HomeMy WebLinkAboutWell New 723 Nevers Road WELL DRILLING BOARD STA71.OF CONNECTICUT PERMIT NUMBER
1ND84 11-6'' •WELL DRILLNG PERMIT .
�. � 22351
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION'OF WELL (Town) (Strait) (Lot Number) RATE
SOUTH WINDSOR 723 NEVFM ROAD 4/16/74
OWNER OF WELL
® INDIVIDUAL' ' .❑ BUILDER ❑ OTHER(Specify) - VFJM HILL
OWNER'S ADDRESS
4URTISIDE 36 MOUNTAIN VIEW RD. , S. WINDSOR, CONN.
PROPOSED ® DOMESTIC ❑ BUSINESHMENT ❑' FARM ❑ TEff Peoplebeing
No.of
USE OF - served.
WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (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 75
nearest source of possible contamination:
"The undersigned is aware that upon completion of the well,a'Well Completion Report"confatning 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 filleii in and it has been countersigned by the Director of Health or his agent
AP (Signatxre)t APPLICANT'S ADDRESS REGISTRATION NO.
-t LAKE ST. I VERNO CONK. 100 .
`•- �i `_i =-" ! or fs4WQffkerorAv@M) DATE
APPROVED ;REJECTED b 4 /
REMARKS z.1 v si`'f.
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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 Office Building
STATE WELL NO.
HARTFORD, CONNECTICUT 06115
OTHER NO.
OWNER
NAME _ I ADDRESS
V21M HILL 36 Y10UN AIN VIEW RD. S. WINDS OROff'.
LOCATION (No. &Street) Crown) (Lot Number)
OF WELL 723 �� 0A A�CL3 q 9'e�IDS
BUSINESS
PROPOSED
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPP Y ❑ INDUSTRIAL
❑
❑ CONDITIONING (Specify)
DRILLINGEQUIPMENT FillROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑COMPRESSED CABLE
OTHER
(Specify)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT I DRIVE SHOE WAS CASING GROUTED?
DETAILS ` . I 19 I THREADED � WELDED �YES ❑NO ❑YES NO
YIELD I HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED � COMPRESSED AIR 35
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) I Depth of Completed Well
LEVEL 2 I 50 in feet below Land surface: 75
MAKE I
LENGTH OPEN TO AQUIFER(feet)
SCREEN Diameter of well including
DETAILS SLOT SIZE I DIAMETER(inches) I
IF GRAVEL I I
GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: gravel.pack(inches):
DEPTH FROM LAND SURFACE I Sketch exact location of well with distances,to at least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
3 Topsoil
3 12 seal rave
12 75 Red Rock
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If yield was tested at different depths during drilling, list belowLt!°
L
FEET- GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO.. DATE OF REPORT DRI ER ignatur
DEPT. OF ENVERONIMENTAL PROTECTION ® WATER RESOURCES