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HomeMy WebLinkAboutWell Repair 331 Smith Street WELL DR ILLING BOARD STATE OF CONNtECTICUT PERMIT NUMBER wDB a L t 69 WELL DRILLING PERMIT• 32011 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 LOCATION OF WELL (Town). (Street) (Lot Number) ! DATE SOUTH WINDSOR SMITH ST. I OWNER OF WELL © INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) ARTHU_ BRQCHU OWNERS ADDRESS 331 SMITH ST. t-FAPPING CONN. PROPOSED DOMESTIC ❑ BUSINESS EST BLISHMENT ❑ FARM TEST❑ WELL Est USE OF People being. WELL PUBLIC AIR❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) served. 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 - T ' 1 • X V M E Approximate number of feet from well to nearest source of possible contamination, qn 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 C o m m is si i on 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, APP Ni(Signature) APPLICANT'S ADDRESS I REGISTRATION NO- LAKE ST. 4 VERNON COITN. 100 Zn Health O I or dpew) DATE REMARKS / RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT WDS-8 12.69 REV.9-71 WELL DRILLING BOARD Do NOT fill in State Office Building STATE WELL NO. HARTFORD,CONNECTICUT 061 is OTHER NO. OWNER NAME I ADDRESS ARTHUR BROCHU 331 SMITH ST. ; S. WIN-DSOH, CONIC. LOCAWELL SkIITh ST (No.A Street) (Town) 0"Number) SOUTH WINDSOR BUSINESS ® ❑ ESTABLISHMENT ❑ FARM' PROPOSED DOMESTIC ❑ TEST WELL USE OF WELL PUBLIC ❑ SUPPLY ❑ INDUSTRIAL AIR OTHER ❑ CONDITIONING ❑ (Specify) COMPRESSEDDRILLING EQUIPMENT ❑ AR ER USSION PERCUSSION❑ CABLE OTHER ® ROTARY El (Spec)fy) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS I I I ®THREADED ❑ WELDED I ®YES ❑NO ❑YES ©NO YIELD(G.P.M.) YIELD HOURS TEST ❑ BAILED ❑ PUMPED . COMPRESSED AIR p . 10 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet) I Depth of Completed Well LEVEL 30 150 iin feet below Land surface: 175 MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN I. DETAILS SLOT SizeI DIAMETER(inches) IF GRAVEL I GRAVEL SIZE(inches)(FROM(feet) ITO(feet) I : I Diameter of well including PACKED gravel pack(inches): DEPTH FROM LAND SURFAC FEET to FEET FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two permanent landmarks. 0 17 Sand & Gravol 17 175 6ieay Reddish BQdrock If yield was tested at different depths during drilling,.Ilst below r E� FEET GALLONS PER MINUTE W cr- T. DATE WELL COMPLETED•+• ; PERMIT NO. REGISTRATION NO.• DATE OF'REPORT WEL LLER ignatur 12 2 I 2011 100 ( 12 /8 C BOARD /