HomeMy WebLinkAboutWell New 707 Chapel Road (2) WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
DB4 71-6' WELL DRILLING PERMIT 5259
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATIO WELL(Town} tree) (Lot Number) DA7
s
OWN OF WELL
INDIVIDUAL BUfLDER OTHER(Specify)
OWNER'S ADDRESS
PROPOSED LrJ DOMESTIC ❑ BUSINESS• TEST =Est.USE OF r• �TABLISHMENf FARM yyEllWELL PUBLIC AIR OTHER
SUPP Y INDUSTRIAL ❑ ONDITIONING ❑ (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
I
,!Flo
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 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 informo-
tion' filled in and it has ount signed by the Director of HMth or his agent. ^
02
A(POVIAHT
(Sign n3 APPLICANT'S ADDA E REGISTRATION NO.
BY(T Ith fficer or Agent) DATE
LJ APPROVED El REJECTED 7/
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-S 12-69 WELL DRILLING BOARD Do NOT Oil in
State Office Building
STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME XS r
OWNER r
LOCATION (No.8 Street) (Town) (Lot Number)
OF WELL
BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL ❑ UP PLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (spLIC AIR ecify)
DRILLING � �iCOMPRESSED CABLE ❑ OTHER
EQUIPMENT ROTARY L�JJ AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER DIAMETER(lnch WEIGHT PER FOOT 4VE SHOE A CA NG RO EDT—
DETAILS DETAILS �( Lr J THREADED ❑WELDED ❑YES ❑NO YES NO
YIELD HOURS G.P.M. YIELD(G./I.M.)
TEST ❑BAILED ❑ PUMPED L n COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specf/yfeet) DURING YIELD TEST(feet) -Depth of Completed Well
LEVEL in feet below Land surface:
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(Inches) I 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 welt with distances,to at least
two permanent landmarks.
G C pLy��
e "g,
ICY
If yield was testei.ot different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PE M T NO. !� REGISTRATION NO. JDAT OF REPORT q WELL RILLER{ ature)
(17
BOARD
.,
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 72-69
WELL DRILLING BOARD Do NOT fill in
State Office.Building
STATE WELL NO.
HARTFORD,CONNECTICUT 06115 ( / s
n OTHER NO.
NAME dI_ AD
RESSOWNER
1 f { � a /
LOCATION v (No. &'Street) f/ %(Town) (Lot Number)
OF WELL
BUSINESS
PROPOSED C�DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL PUBLIC AIR 1:1SUPP Y ❑ INDUSTRIAL CONDITIONING OTHER
peif )
DRILLING I L I ROTARY L�J R PERCUSSION PERCUSSION C-OMPRESSED CABLE OTHERif )
EQUIPMENT --
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS THREADED ❑WELDED ❑YES ❑NO ❑YES ❑NO
f YIELD �,f�_ HOURS G.P.M. YIELD(G.P.M.)
TEST ❑ BAILED 11 PUMPED 5 COMPRESSED AIR
W�
WATER MEASURE FROM LAND SURFACE—STATIC(Speclfy/eet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL } in feet below Land surface: 49
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 _ Sketch exact location of well with distances, to at least
FORMATION DESCRIPTION
FEET to FEET two permanent landmarks.
71
114)
t�f.l� li
I
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 DRILLER(Si ature)
,
aee E�e^e� €tee-ce-.t ergrrr•€� rar�:e to sF�e�at,a