HomeMy WebLinkAboutWell New 80 Rosemary Lane WELL DRILLING BOARD STATE OF CONNECTICLIT PERMIT NUMBER
WD" III', WELL DRILLING PERMIT 30387
/
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 0611S
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
South 4Iindsor Rose Ma=Lane 10 18/13/75
OWNER OF WELL
L+1 INDIVIDUAL ® BUILDER ❑ OTHER(Specify) Cote Carpenters
OWNER'S ADDRESS
- _101_,S=1t'h Whitney Street, 14artfordt.' Conn.
PROPOSED. BUSINESS PEST Est.No.of
DOMESTIC ❑ ESTABLISHMENT El FARM ❑ WELL -People being
USE OF served.
PUBLIC AIR OTHER
WELL ❑ 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 least two roads Well location on lot and to house(if present)
Indicate North
- P
- i
n%
X
(0
Rom I' larr(6 mane '
Approximate number of feet from well to ,�)
nearest source of possible contamination: %
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 Supple n to the General Statutes must be sent to the owner,the Board and the Water Resources Commission on the form provided by the
Boa is per s not va until all information is filled in and it has been counter-signed by the Director of Health or his agent.
APPLICA ($i re) APPLICANT'S ADDRESS REGISTRATION NO.
L e Stre t, Vernon, Conn.
BY a Ii h O or or ADS) DA;EROVED REJECTED �� ,
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICU4 Do NOT fill in
WDB-5 12-69 REV. 9-71 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD, CONNECTICUT 06115 StA -(33
OTHER NO.
NAME ADDRESS
OWNER ' I .{ . . �IHITNEY ST. , HART-FORD� 00 .
LOCATION (No. &Street) (Town) (Lot Number)
OF WELL ROSE tL&RY LAn SOUTH WIND aOR `o
PROPOSE®
DOMESTIC ❑ BUSINESS ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL ❑ OTHERPUBLIC AIR SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING (Specify)
DRILLING
EQUIPMENT ROTARY ❑ A RMPRESSED PERCUSSION ❑ PERCUSSION (Specify)
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
CASING YES N
DETAILS �G ( 6 I 19,*45 (� THREADED I � ❑ WELDED I � O❑ ❑YES NO
YIELHOURS YIELD(G.P.M.)
TEST "4°�j
EST ❑ BAILED ❑ PUMPED � COMPRESSED AIR
WATERMEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet)
Depth of Completed Well
LEVEL Pa in feet below Land surface: 175
MAKE 15 I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) I IF GRAVEL I Diameter of well including I GRAVEL SIZE(inches)(FROM(feet) TO(feet)
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances,to at least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
740 07 A•r
10 Reddish Rom
r
If yield was tested atdifferent depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. +DATE OF REPORT LL- (Signature)
DEPT. OF ENVIRONMENTAL PROTECTION — WATER RESOURCES
WELL DRILLING BOARD STATE'-r t NW—,TICU PERMIT NUMBER
W094 1
1-69 WELL DRILLING PERMIT 3 2 5.7 7
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) ($tract) (Lot Number) DATE
SOUTH WINDSOR ROSE MARY IATTE �� I 1/7/76
OWNER OF WELL
❑ INDIVIDUAL ® BUILDER ❑ OTHER(Specify) (30713 CA RPF.NTER,S
OWNER'S ADDRESS
101 SOUTH VJHIMTEY ST. , HARTFORD, C01-11 .
PROPOSED ❑X DOMESTIC ❑ BUSINESS TEST Est.No.of
ESTABLISHMENT ❑ PARht ❑ WELL People being
USE OF served.
WELL ❑ PUBLIC Y ❑ 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 least two roads Well location on lot and to house.(if present)
Indicate North
- 1
X
Approximate number of feet from well to
nearest source of possible contamination: 25
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.
_,ANT(Signature) APPLICANT'S ADDRESS REGISTRATION NO.
. L Aim- S - VMT01-r COIRIT. 100-
owri Ofiker or dy DATE
APPROVED ❑ REJECTED
S I ` S'
REMARKS
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 97
HARTFORD,CONNECTICUT 061]5 ' Ell/
OTHER'NO.
Ind W011 Oil Lot
NAME i ADDRESS ��tt ��v � { t �€
OWNER 0i'MR faA��N'TE-R8 I . 61 S. HIET EY ST. HAR FORD V0 s
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL RCUSE NARY LAKE O1 M! WIMSO .
DOMESTIC ❑ BUSINESS ESTABLISHMENT ❑ FARM TEST WELL
PROPOSED
USE OF PUBLIC AIR WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
CASING 0 �± A THREADED ❑ WELDED �YES ❑NO ❑YES J1 NO
DETAILS i1 I ( 19,4
HOURS YIELD(G.P.M.)
TEST ❑ BAILED ` ElPUMPED COMPRESSED AIR 10
- MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet) I I WATER Depth of Completed Well
LEVEL 20 80 in feet below Land surface: 100
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN __
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL GRAVEL SIZE(inches) FROM(feet) TO(feet)
Diameter of well including
I I PACKED: , gravel pack(inches):
DEPTH FROM LAND SURFAC FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
0 10 Sand & G a-vel
10 100 P-eddish Rock
s
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
ef
DATE WELL COMPLETED PERMIT NO._ REGISTRATION NO. DATE OF REPORT h'D R(Sin ure
-100
PRO'T'FO'T'ION -W,TE_R RFSOU-IRCES