HomeMy WebLinkAboutWell New 24 Rosemary Lane (2) WELL DRIWNG BOARD STATE d-CONIMTICUT
•PERMIT NUMBER
wDls a 1I 69 WELL DRILLING PERMIT 4297.3
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Toms) Mired) (Lot Number) DATE
SOUTH WINDSOR ROSIR2LkRY LANE 14 I 10/3/77
OWNER OF WELL
❑ INDIVIDUAL 0 BUILDER ❑ OTHER{Specify) RICHARD KR'MEX
OWNER'S ADDRESS
49 ROSEMARY LANE, S. WINDSOR, GONN
FRS O F DOMESTIC ❑. BUSINESS
'� ❑ FARM ❑ WELL People be n
USE OF - served.
WELL PUBL❑ LY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (OSP�fy) 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 location on lot and to house(of present)
01
(D
Indicate North
7S'
//o v s
.�C
I�JAJC
t
Ro s F.�c�A /t �.9�L
Approximate number of feet from well to
nearest source.of possible contamination: Sanitary Sewers
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 cvunteriigned by the Director of Health or his agent.
00 AO CANT $ m APPLICANTS ADDRESS REGISTRATION NO.
LAKE ST. VERNON CON7T. 100 -
BY{Toms►8eoitA Officer or Agent) . DATE
tg(APPROVED ❑ REJECTED I 1d77
j
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
WDB-5 12-69 REV.9-71 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME I ADDRESS �Y _
OWNER T� 'bt P�i S-• n ME r--e�y-e Zy 9 S7. q ;PY T QE £,.3- I � ` �01i s
Li.�.�saaZ3�.� S. si.daLa�laLas� .f �i:�+_.uz�#.`t�id�. Ltd�.l r..r g a 1�v 3a<��t'.�� `-.+
LOCATION
(Nn & Street) (Town) (Lot Number)
OF WELL R31:a(£s,Pff LANE 14
BUSINESS
PROPOSED
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF PUBLIC AIR WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
ER
DRILLING � ROTARY ❑ q RM PERCUSSION ❑ PERCUSSION ❑PRESSED CABLE (Specify)
EQUIPMENT _
LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS
41 6 10 t; I s�'i THREADED ❑ WELDED RYES ❑NO a]YES 1:1NO
HOURS YIELD(G.P.M.)
YIELD
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR `J
MEASURE FROM LAND SURFACE—STATIC (Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
WATER
LEVEL 110 00 I in feet below Land surface: 1
MAKE I
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) I IF GRAVEL I I GRAVEL SIZE(inches) FROM(feet) TO(feet)
Diameter of well including
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
0 Clay ,�V
i --
LJ "
f
If yield was tested at different depths during drilling, list below ff
FEET GALLONS PER MINUTE
d
DATE WELL COMPLETED PERMIT NO REGISTRATION NO. DATE OF RLPORT /r� ( WEL�j�D,$���LLER(Signsur{,ee))f�
,1 Q;/';S1 P I f I i ' ��`+ � •a'^�`".+"�
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