HomeMy WebLinkAboutWell New 00 Abbe Road Extension (3) WE4':DRILLING BOARD PERMIT NUMBER
,r .t STATE Of CONNECTICUT
worgq. IIan WELL DRILLING PERMIT 2 85,/
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL(Town) (Street) / (Lot Number) DATE
J � o �� FX2— � 70
OWNER OF WELL
❑INDIVIDUAL IN BUILDER ❑ OTHER(Specify) /-0
OWNERS 7RESS
s
PROPOSED BUSINESS TEST Est.No.of
USE OF DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑
WELL People being
served.
WELL PUBLIC AIR❑ UHER PP Y ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTpec;W >/
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot
location of lot fo of least two roads Well location on lot and to house(if present)
L)
Indicate North
ILI
y �xT
Approximate number of feet from well to
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 Seaton 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.
APP ( afuro ^ L APPkICANjT S�DRESS/' REGISTRATION NO.
I ti /1 V t' yf G vt �/Lt l0 U
r BY•(fown Health �fficer or Agent) DATE
Fr—]APPROVED ❑ REJECTED r S
REMARKS
�•,
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-S-'r2-69 WELL DRILLING BOARD Do NOT Fill;n
State Office Building STATE WELL NO,
HARTFORD,CONNECTICUT 06115
OTHER NO.
OWNER NAME ADDRESS
r a 69 Ash Rd. , Wapping, Conn.
LOCATION (No. ,Street) (Town) (Lot Number)
OF WEu Abby, Ext. S. Windsor 2
NESS
PROPOSED
® DOMESTIC [:1 ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING OTHER)
DRILLING COMPRESSED CABLE EQUIPMENT PC] ROTARY ElA R PERCUSSION ❑ PERCUSSION CI ((Specify)
CASING LENGTH(feet) 61AMETER(inches) WEIGHT PER FOOT DRIVE SHOE S C NG OUT
DETAILS 22 6 19.45 ® THREADED ❑WELDED C�C..1 YES ❑NO YES NO
YIELD HORS G.P.M. YIELD M.)
TEST ❑BAILED ❑ PUMPED IN COMPRESSED AIR 1 (O.P.
30 30
WATER MEASURE FROM LAND SURFACE—STATIC(Speclty feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 20' 60 (n feet below Land surface: ?5
MAKE LENGTH OPEN TO AQUIFER(lest)
SCREEN
DETAILS SLOT SIZE DIAMETER(Inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: grovel pack (inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances,to at least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
0 12 Clay,
12 75 Redrock
j
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE — -Z3 r
E' )<
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WEEV69L R(Si attire)
213
BOARD