HomeMy WebLinkAboutWell New 733 Nevers Road -7�u Nees Rd
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
11-6' WELL DRILLING PERMIT 33068
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OP WELL (Tow») (Btnet) (Lat Xumber) f DATE
SOUTH WINDSOR NEVERS ROAD, B +I 2/27/76
OWNER OF WELL -
Q INDIVIDUAL ® BUILDER Q OTHER(Specify) CALVIN BANCROFT
OWNER'S ADDRESS
41 MILLER' ROAD, E. WINDSOR, CONN. 06016
M114ESS TEST Est.No.of
PROPOSED' ® DOMESTIC Q ESTABLISHMENT Q FARM Q WELL People being
USE OF
.served.
WELL PUBLIC AIR OTHER
Q SUPPLY Q INDUSTRIAL Q CONDITIONING Q:(Specify) 5
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)
. (D
Indicate North [- R0r4�
ke V�F
G&4.H,w l 7 u Cy(1'C--2S
;3S405
4
X 'R0/)D
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
Qoard. 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,
T(Si nature) ADDRESS I REGISTRATION NO.
JWPLICANT'S S C a.00
BY ffiaer r _ I DATE
APPROVED Q REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT DO NOT ft�� in
12-69 REV.9-71 WELL DRILLING BOARD
State Office Building . STA TE WELL NO.
5W
HARTFORD,CONNECTICUT 06115
OTHER NO.,
NAME ADDRESS
OWNER IN BAINC-110PT I 41 NIL Z. IJINDSORi 0 1\711 e
LOCATION (No. &Street) (Town) (Lot Number)_
OF WELL N71K; I�r' 3 ROAD 80UTH W rOMa
BUSINESS
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL ❑ OTHERPUBLIC AIR
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING (Specify)
DRILLING DRILLING COMPRESSED CABLE ❑ OTHER
EQUIPMENT ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION (Specify)
CASING I TH (feet) DIAA!TER (inches) V!EI� HOE HT FOOT DRIVE S WAS CASING GROUTED?
DETAILS 21 ( 6 1904 I � THREADED ❑ WELDED YES ❑NO ❑YES KNO
HOURS YIELD(G.P.M.)
TESTT YIELD ❑ BAILED ❑ PUMPED ® COMPRESSED AIR 6
WATER MEASURE FROM LAND SURFACE—STATIC (Specify feet)I DURING YIELD TEST(feet) I Depth of Completed Well
LEVEL 0 in feet below Land surface: 225
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well incl uding
(GRAVEL SIZE(inches)FROM(feet) �TO(feet)
-PACKED: I gravel pack(inches):
DEPTH FROM LAND.SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET �n two permanent la�nd(marks.
V 15 Sand & Gravel �'�8I 1�gl i s'!�y' )�J
58 225 Bedrock
If yield was tested at different depths during drilling, list below .i
FEET GALLONS PER MINUTE
J0
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT LD LLE (Signatu 8/76
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