HomeMy WebLinkAboutWell New 151 Trooy Road WELL NG BOARD STATE OF CONNECIICUT PERMIT NUMBER
wns•a 11.69 WELL DRILLING PERMIT ' 59712
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Toros) (Street) (Lot Number) DATE
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OWN OF WELL
OWN
❑ BUILDER ❑ OTHER(Specify) `
OWNER'S ADDRESS
PROPOSM DOMESTIC, ❑ BUSINESS FARM TEST Est.No.of
ESTABLISHMENT ❑ ❑ WELL People being
USE OF served.
V ❑ AIR OTHR
SUPPLY ❑ INDUMIAL ❑ CONDMONING ❑ (Specify)
SKETCH OF WELL LOCATION
Locate well with reaped to at least two roads,.showIng distance from intersection and front of lot
Location of lot to at least two roads Well location an lot a ouse(if present)
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Indicate North
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Approximate number of feet from well tol
nearest source.of possible contamination:
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 fhe form provided by the
Bo T} . ermi is not vali"ngj all information Is filled in and it has been counter-signed by the Director of Health or his agent.
APPLICANT Sionatun) j� • APPLICANT'S ADDRESS I REGISTRATION NO.
(30 l.�i�•RY.e�7T'' IQ A 41 cP, 060611 ,3f!
BY(Tows Seank Officer DATE 1
MI-APPROVEDEorW
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REMARKS
17.
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
r, WELD.COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV.9-71
WELL DRILLING BOARD Do NOT fill in
STATE WELL NO.
State Office Building
HARTFORD, CONNECTICUT 06115
OTHER NO.
OWNER NAME ADDRESS
T4nrr-7 Vi las 1583 I'll ing-ion mod. S. Windsor
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL 151 r
BUSINESS
❑ ESTABLISHMENT HMENT ❑ FARM
PROPOSED DOMESTIC ❑ TEST WELL
USE OFPUBLIC
AIR
WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING ❑ COMPRESSED CABLE ❑ OTHER
EQUIPMENT ROTARY AIR PERCUSSION El PERCUSSION (Specify)
CASING
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
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DETAILS 15 0 [? 119•45 I �} THREADED ❑ WELDED I (—]YES ❑NO �YES ❑NO
YIELD ❑ PUMPED HOURS YIELD(G.P.M.)
TEST BAILED COMPRESSED AIR
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
WATER I Depth of Completed Well
I
LEVEL in feet below Land surface: 20
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
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 SURFACf - Sketch exact location of well with distances, to at least
FEET_- to FEET
FORMATION DESCRIPTION two permanent landmarks.
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If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. (DATE OF RLPORT I WELL DRILLER(Signatura'k T +
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