HomeMy WebLinkAboutWell New 32 Rosemary Lane --a
-WELL DRILLING BOARD STATEOFtbNNECiIGtJT
PERMIT NUMBER
WO" 11.69 WELL DRILLING PERMIT 4 2 6 3'8-
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
SOUTH •WINDSOR ROSEMARY LANE 3 9/21/77
OWNER OF WELL
[] INDIVIDUAL 10 BURR ❑ OTHER M efy) U & R HOUSING CORP.
OWNER'S ADDRESS
99 E. CENTER ST. , MANGHESTER CONN.
BUSINESS TEST Est.No.of
PROPOSE ® DOMESTIC ❑. ESTABLISHMENT '� ❑ FARM ❑ WELL People being
USE OF served.
WELL ❑ PUBLIC
AIR OTHER
SUPPLY
❑ INDUSTRIAL - ❑ CONDITIONING ❑ lslecify)
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)
o ` pl K
Indicate North �� \
Ul)��
�.diA
I-a&A .
Approximate number of feet from well to nearest source of•possible contamination;- '751 (Sanitary Sewers)
The undersigned is aware that upon completion of the well,a"Well Completion Report"containing construction details and information required under Section
15.131 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
T iyr+atu ) APPLICANTS ADDRESS REGISTRATION NO.
LAKE ST. , VERNON CONN. I 100
Y(fowls Health O or ent) DATE
APPROVED ❑ REJECTED
REMARKS ,
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
r.
M A
WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
WDB-5 1269 REV.9.71 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD, CONNECTICUT 06115
OTHER NO.
NAME I ADDRESS
OWNER F' -*.,.r< , ? �t-1 ! Y t Y..,.,i..
s 3 CR, R !.a#.US -TG 4 r4 J ,. • .0 a ii a. sl r s_t-. g a a{3 a _i ra`r Cei � Gum,
LOCATION (No. & Street) Crown) t (Lot Number)
OF WELL �O �'ef'�..1=,RY Ll�Lh�a OTi r,i 70� 3
BUSINESS
PROPOSED
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF PUBLIC AIR OTHER
WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING COMPRESSED CABLE OTHER
ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
y)
LENGTH (feet) DIAMETER (inches)I WEIGHT PER FOOT I DRIVE SHOE WAS CASING GROUTED?
CASING ❑ ❑NO a]YES ❑NO
DETAILS !s 7 ( ( I ® THREADED WELDED YES
HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED Gd COMPRESSED AIR S
MEASURE FROM LAND SURFACE—STATICy )(Specify feet DURING YIELD TEST(feet) I Depth of Completed Well
iLEVTEfR I- I 1 in feet below Land surface: 125
MAKE I 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 FORMATION DESCRIPTION Sketch exact location of well with distances,fo at least
FEET to FEET two permanent landmarks.
q opsoil
10
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10 125 Bedrock � r
g
4-4
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1
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If yield was tested at different depths during drilling, list below a iJ) 3
FEET GALLONS PER MINUTE
1
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DATE WELL COMPLETED PERMIT NO REGISTRATION NO. DATE OF REPORT ' WELL DRIL•�LER($_Ignature)