HomeMy WebLinkAboutWell New 00 Buckland Road (2) WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
VVD" 11-69
WELL DRILLING PERMIT 2632
STATE OFFICE BUILDING,HARTKAD,CONNECTICUT 06115
r
LOCATION OF WELL(Town) (Street) / (Lot Nvmber) DATE
u of
OWNER OF WELL
®INDIVIDUAL ❑BUILDER ❑ OTHER(Specify)
OWNERS ADDRESS /
PROPOSED �( 'BUSINESS TEST Est.No.of
USE OF F-s! DO�TIC ❑ ESTABLISHMENT L_J FARM ❑
YVELL People being
WELL ❑ SUPPLY ❑ INDUSTRIALAIR served
❑ 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 on lot and to house(if present)
Indicate North
12114
�tj c_Al vl &vet( Zr- f-T ?
X
s
Approximate number of feet from well to pt
nearest source of possible contamination: d
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 Ad 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.
(5+ re APPLE Ni'S AD
��Lr►7
REGISTRATION NO.
Q V G • !�O
BY(I, Health Officer or Agent) DATE
❑APPROVED ❑ REJECTED r�
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WELL DRILLING BOARD D NOT fr!!in
WDB-5 12-69 STATE WELL L NO.
State Office Building , i
HARTFORD,CONNECTICUT 06115 5�'V
OTHER NO.
NAME ADDRESS
OWNER e;,
nadcort Conn.
LOCATION Street) " (Town) (Lot Number)
OF WELL B' ,c .a';d €d a S3 s Windsor
BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING OTHER
DRILLING
MENT ® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION OTHER
EQUIP )
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS J. THREADED El WELDED YES ❑NO ❑YES LINO
YIELD HOURS G.P.M. YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED L COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 200 in feet below Land surface: 300
SCREEN 1ENGT
MAKE H OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET to FEET two per landmarks.
100 ciaY u
1 ao 300 Bedrook
O/'q
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 WELL DRI dfR(S�gnatur
1 1 7 1 � �
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDS-5T 12-69 WELL DRILLING BOARD Do NOT fig in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER ta 186 Brook St. , S. Windsor, Conn.
LOCATION (No. treat) (Town) (Lot Number)
OF WELL Buckland Rd. S. Windcor
BUSINESS
PROPOSED
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (specify)
DRILLING COMPRESSED CABLE EQUIPMENT ® ROTARY ❑ AIR PERCUSSION ElPER PERCUSSION ❑ (specify)
CASING LENGTH(feet) DIAMETER(Inches)IWEIGHT PER FOOT [� DRIVE SHO rl CASING GR�j TED?
DETAILS 24 6 19.45 4�I THREADED ❑WELDED 0 YES ❑NO LJ YES NO
YIELD HOURS 1 G.P.M. �5 YIELD(G.P.M.) �5
TEST ❑BAILED ❑ PUMPED Lgl COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 30 200 in feet below Land surface: 300
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(Inches) IF GRAVEL Diameter of well including GRAVEL SIZE(Inches) FROM(feet) TO(feet)
PACKED: gravel pack (Inches):
DEPTH FROM LAND SURFACE FEET to FEET FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
two permanent landmarks.
0 14 - Sandy Topsoil
14 100 Clay C1 C, r/y
100 300 Bedrock
UnIck—
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 WELL D R( gnatur
11/17/70 2632 100 12/3/70
BOARD