJW ❑YES �NO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED F* COMPRESSED AIR 4 p
WATER MEASURE FROM LAND SURFACE—STATIC (Specify feet) DURING YIELD TEST(feet) I Depth of Completed Well �7
LEVEL 25
in feet below Land surface: 1
50
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) IF GRAVEL Diameter of well including 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.
Q 2 #! .
2 20 Sand & Grav*l
20 26 Hardpan
26 150 Reddish lAock
1
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTEjCt L
-- _ (A
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WEL RI IE (Signs e)
DIRECTOR OF HEALTH
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
w°e-a 11-69 WELL DRILLING PERMIT 10963
` STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
OWNER OF WELL
❑ INDIVIDUAL BUILDER ❑ OTHER(Specify) JUN LAM
OWNER'S ADDRESS
44 EMY ST. 9 MOOMBRI aft.
PROPOSED BUSINESS TEST Est.No.of
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
WELL PUBLIC AIR❑ SUR 6
PPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (SpeOTHcify)
SKETCH OF WELL LOCATION
Locate well wil respect to at least two roads,showing distance from intersection and front of lot
Location of lot to at least twig roads ) ) W&location on lot and to house if present)
/ E �dAj�
Indicate North
X �
wAr , 4
� E
Approximate number of feet from well to
nearest source of possible contamination: 25
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.
APPLI ( 'gnature) APPLICANT'S ADDRESS REGISTRATION NO.
ym
' BY(sown H alth Officer or gent) DATE
0;4PPROVED ❑ REJECTED
REMARKS
ciNec11c 9164Fi
DIRECTOR OF HEALTH