HomeMy WebLinkAboutWell Repair 319 Smith Street WELL DRILLING BOARD STATE`&t.ONNECTICUT PERMIT NUMBER
W X" 11-69
WELL DRILLING PERMIT 8 C
STATE OFFICE BUILDING,IMOl IRD,CONNECTICUT 06115 U
LOCATION OF WELL(Town) (Street) (!oF Number) DATE
SOUTH WINDSOR 319 SMITH ST. 1�/?�?1
OWNER OF WELL
EINDIVIDUAL ❑BUILDER ❑ OTHER(Specify) THEODORE GILL
OWNER'S,ADDRESS
319 SMITH ST. , S. WINDSOR, CONN.
PROPOSED BUSINESS TEST Est.No.of
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM
USE Of � ❑WELL People being
PUBLIC OTHER served.
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 'd to house(if present)
Indicate North
. yrFr.
13Sf f
L),r
04
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I
I
Approximate number of feet from well to
nearest source of possible contamination: 75
The undersigned is aware that upon completion-of the well,a"Well Completion Report"containing construction details and information required under Section 6 of
Public Ad 659 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 inforrho-
tion is filled in and it has been counter-signed by the Director of Health or his agent.
APPLICANT'S ADDRESS REGIS 1 OO NO.
LAKE ST. , N, CONN.
BY(Town Ith Off or Agenff DATE
(APPROVED ❑ REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE Of CONNECTICUT
WDB-s 12-69 WELL DRILLING BOARD Do NOT fill in
`State OA'ice?tSuilding STATE WELL NO.
HARTFORD,CONNECTICUT 06113
OTHER NO.
OWNER
NAME ADDRESS
THFrODORE GILL
LOCATION (No.a Street) (Town) (Lot Number)
OF WELL 319-SMITH ST. SOUTH WINDSOR
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ISHMENT ❑ FARM
PROPOSED ❑ TEST WELL
USE OF
WELL AIR
❑ SUPPL`Y ❑ INDUSTRIAL ❑ CONDITIONING ElOTpeHER)
DRILLING COMPRESSED CABLE
EQUIPMENT 9 ROTARY ❑ AIR ElPERCUSSION PERCUSSION ElCUSSION OTHER
(Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRI E SHOE WA CASING GROUTED?
DETAILS 75 6 19.45 O.THREADED ❑WELDED �I YES ❑NO YES 9 NO
YIELD —
TEST ❑BAILED ❑ PUMPED l COMPRESSED AIR HOURS 1 G.P.M. 8 YIELD(p.P.M.)
WATER MEASURE FROM LAND SURFACE—STATIC(Specify teet) DURING YIELD TEST(feet) 8
Depth of Completed Well
LEVEL 30 100
in feet below Land surface: 125
MAKE
SCREEN LENGTH OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE DIAMETER(inches) GRAVEL SIZE(inches) FROM(feet) TO(lest)
1F GRAVEL Diameter of well including
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 15 Sandy Topsoil
15 65 Hardpan
65 125 Reddish Rock
If yield was tested at different depths during drilling,list below /
i
FEET GALLONS PER MINUTE
ter'
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WEL - R LL (Bien me
12/16/71 8156 100 12/20/71
BOARD