HomeMy WebLinkAboutWell New 42 Strong Road WELL DRILLING BOARD STATOlY CONNECTICUT PERMIT NUMBER
wDB4 nag WELL DRILLING PERMIT 32366
STATE OFFICE BUILDINGNARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (9tree) (Lot Number) DATE
OWNER OF WELL
SOUTH wmpst)R STRONG ROAD
,
® INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) JUDSON BANCROFT
OWNER'S ADDRESS
359 HILLS ST. , E. HARTFORD, CONN..
PROPOSED ❑ ❑ BUSINESS ❑ TEST Est.No.of
X DOMESTIC ESTABLISHMENT FARM WELL People being
USE OF Alit OTHER served.
WELL ❑ SUPPLY ❑PUBLIC 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 and to house Of present)
Indicate North
0�
X TaHK
A
-ow C
S4�0ij6
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
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 counter-signed by the Director of Health or his agent.
AP NT to urs) APPLICANT'S ADDRESS REGISTRATION NO.
LAKE ST. VERNOII CONN.. I 100
- •I BY Sean jJtear or dpext) DATE l
APPROVED ❑ REJECTED
REMARKS I/ y O I
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE bF CONNECTICUT Do NOT fill in
WDM 12a9 REV.9.71 WELL DRILLING BOARD
State OffiFe Building
STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER JUDSON BANCROFT I HILLS- ST.. • E. HARTFORD CONN.
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL STRONG •ROAD SOUTH MEMO
.0
BUSINESS
® ❑ ESTABLISHMENT ❑ FARM
PROPOSED DOMESTIC ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING
COMPRESSED CABLE
EQUIPMENT ® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ ((Specify)
CASING - LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT VE SHOE WAS CASING GROUTED?
DETAILS - 1 2 I I 1 I THREADED ❑ WELDED I DRI®YES ❑NO ❑YES ®NO
HOURS- YIELD(G.P.M.)
YIELD ❑TEST BAILED ❑ PUMPED ® COMPRESSED AIR + 8 20.
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATER Depth of Completed Well 1(5
LEVEL 30 100 in feet below Land surface:
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including
I GRAVEL SIZE(inches)FROM(feet) ITO(feet)
PACKED: , gravel pack(inches):
DEPTH FROM LAND SURFACI
FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
0 3 T
22 -gand & Qravel
22 53 Gravel
-53 122- Grave-1
122 1 Rad 'Rock
�l, hA I< .
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO.' REGISTRATION NO: DATE OF REPORT W E (Signatur
12 10 ( 32366 100 112 1 )
f BOARD