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HomeMy WebLinkAboutWell New 81 West Road WELL DRILLING BOARD• STATE OF-CONNECi(CUT, PERMIT NUMBER WDB-4. 111�a 4579 WELL DRILLING PERMIT :: • STATE OFFICE BUILDING,HARTFORD.,CONNECTICUT 06115 r7. LOCATION OF WELL(Town) (Street' � (lot Number) DATE G' OWUER OF WELL _ INDIVIDUAL ❑WILDER ❑ OTHER(Specify) OWNER'S ADDRESS a.. PROPOSED DOMESTIC El ESTABLISHMENT TEST Est.No.of USE OF ESTABLISHMENT ❑•FARM ❑ WELL People being PUBLIC served. WELL ❑ SUPPLY ❑ INDUSTRIAL AIR OTHER ❑ CONDITIONING ❑ (specify) ' 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 an lot and to house(if-present) Indicate North. $0.,4 1 C ''Q a �C � yd6 r Wry b. Approximate number of feet from well ta, 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 6 of Public Act 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 informa- tion is filled in and it has been counter-signed by the Director of Health or his agent. APPLICANT(Signature) APPLICANT'S ADDRESS ,r,� `,' �•' REGISTRATION NO. �+ AIQ BY(Tqw~Officer or Agent) DATE Pi�PPROVEID ❑ REJECTED oor REMARKS A - RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT WDB-5 12-69 WELL DRILLING BOARD Do NOT fill in State Office Building. STATE WELL NO. HARTFORD,CONNECTICUT 06115 ( OTHER NO. NAME ADDRESS OWNER _ 8 1 t°` .fit S €l'qa l2 ='fr t.r'� , LOCATION c. o. & Street) (Town) (Lot Number.) OF WELL l ; E BUSINESS PROPOSED 13,DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF WELL PUBLIC❑ SUPPLY ❑ INDUSTRIAL AIR OTHER ❑ CONDITIONING (Specify) DRILLING COMPRESSED CABLE ER ROTARY ElA R PERCUSSION ❑ PERCUSSION ❑ (Spe(Specify) ) CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS ' THREADED ❑WELDED YES ❑NO El WELDED ❑NO YIELD HOURS G.P.M. YIELD(G.P.M.) - TEST ❑ BAILED ❑ PUMPED ❑ COMPRESSED AIR 4 7 WATER MEASURE FROM LAND SURFACE—STATI{(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL tA in feet below Land surface: MAKE 275 LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) GRAVEL SIZE(inches) FROM(feet) TO (feet) IF 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.. -� H a i/l 105 hod _ 5 a t I `,, If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE ` m dFc SL)lllva�t Ave DATE WELL COMPLETED. PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) f f: 6tI 1'T I'm Pt 14 PE`F`49 EPLRE�x iro/v„ ,sFEEP:cE WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in WDB-S 12.69 WELL DRILLING BOARD STATE WELL NO. State Office Building HARTFORD,CONNECTICUT 06115 OTHER NO. NAME ADDRESS OWNERWatbkk (j"t Sty Soad GIlx LOCATION O.&Street) (Town) (Lot Number) OF WELL west Ste NESS ®DOMESTIC ❑ EST BL SHMENT ❑ ❑ TEST WELL PROPOSED FARM USE OF WELL n SUPLIC PLY El INDUSTRIAL ❑ AIR ❑ OTHER CONDITIONING (Specify) DRILLING COMPRESSED CABLE EQUIPMENT Q ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ STpecify) CASING LENGTH(teat) DIAMETER(inches) WEIGHT PER FOOT VE SHOE WAS CASING ROUTED? DETAILS 115 6 19 ® THREADED ❑WELDED YES ❑NO ElYES LJ NO YIELD HOURS G.P.M. YIELD(G.P.M.) TEST ❑BAILED ❑ PUMPED © COMPRESSED AIR 4 1 1 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL 50 in feet below Land surface: 915 MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN 'DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(leet) TO(test) PACKED; 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. 105 215 ud jwcA 7t 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 WE DRILLER(S/ store) ,� 1 -8-71 4519 i BOARD