HomeMy WebLinkAboutWell New 39 Rosemary Lane WELL DRIWNG BOARD STATE OFF NNECI$CUT PERMIT NUMBER -
WOB4 1
1-6' 'WELL DRILUNG PERMIT 4 2 6 3'8-
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT o6TT5
r
r LOCATION OF WELL (Town) (Street) (Lot Number) DATE
SOUTH •WINDSOR ROSEMARY LANE 3 I 9/21/77
OWNER OF WELL
❑ INDIVIDUAL ® BUILDER ❑ OTHER(Specify) U & R HOUSING CORP.
OWNER'S ADDRESS
99 E. CENTER ST. T_MANCHESTEH, CONN.
PROPOSE 2 pOMESTIC ❑ BUSINESS Est.No.of
ESTABLISHMENT '� ❑ FARM ❑ WELL People being
USE OF served.
V AIR OTHER '
❑ SSU�y ElINDUSTRIAL - El CONDITIONING ❑ (Specify) 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(if present)
' Indicate North
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Approximate number of feet from well to nearest source ofpossible-contamination:- 75'
(Sanitary Sewers
The undersigned is aware that upon completion of the-well,a'Well Completion Report"containing construction details and information required under Section
15.131 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.
T {ynatu ) APPLICANT'S ADDRESS REGISTRATION NO.
LAKE ST. , VERNON. CONN. 100
Y Town Health Offigor or ent) DATE
APPROVED ❑ REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
M A
ELL SOMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
B-5 1269 REV. 9-71 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER Tr t' g-q-r-r` ", ;;x -e ^'{`;'�-� t-st ,-€ ,..1 .'t.w"
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LOCATION (No. & Street) (Town)
YY�� (Lot Number)
OF WELL v fy,+'_e'.. .LL a.,. t to sT ij i %� "< 7
BUSINESS
PROPOSED Ed DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (AIR STHER
pecify)
DRILLING COMPRESSED CABLE ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
THER
EQUIPMENT y)
CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS it I Fx� THREADED ❑ WELDED I 1i YES ❑NO &]YES ❑NO
YIELDHOURS YIELD(G.P.M.)
,,
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR 4 150
WATER MEASURE FROM LAND SURFACE—STATIC (Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL } I �d I in feet below Land surface: 125
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,fo at least
FEET to FEET two permanent landmarks.
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If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
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DATE WELL COMPLETED PERMIT NO REGISTRATION NO. DATE OF REPORT L•l DRtI, ER f($Ignature)
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