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HomeMy WebLinkAboutWell Repair 220 Niederwerfer Road WELL DRIWNG BOARD STATE OF CONNECTICUT PERMIT NUMBER wDB.a I>I s9 WELL DRILU(4 PERMIT 56727 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 LOCATION OF WELL (Town) J /� �(Ftrcet) (Lot Number) DATE (I�/ AJ JQ dl`/t,p OWN OF WELL INDIVIDUAL ❑ BUILDER OTHER N.Ify) OWNER'S ADDRESS •�i�`it� (4 /!!/���✓����� Z'6o f. l+ e3�'D�O d; &1,*4VSdK PROPOSED DOMESTIC C� EST BUSINESS TEST ❑ FARM VA �p ng USE OF OTHER served. - WELL ElUPp Y ❑ INDUSTRIAL CONDITIONING ❑ (Specify) SKETCH OF WELL LOCATION Locate well with res 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 esent) indicate North Approximate number of feet from well to / nearest source of possible contamination: / 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 Bo rd. This pe ' if vgjid until all information is filled in and'it has been counter-signed by the Director of Health or his agent. �jv � Go� " APPLI ) �APPLICANT'S ������ � �� • rr� )REGISTRATION NO. ��]/ BY(TQown Health O dyn/i�t) DATE L J APPROVED El i EJECTED .2'¢ s"ta�es'i/"drr+ot* oi� 'yt'1Tacs'7C' ji cia•'t,( e-Mart- '7Ynn.7" ��j'�mrt:ct! /J 7SY flnbit,e/`f RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT DO NOT fill in WDB-5 1249 REV.9-71 WELL DRILLING BOARD STATE WELL NO. State Office Building HARTFORD,CONNECTICUT 06115 OTHER.NO. NAME ADDRESS O1Nr'� Frank H. Niederwerfer l 260 Niederwerfer Rd. South.Windsor, Ct. LOCATION _ (No.6 Street) (Town) (Lot Number) °FwHL 220 Niederwerfer Road. South Windsor, Ct. BUSINESS X DOMESTIC ❑ ESTABLISHMENT ❑ ❑ PROPOSE ❑ FARM TEST WELL USE OF WELL ❑ PUBLIC AIR OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) COMPRESSEDDRILLING EQUIPMENT ❑ ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING LENGTH(feet) (DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS ]],5 6 �9*45 I © THREADED ❑ WELDED I YES .❑NO ®YES ❑NO HOURS YIELD(G.P.M.) YIELD ❑TEST BAILED ❑ PUMPED ❑ COMPRESSED AIR 4 8 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL 40 1 99 � in feet below Land surface: zoo MAKE I LENGTH OPEN TO AQUIFER(feet) - SCREEN DETAILS SLOT SIZE, DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches)FROM(feet) TO(feet) -PACKED: I gravel pack(inches): DEPTH FROM LAND SURFAC( FORMATION DESCRIPTION Sketch exact location of well with distances,to at least •FEET to FEET two permanent landmarks. ' 0 98 Hardpan 98 200 Red rock • L4 S'S' ✓ If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE Eastern Drill Co. DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF RLPORT WELL DRILLER(Signature) 10/25/79 -%727 _.3 110/31/79. (� fj � SAC get_LA BOARD