HomeMy WebLinkAboutWell New 25 Rosemary Lane VIELL DRILUNG BOARD STATE OFtCONNECTICUT PERMIT NUMBER
wDe a 11.69 WELL DRILLING PERMIT 5 0 0 41-
t, STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Tow») (Street) (Lot Number) I DATE
SOUTH tIINDSOR ROSEHARY LANE 13 I+ 7/11/78
OWNER OF WELL
❑ INDIVIDUAL ® BUILDER ❑ OTHER(Specify) RICHARD S. KELLEY
OWNERS ADDRESS
49 ROSRIARY LANE, S. WINDSOR; COIIMT.
PROPOSED DOMESTIC ❑ BUSSS INN SNMENi- '� El ' ❑ TEST Est.No.of
USE OF
WRL People being
WELL ❑ PUBLIC
El INDUSTRIAL a� OTHO served.
SU
❑ CONDITIONING ❑ (Specify) 4
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 1 tion on lot and to house Of present)
• Uu'vC !4 r vto1J'
t
Indicate North
Husc 2 41c
R
r
Approximate number of Beet from well to 8E 7
nearest source of possible contamination:
The undersigned is aware+0 upon completion of the well,a'Well Completion Report'containing construction details and Information required-under Section
25131 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 'n ion is filled in and it has been countersigned by the Director of Health or his agent.
I
C rs APPLICANT'S ADDRESS f REGISTRATION NO.
LAKE ST. , VERNON, CONN. +I 100
BY Town SeaRA Otl+eer or dperrt) f DATE
❑ RRJECiED 6 �'' -�/i -1'F
REMARIM
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELE 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.
f
OWNERNAME ADDRESS
i RICHLR s s t s
t��. 'fir� IRO���3�'�ARY LA.
LOCATION (No.& Street) (Town)
-t�,r��r�z�. � T _y �cp� (Lot Number)
01-WELL -Ct'4rr.3.1:#`stipl ,fit � -0 6�-�-NDSOR 1
BUSINESS
DOMESTIC ❑ ESTABLISHMENT HMENT ❑ FARM PROPOSE® ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ElINDUSTRIAL Elj�
t--1 CONDITIONING (Specify)
DRILLING ❑ COMPRESSED CABLE ❑ OTHER
ROTARY
EQUIPMENT AIR PERCUSSION ❑ PERCUSSION (Specify)
LENGTH (feet) DIAMETER (inches)I WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
CASING
DETAILS I �L�y ,},r� I � THREADED ❑ WELDED I �YES ❑NO �YES ❑NO
YIELD HOURS YIELD (G.P.M.)
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR 3s
WATER
MEASURE FROM LAND SURFACE—STATIC (Specify feet) (feet)I DURING YIELD TEST(f I "!°
Depth of Completed Well 15
LEVEL 25 in feet below Land surface: ��
MAKE (LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER {inches) I IF GRAVEL 1 GRAVEL SIZE(inches)(FROM(feet) TO(feet)
Diameter of well including
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFAC
FEET to FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
two permanent landmarks.
6'LL
-1 . 150 Bedrock e `Iq
_R
J
G U� �
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO, DATE OF RLPORT W RIL R Signat re)
10(
m ` ►>1,
v