HomeMy WebLinkAboutWell New 87 Rosemary Lane WELL DRILLING BOARD STATE oucrOG- cur -U PERMIT NUMBER
WDB 4 11-69
WELL DRILLING PERMIT 25213
STATE OFFICE BUILDING,HARTFQV,CONNECTICUT 06115
J
LOCATION OF WELL (Town) (street)T—. _
SOUTH WINDSOR D_ Lot Xumvor) DATE
OWNER OF WELL 6 , 5�26�')4
❑ INDIVIDUAL - BUR= ❑ OTTiHL lSpeclfy) CARLO PRES:TILIO
OWNER'S ADDRESS
69 ASH ROAD, WAPPING, CONN.
PROPOSED ® DOMESTIC ❑ BUSINESS ❑ ❑.TEST Est.No.of
USE OF
ESTABLISHMENT FARM WELL People being
- AIR served.
❑ SUPPLY ❑ INDUSTRIAL. El CONDITIONING
PUBLIC ❑ (Specify)
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 Cf present)
a015
Indicate North o
1`.BB r t' 'oAo ExT.
1
S�Uj
Approximate number of feet from well to`
nearest source of possible contamination: RA n i I A
• *v-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 fonn 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,
APP S' ) I APPLICANT'S ADDRESS REGISTRATION NO.
LAKE-ST. , VERNON, CONN._, I 100
RKS
B Oran E'eaitA ar or. M
DATEEl REJECTED _ I DO" Y
REMA v .
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
w -
WELL COMPLETION REPORT STATE OF CONNECTICUr Ro NOT fill in
WDB-5 12-69 REV.9-71 WELL bRiLLING BOAR®
STATE WELL NO.
State Office Building /
HARTFORD, CONNECTICUT 06115 !
OTHER NO.
OWNER
NAME ADDRESS
` �v
0��0 PRESTILIO 69 ASH ROAD,, AP— DING# i ONN.
LOCATION (No. & Street) (Town)
(Lot Number)
OF WELL R01 MJARY .lvtAffE SOUTH WI NDSOR 6
BUSINESS
❑ ESTABLISHMENT ❑ FARM
PROPOSED DOMESTIC ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
COMPRESSEDDRILLING
EQUIPP ENT ROTARY ❑ AR ERCUSSSION ❑ P RCUSSION ❑ ((Specify)
LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 15 1 o�- ❑ WELDED Ei YES I
DETAILS I THREADED ( ❑NO ❑YES R NO
YE TEST
❑ ❑ I HOURS YIELD(G.P.MJ
TEST BAILED PUMPED COMPRESSED AIR�
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATERI ( Depth of Completed Well
LEVEL 10 90
in feet below Land surface: 100
MAKE - I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) I
IF GRAVEL Diameter of well including
I (GRAVEL SIZE(inches) FROM(feet) ITO(feet)
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 13 Sand & ray*
-13 00 Reddish Book
tr
3 e f u5
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If yield was tested at different depths during drilling, list below ('jo
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WE EJ,L.-t•)R�.LE Signat re)
DEPT. OF ENVIRONMENTAL PROTECTION - ViARTER RESOUIRCB