HomeMy WebLinkAboutWell New 235 Pierce Road s•VELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
WD" 11-69 WELL DRILLING PERMIT 1583 !'
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 +
LOCATION OF WELL,e�wn) reef) (Lot Number) DATE
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OWNER OF WELL
(001 K�INDIVIDUAL ❑BUILDER ❑ OTHER(Specify) Q �. ,p-0 PL y.
OWNERS ADDRESS J
PROPOSED DOMESTIC BUSINESS TEST Est.No.of
USE OF ❑ ESTABUSHMENT ❑ FARM. ❑ WELL People being
WELL PUBLIC ❑ AIR ❑ OTHER served.
❑ 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 1'J }�_/` C
ArFr
l/10 ti1 f-e—
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 6 of
Public Act 659 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 informa-
tion is filled in and it has been counter-signed by the Director of Health or his agent.
APPU (Si olu 5 ADDRESS REGISTRATION NO.
\.
6 S ..Ue&-h eti o Cj
BY(To, Health Officer orAgent) DATE
❑APPROVED ❑ REJECTED t
REMARKS a
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
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DELL COMPLETION REPORT STATE OF CONNECTICUT WDII-s 12-69 WELL DRILLING BOARD Do NOT All in
STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER Charles Green 1?57 Ellington Rd. , S. Windsor, Conn.
LOCATION (No.6 Sheet) (Town) (Lot Number)
OF WELL Pierce Road S. Windsor
BUSINESS
PROPOSED
®DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC❑ SUPPLY ❑ INDUSTRIAL ❑ AIR ❑ OTHER
CONDITIONING (Specify)
DRILLING COMPRESSED CABLE R
EQUIPMENT ElROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ OTpHE y)
CASING LENGTH(feet) DIAMETER(Inches) WEIGHT PER FOOT R VE SHOE WAS CASING GROUTED?
DETAILS 2 ® THREADED ❑WELDED E]YES �NO ❑YES OfJ NO
YIELD • HOURS G.P.M. YIELD(G.F.M.)
TEST ❑BAILED ❑ PUMPED COMPRESSED AIR 1 30 30
WATER MEASURE FROM LAND SURFACE—STATIC(SpecllyURING YIELD TEST(feet) Depth of Completed Well
LEVEL Overflowing feet) D 50 in feet below land surface: 150
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE _ DIAMETER(Inches) IF GRAVEL Diameter of well including LGRAVELFROM(let) TO(lest)
PACKED: gravel pack (Inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances,to of least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
0 50 Clay
50 110 Sandstone . h c o a
ilo 150 Redrock
�Wel/
I
/fovLS�
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WEL t (SI reJ
70
BOARD
4 p
WELL COMPLETION REPORT STATE OF CONNECTICUT
WAB-5 12-69 WELL DRILLING BOARD Do NOT fill in
State Office:Building STATE WELL NO.
HARTFORD, CONNECTICUT 06115 Sw '/'_0?
OTHER NO.
NAME ADDRESS
OWNER Charles Green 1757 ..�:a�,lingluo-n -Rd. , S. Windsor,r, vor'.Ln.
LOCATION (No. &Street) (Town) (Lot Number)
OF WELL eree Road S. WindsorBUSINESS
PROPOSED ' DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR❑ ER
SUPP Y ❑ INDUSTRIAL El CONDITIONING ❑ Opeif I
DRILLING EQUIPMENT ® ROTARY ❑ A COMPRESSED R PERCUSSION ❑ PERCUSSION ❑CABLE OTHER
I
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 1 THREADED ❑WELDED CAI YES NO ❑YES 6j NO
YIELD HOURS G.P.M. YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR ;toca
MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet)
WATER � Depth of Completed Well
LEVEL Ll�i1<h'�ng � in
Over feet below Land surface: -150
-6
MAKE 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: gravel pack (inches):
DEPTH.FROM LAND SURFACE - - Sketch exact location of weft with distances, to at least
FORMATION DESCRIPTION two ermanent landmarks.
FEET to FEET P -
0 5
5
110 Sandstone `
130 h
t
4 i
N,�
fir €,} us
vn
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
t
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT r W L 1L (SCe)
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