HomeMy WebLinkAboutWell Repair 244 Windsorville Road WELL DRILUNG BOARD STATE OF 66NNECTICUT PERM NUMBER
wOs a 1149 WELL DRILt1NC-PERMIT 14686
STATE OFFICE BUILDING,HARTFORDD,CONNECTICUT 06115
LOCATION OF WELL(Town) (reef) (lot Number) DATE
SOUTH WINDSOR I1�DSORVILLE ROAD
OWNER OF WELL
®INDIVIDUAL ❑BUILM ❑ OTHER(Specify) OLIVER. THERIAIT
OWNERS ADDRESS
15 SOUTH ST. , WIHDHOR LOCKS, COHN.
PROPOSED ® ❑ BUSINESS TEST Est.No.of
DOMESTIC USE OF ESTABLISHMENT ❑ FARM . ❑ WELL People being
served.
WELL PUBLIC AIR' OTHER
❑ SUPPLY ❑ 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 of least two roads Well location on lot and to house(if present)
Indicate North
�i'jpd'un�4C
//0 L) S'E
I
GR;F RQ
FN Ao 13S DRi vF
• LfJi J'o Ur ALE oA�
Approximate number of feet from well to
nearest source of possible contamination. 85
The undersigned is aware that upon completion of the well,a 'Well Completion Report"containing construction details-and information required-under Section 25-131•: I
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 H has been counter-signed by the Director of Health-or his agent.
APeLtGAK
g^O(S' m) APPLICANT'S ADDRESS REGISTRATION NO. I
LAKE ST. , VERNON CONIT. 100
B wn HeoNh Tr or Agent)' DAB
APPROVE ❑
REMARKS -
o v,• 3
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
'WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12.69 REV.9-71 WELL DRILLING BARD DO NOT fill tin
.. State Office Building STATE WELL NO,
HARTFORD, CONNECTICUT 06115 S(,(j y f
OTHER NO.
NAME ADDRESS
OWNER OLITLR THE I I 15 SMUTH S e s .WINDS .LWK % C0 o
LOCATION p+,( (No. & Street) (Town)
(Lot Number)
_
OF WELL � ;r�`INDI sSSORVILLUS, RKA U Fair-IL �3
BUSINESS
PROPOSED 7 DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF,
WELL ❑ PUBLIC AIR
SUPPLY ❑ INDUSTRIAL. OTHER
❑ CONDITIONING ❑ (Specify)
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
:LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT CASING DRIVE SHOE WAS CASING G I1TED?
DETAILS 6 I 6 I . 19.4 I F1 THREADED ❑ WELDED I YES ❑NO ❑YES NO
YIELD El BAILED ❑ PUMPED COMPRESSED AIR HOURS YIELD(G.P.M.)
TEST 14
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
WATER
LEVEL 4 i in feet below Land surface: 96
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) I IF GRAVEL ( GRAVEL SIZE(inches) FROM(feet) i0(feet)
I` 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.
eJ
1 fy h 4,_
C
If yield was tested at different depths during drilling, list below �}�
FEET GALLONS PER MINUTE
wig
A M_A Aa d l F
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO, DATE OF REPORT I WEE RIL Signat a -.r-
f
DEPT. OF ENVIRONMENTAL PROTECTION
WEL•L•COMPLETION'REPORT STATE OF tqkNECTICUT " Do NOT fill,in,
WDB-S 12-69• REV.9-71 WELL DRILLING BOARD STATE WELL NO,
State-Office ifuilding
HARTFORD,CONNECTICUT 06115.
OTHER NO.
NAME ADDRESS
OWNER OLIVER THERIAPz I 15 SOUTH ST. ,- W11 DSOR LOCKS, 60MT.-
LOCATION (No.&Street) ,(Town) (Lot Number)
OF WELL WINDSORVILIL ROAD . SOUTH WINDSOR
USAESS
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM. ElTEST WELL-
USE USE OF. PUBLIC 7
AIR OTHER-
WELT SUPPLY ❑ INDUSTRIAL ; CJ CONDITIONING ❑ (Spea'fy)
OTHER
COMPRESSED. BLE
DRILLING [j] ROTARY ❑•A R PER USSION
EQUIPMENT. ❑ PERCUSSION El.(Specify)'
LENGTH(feet)..' DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
CASING,
DETAILS: 6 I. 6 I ''19.45 I• ® THREADED ._❑ WELDED 1 '�YES ❑NO ❑YES ®NO
HOURS YIELD(G.P.M.)
YIELD TEST ❑.BAILED' ❑ PUMPED- 4�9COMPRESSED AIR` I ; .4 - 14
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet)' I Depth of Completed Well
LEVEL L40. 5 in feet below Land surface: 96
MAKE T—
LI"GTH'OPEN.TO AQUIFER(feet)
SCREEN
DE?AILS SLOT SIZE DIAMETER'(inches) IF GRAVEL GRAVEL SIZE(inches)FROM(feet) TO(feet)
Diameter of well.including-
I I:PACKED: I gravel pack briches):
DEPTH FROM.LAND'SURFACE CRIPT
Sketch exact location of well with distances,to at least
"FORMATION DES ,.ION
FEET to •FEET• two"permanent landmarks.
0 -12. Topsoil -
12: Sdnd & .Gravel
55 96" Coarser -Gravel'
If yield was tested at different depths during drilling, list below cs7 'b
• FEET GALLONS PER MINUTE 'z \ PR
t
�Nszrd.& .X.
DATE-WELL COMPLETED i PERMIT NO.- REGISTRATION NO. DATE OF REPORT WE R Signa re)
2%9 73 ( 14686 100 2/9/73
BOARD -