HomeMy WebLinkAboutWell New 36 Ridge Road WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
1tI1DB.1 11•69 WELL DRILUND PERMIT- 56529
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Toms) (Street) (Lot Number) DATE
So. Windsor 36 i Ridge Rd. I 8/21/'?9
OWNER OF WELL
f] INDIVIDUAL ❑ BUILDER . ❑ oTHER ft-ify) Thomas Burgess
OWNER'S ADDRESS
36 Ridge Road, So. Windsor, Ct.
PROPOSED DOMESTIC BUSINESS❑ ESTABLISHMENT ❑ FARM ElWELL People being
TEST Est.No.oF
USE OF served.
WELL ❑ SUPPLY I 4
❑ 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 Of present)
indicate North
�3r k� o IPD S&PrX 7V
Approximate number of feet from well to ?5 f
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
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.
APPUCA�ipWsrf APPLICANT'S DRESS REGISTRATI NO.
(. Lake Street, Vernon, Ct. ! 1�0
BY
I TmJA�OJe�dyent) j� DATE
APPROVED ❑ REJECTED
REMARKS
RETURN THIS COPY-TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV.9-71 WELL DRILLING BOARD} Do NOT fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER T'-IO S 36...R.-rLDGE RD e $ S. IJINDSO .v CT.
e
LOCATION (No.&Street) (Town}
� (Lot Number)
OF WELL 36 RID 3 PD. ��T �� aguesi t R
❑ ESTABLISHMENT ❑ FARM
BUSINESS
PROPOSED DOMESTIC El TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL
❑
❑ CONDITIONING (Specify)
DRILLING X1 ROTARY ❑ AIR MPERCUSSSION ❑ PERCUSSION ❑ ((Specif
PRESSED CABLE
EQEQUIPMENTy)
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETACASIILS I19.45 ❑ WELDED � YES
I THREADED I ❑ ❑NO ❑YES 0 NO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED Fal COMPRESSED AIR ` 4 r
WATER MEASURE FROM LAND SURFACE—STATIC (Specify feet)I DURING YIELD TEST(feet) I Depth of Completed Well
LEVEL 30 1 I in feet below Land surface:
MAKE 125
I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE ( DIAMETER(inches) IF GRAVEL Diameter of I well incl ding
I GRAVEL SIZE (inches) FROM(feet) ITo (feet)
u
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFAC
FORMATION DESCRIPTION Sketch exactlocation of well with distances,to at least
FEET to FEET
two permanent landmarks.
0 Sand & Gravel
83 31 Clay
! '°( l �
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
e
DATE WELL COMPLETED +PERMIT NO. I REGISTRATION NO. DATE OF REPORT f WEL R Oignature
DEPT. OF ENVIRONMENTAL PROTECTION -WATER RESOURCES