HomeMy WebLinkAboutWell New 550 Strong Road WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV.9-71 WELL DRILLING BOARD Do NO fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 061IS
OTHER NO.
OWNER
NAME. I ADDRESS
R0000 Ij0NACt
LOCATION (No.&Street) (Town)
OF WELL 550 Sa MONI'a, ROAD (tot Number)
DOMESTIC ❑ ESTABLISHMENT ❑ FARM
BUSINESS
PROPOSED USE OF ❑ TEST WELL
PUBLIC
WELL ❑ SUPPLY ❑ INDUSTRIAL
AIR OTHER
❑
❑ CONDITIONING (Specify)
DRILLING ROTARY AIRPRESSED PERCUSSION CABLE
— R ❑.OTHER
EQUIPMENT ❑ PERCUSSION (Specify)
CASING LENGTH (feet) DIAMETER(inches)I WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
-
DETAILS 32 I 1%4'q I Frl THREADED ❑ WELDED I g]YES ❑NO ❑YES NO
YIELD HOURS YIELD (G.P.M.)
TEST ❑ BAILED El PUMPED ® COMPRESSED AIR
50
MEASURE FROM LAND SURFACE--STATIC'(Specify feet)I DURING YIELD TEST(feet)WATER I Depth of Completed Well
LEVEL G5. in feet below Land surface:
MAKE 1�
I 175
SCREEN LENGTH OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE I DIAMETER(inches)
IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet)
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.
.2 .175
tom'
u� �
If yield was tested at different depths during drillinq, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED I PERMIT NO. I REGISTRATION NO. I DATE OF REPORT WEL LLER ignatur
DEPT. OF ENVIRONMENTAL PROTECTION-WATER RESOURCES
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
WD15.4 11-69 WELL DRILLING PERMIT 4'6 12 3-
STATE OFFICE BUILDING,HARTFOW,CONNECTICUT 06115
LOCATION OF WELL (Town) (Street) (Lot Number) 19/23/78
DATE
So. Windsor, Conn. Strong Road
OWNER OF WELL
INDIVIDUAL ❑ BUILDER ❑ OTNER(Specify)
OWNER'S ADDRESS
Philip Simonson, 500 Strong Road, So. Windsor, Conn.
PROPOSED 1Fs -❑DOMESTiC BUSINESS• FARM❑ ❑ TEST Est.No.of
USE OF hiFa ESTABLISHMENT '� WELL. People being
WELL ❑ SPUBLIC
UPPLY ❑ INDUSTRIAL ❑ AIR OTHER served.
CONDITIONING ❑ (Specify) 1 f ami 1y_
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 Last two roads Well location on lot and to house Of present)
Q,
mil
ll�
Indicate North
G
I�5 ePTI C✓
Approximate number of feet from well to 7j f t.
nearest source of possible contamination:
The undersigned is aware that upon completion of the well,a"Weil Completion Report' curtaining constnxtion 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.
LICANT 6iynature) APPLICANT'S AD U or rl 1 ng Co. REGISTRATION NO.
�1047 Main St. So. Glastonbury, Conn. I 10
❑ f BY(Town Seagh Offker or ent) DATE
APPROVED
REMARKS
g-2k'7S7
RETURN THIS COPY TO' CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CO►dNECTICUr Do NOT fill in
WDB-5 12-69 REV. 9-71 WELL DRILLING BOARD
State Office Building
STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
OWNER NAME ADDRESS
LOCATION (No.&Street) (Tow
,n) (Lot Number)
��++
OF WELL ` 00 Strong: St. South uth zling
sor
BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF AIR WELL ❑ THER
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)(
DRILLING ElROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specif
COMPRESSED CABLE OTHER
y)
y)
LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE
CASING ❑ WELDED YES SHOE WAS CASING GROUTED?
I I ❑ (DETAILS I THREADED ( ❑NO ❑YES NO
HOURS YIELD(G.P.M.)
YIELD ❑ ❑ PUMPED COMPRESSED AIR
TEST BAILED ❑
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) 12
WATER I I Depth of Completed Well
LEVEL 30" in feet below Land surface:
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) (IF GRAVEL GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: 1 Diameter of well including gravel pack(inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances, to at least
FEET to FEET
FORMATION DESCRIPTION two permanent landmarks.
O 125 5 sand and gra -
1
)
!
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
t
# AR4�3
kk
t
DATE WEELL+COMPLETED PERMIT NO. I REGISTRATION NO, DATE OF RLPORT WELL DRILLER(Signature)? j] f
7
DEPT. OF ENVIRONMENTAL PROTECTION-WATER RESOURCES