HomeMy WebLinkAboutWell New 49 Rosemary Lane WELL DRILLING BOARD y STATE S'Fi'CONNL",TICUT PERMIT NUMBER
WDBr/ 11-69 WELL DRILLING PERM 31428
STATE OFFICE BUILDING,KARTFORD,CONNECTICUT 06115
LOKATION OF WELL (Town) (Street) (F,ot Number) DATE
SOUTH WINDSOR ROSEMARY LANE .4A I 10/13/75
OWNER OF WELL
G] INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) RICHARD KELLEY
OWNER'S ADDRESS
20 WILLOW ST. , S. WINDSOR, CONN.
PROPOSED BUSINESS TEST EsL No.of
a DOMESTIC ❑ ESTABLISHMENT ❑ FARM• ❑ WELL People being
USE OF served.
WELL PUBUC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) 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 Last two roads Well location on lot and to house(if present)
Indicate North
)( �oU�
Ise � �—
•
. 0
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 countersigned by the Director of Health or his agent:
ign tare APPLICANT'S ADDRESS REGISTRATION NO.
t : LAKE ST. , -VERNON, CONii. 100
n Jiealth r or Agent) DA714
( APPROVED s❑ REJECTED REMARKS 1. I O
y � •t .S
S •
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE d coNNThicur Do NOT fill in
WDB-5 12-69 REV.9-71 WELL DRILLING BOARD
- State Office Building STATE WELL NO. '
HARTFORD,CONNECTICUT 06115.
OTHER NO.
NAME ADDRESS
OWNER RICHARD KEZLEY 20 WILLOW ST. 9 S. WINDSOR 9 CONN..
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL RO=uff Y' LANE SOUTH WINDSOtR *A
BUSINESS
PROPOSED
lid PROPOSED ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL ❑ AIR OTHER
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT ❑ ROTARY ❑ AIR P R USSION ❑ PERCUSSION ❑ (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGH DRIVE SHOE WAS CASING GROUTED?
DETAILS 21 6 IT PER FOOT
19 e 4 • I ® THREADED ❑ WELDED I ®YES [:]No ❑YES E NO
YIELD
HOURS -YIELD(G.P.M.)
❑ BAILED ❑ PUMPED ® COMPRESSED AIR
TEST
' 4 1.5
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATER I ( Depth of Completed Well
LEVEL 10 80 in feet below Land surface: 100
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Di I GRAVEL SIZE(inches)FROM(feet) �70(feet)
Diameter of well including
I PACKED: I 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 9 Sand & Gravel
100 Red Rock
3 .
WCALI-
If yield was tested at different depths during drilling,list below
FEET GALLONS.PER MINUTE
C
DATE WELL COMPLETED_ PERMIT-NO. REGISTRATION NO. DATE OF REPORT WE ER ignatur)
10 2 •:x-54 I r 1428 I 100 ( 10/2 /?5
BOARD