HomeMy WebLinkAboutWell New 48 Rosemary Lane WELL DRILLING BOARD STATE OF CONNECTICUT �C PERMIT NUMBER
wos a II.69 WELL DRIL11NG •PERM 3 719
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 /
LOCATION OF WELL (Town) (6treet) (Lot Number) DATE
SOUTH WINDSOR ROSEMARY LANE 12 8/29/7
OWNER OF WELL
❑ INDIVIDUAL ® BUILDER ❑ OTHER(Specify) JORDAN CO. (ROBT. PECK)
OWNERS ADDRESS
26B AMATO -DR. , S.- WINDSOR, CONN.-
PROPOSED ® DOMESTIC FARM❑ BUSINESS ❑ TEST Est.No.of
USE OF ESTABLISHMENT ❑ WELL People being
served.
WELL ❑ SUPPLY (specify)PUBLIC AIR❑ INDI)STRKIL ❑ CONDITIONING ❑ (spfy) 5
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 - UL(-
,
67
�8 o R A.
a U(I'
C XT. ..
way -
7�
Approximate number of feet from well to
nearest source of possible contamination: Se itam 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 counter-signed by the Director of Health or his agent.
I NT( pnatu a) APPLICANT'S ADDRESS REGISTRATION NO.
LAKE T. Iion
^+ By JT, 1i+rc� ) DATE
APPROVED ❑ REJECTED
RE RKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-S 12-0 REV.9-71 WELL DRILInNG BOARD
Do NOT fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
OWNER
NAME ADDRESS
- I -
JORD N CO. 26B .AMATO DR. S. WINDSOR9 CONN.
LOCATION .(No.&Street) (Town) (Lot Number)
OF WELL ROSEMARY LANE SOUTH WINDSOR 12
❑ BUSINESS
-E TABLISHMENT ❑ FARM PROPOSED DOMESTIC ❑ TEST WELL
USE OF
WELL ❑ PUBLIC AIR OTHER
SUPPLY ❑ INDUSTRIAL -
(❑ CONDITIONING ❑ (Specify)
DRILLING COCABLE OTHER
EQUIPMENT ®ROTARY ❑ A RMPRESSED PERCUSSION - D PERCUSSION - ❑ (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 21 6 I 19.45 I ® THREADED ❑ WELDED I [NYES []NO ❑YES NO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED ® COMPRESSED AIR I 4 20
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 1 80 I in feet below Land surface: 100
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including
GRAVEL SIZE(inches)FROM(feet) I--TO(feet)-
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACI
FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
.0 Sand- &- Clay
100 1 Reddish "Rock
Ube
�bt
td W
Uj
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
T.
C. L
DATE WELC!COMPIETED PERMIT NO. REGISTRATION NO. DATE OF REPORT DRI L (Sig atur
9/9/75 30719 100 9/15/75
BOARD