HomeMy WebLinkAboutWell Repair 291 Smith Street WELL DRILLING BOARD STA OF CONNECTICUT PERMIT NUMBER
wDB-a 114' WELL DRILLING PERMIT 26002
STATE OFFICE BUILDING,'I+ ikRD,CONNECTICUT 06115
LOCATION OF WELL (Town) tract) (Lot Number) -SOUTH WINDSOR SM DATE
ST. 20 I 10/3/74
OWNER OF WELL
0 INDIVIDUAL ❑ BUILDER ❑ OTHER fteeify) DONALD MIKKELSON
OWNER'S ADDRESS
15 PINE DRIVE, WINDSOR, CONN.
PROPOSED Y❑ DOMESTIC ❑ BUSIB�L1 HMENT ❑ FARM ❑ TEST Est.No.of
USE OF ESTAWELL People being
WELL ❑ PUBLIC. ❑ served.
INDUSTRIAL ❑ CONDITIONING ❑ (Sp'�ify) 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
L),r
rH
-�u�/�L,�,mod '��.� o • - t1`.vt � T
Approximate number of feet from well to
nearest source of possible contamination: 10?
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.
/1f ILICAN (6 ure APPLICANT'S ADDRESS REGISTRATIONNO.
FAKE ST.. , VERNON, CONK.
BY Tow»Health Officer or dpsnt). DATE
APPROVED ❑ REJECTED I je O
REMARKS l
RETURN THIS COPY TO CONNECTICUT.WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV. 9-7I WELL DRILLING BOARD Do NOT fill in
State Office Building - STATE WELL NO.
HARTFORD,CONNECTICUT 06115 LIU _
OTHER NO. r
NAME ADDRESS
OWNER ALD YMMELS01tI 15 PINE DRIrvEs WIND50R,
LOCATION n2 (No. & Street) (Town) (Lot Number)
OF WELL t�i� �� ST o t- � T K O .
20
BUSINESS
C ❑ ESTABLISHMENT ❑ FARM
PROPOSED DOMESTIC ❑ TEST WELL
USE OF
WELL PUBLIC❑ SUPPLY ❑ INDUSTRIAL El CONDITIONING ❑AIR ((Specify)
DRILLING Fy
❑ A RMPERCUSDION CABLE
EQUIPMENT - RO TARY ❑ PERCUSSION ❑ OTHER
(Specify)
CASING LENGTH (feet) I DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE
� � � WAS CASING GROUTED?
DETAILS
is I THREADED ❑ WELDED I ]YES ❑NO ❑YES 3FEINO
YIELD HOURS YIELD(G.P.M.)
TTEST ❑ IBAILED 'PUMPED � COMPRESSED AIR ;
MEASURE FROM LAND SURFACE STATIC(Specify feet, DURING YIELD TEST(fee 15
WATER I Depth of Completed Well
LEVEL 20in feet below Land surface: 11
MAKE
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) IF.GRAVEL
Diameter of well including I GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: gravel pack (inches}; I I
-DEPTH FROM LAND SURFACE
FEET to FEET FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
two permanent landmarks.
3 opsoi .
2 Sand Gravol
Clay
Reddish Rock _ 1(:'
I
I
j -
i
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
C�a4 c
ci�tt(�v��tG �v�'ttt
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT DRIL ER ignatur)
OEPT� OF ENVIRONMENTAL PROTECTION WATER RESOURCES