HomeMy WebLinkAboutWell New 320 Long Hill Road (2) WELL DRILLING BOARD STATE OF COn NECTICUT PERMIT NUMBER
w°B a 11-69 WELL DRILLING PERMIT - 26140
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STATE OFFICE BUILDING1l1RTFOG;CONNECTICUT 06115
i
LOCATION OF'WELL-(Town) (Street) (Lot Number) DATE
SOUTH WINDSOR 329 LONG HILL ROAD ( 11/41,74'
OWNER OF WELL
INDIVIDUAL ❑ BUILDER ❑ OTHER(specify) JOHN MYERS
OWNER'S ADDRESS
LASE ST. , VERNON, CONN.
PROPOSED ® DOMESTIC ❑ EST BUSIABLISHMENT ❑ FARM NESS ElWELL PeoP le being
USE OF served.
WELL ❑ R OTHER
PUBLIC
UPP Y ❑ INDUSTRIAL ❑ CIONDITIONING ❑ (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 at least two roads Well location on lot and to house(if present)
W
Indicate North 1 D"JG
WOAD
10X CA JAIL
Approximate number of feet from well to ?5
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
25-131 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 it has been counter-signed by the Director of Health or his agerd.
6ORkmkK(S" ns) APPLICANT'S ADDRESS (REGISTRATION NO.
LAKE ST. , VERNON, COIVN' -•, 100
✓ BY Town SeaitA Of oer or dye ) DA
® APPROVED REJECTED ( (� I�7
REMARKS '
/Lftmt�� AEX/,VlTE f/�E/Fe-�VIN�� S/ECD �OQATIVAI .►�i'�D`�a '
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RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT t sTATE or.�eom.4micu.r Do Nor fill in
11YD8 5 1269 aev:v ii _ WELL DRIILING'BOARD•
". -STATE WELL NO.
State•Offka.84kiing
'1HARfFOR6,. :gNNECiIUT•06115 T '
` OTHER-NO.
OWNER.
.NAME ''; •+ :.'- ADDRESS
JQHN MEYERS•-. : . LAKE`.ST'. ,._VEHNON,::r CONN:
LOCATION n _(No &Street) :•'(Town)' (Lot Number)
oF:wEtl 320 LONG'HSLL.ROAD' SOUTH WINDSOR.
BUSINESS
PROPOSED. r.DOMESTIC. `O:ESTABLISHMENT O FARM a TEST WELL
-
USE OF ' -
. WELL= PUBLIC'' AIR' OTHER t
SUPPLY: C�.INDUSTRIAL' CONDITIONING- ..(Specify) '
DRILLING
EQU PM NT ® ROTARY A RMPRESSED PERCUSSION • �`R USSlbl_•: O•(Spedfy)•_.'
CASING LENGTH(feet) -' DIAMETER(inchei) WEIGHT PER FOOT DRIVE SHOE. ;'WAS CASING GROUTED?
I ( t" •Q YES NO DETAILS'• ONOI O f L I ®
- .
1 ; -HOURS
YIELD YIELD(G.PM)•YIELD
TEST OAIL :PUM OMPREED' R '
AE .
MEASURE FROM LAND SURFACE�TATIO'(Specify feet),DURINCa'YIEID TEST(feet) . 4 e
WATER'' �• (' - Depth'o{Completed Well
LEVEL .20 ?r) I in:feet:lielow4Land surfaced 200'
{
LENGTH i.` (• OPEN i0 AQUIFER`feet
SCREEN :i * - .o:•' -
,I:
DETAILS• SLOT.SIZE s; DIAMETER•(inches) IF'GRAYEL. "' ' GRAVE!'SIZE(inches).F.ROM.(feet), TO•(feet)
- Diameter of.well hicluding'
PACKED: �:• gravel pack{inches): (•' ('.
DEPTH-FRONT LAND SURF6a J - : .y_ ;
FORMAf10N'DESCRIPTION` ' Sketch�exact'locajion of well-with-iiistance5,to`at•least
-FEET 'f= two-permanenf�landmaiKse =�: :- :#• •,.. ,".•y `� r�
�i -.A•. ••`\ate 4^
O
t.r:.a:ti..- - :j; t" _ �-. -.mot••,•, ,y�Fa' +_: .yt• .,�,,,:• •.i !:r! '- ,e±.•�` -`'\.
i:. p:
Via. - tee _ _ •-S• _ •y•i'-
•ra r.,•r.. - -•x• - :y sJ.:mot:'.t, �`'a• }.�\•a'.'�� _ -- .r
.43
X,f_ •tom _ {. _ !'',r.,.�.• • - '•t. •• '•'� _ � 'r
,t+.•�l�•�. 4. _ LL ''i.. �i'i: . '<St `G•'.7. .'4•"S s i..� '`'�•.{!'.�•- ..`.
- rtr
f 'd rwa's test,
n.
f'Tel ed at iliff'erant`'de tF( 4rin- drillin "list bel
FEET` '+'
GAI LONS`'PER IIf11Nl)TE%
. '• '.'
,K: - .•`{ "fib_ ..< - �-t� - -
Al
` •y j ,'.i' �- is •,!''" je,
••' Via''" ':?,c •�-�f'�:' :s•�.. :ti..• - _ _ ..
z'Y :FATE.WELL COMPLETED;-',ZPERMIT.
12.%1 0%•.4''::�_P E�RM IT:2NfO;140- •�:-- `100�.� r (
E gn. P4 e)
:1�2' 1• 4� :.
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV, sat WELL DRILLING BOARD Do NOT fill in
State Office Building STATE WELL NO.
HARTFORD, CONNECTICUT 06115
3!� OTHER NO.
OWNER NAME ADDRESS
LOCATION (No. &Street) (Town)
OF WELL 20 LONG HIT. is ROAD & l,�'' ICI R. (Lot Number)
Q DOMESTIC BUSINESS
❑ ESTABLISHMENT ❑ FARM
PROPOSED ❑ TEST WELL
USE OF
WELL ❑ PUBLIC AIR
SUPPLY ElINDUSTRIAL ❑ CONDITIONING ❑ ((Spec fy)
DRILLINGEQUIPMENT lidROTARY ❑ A RMPRESSED PERCUSSSION ElP PERCUSSION ❑ (CABLE (Specfy)
CASING
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS6 119- 5 I FA THREADED ❑ WELDED I IN YES ❑_NO ❑YES [3q NO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED Fil COMPRESSED AIR 4
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet) I Depth of Completed Well
LEVEL 20 175 5 in feet below Land surface: 200
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL I GRAVEL SIZE(inches)(FROM(feet) TO(feet)
Diameter of well including
I I I PACKED: I 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.
0 30 Sand Graved ���Y t � ���s 1� 1" w G
30 2 L Rom
i
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE }
1 €
t
Q �a rJ � ttitt�� Ot tT
l_=(li„ o c(.
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT LLE Sigha.re
12 74_I 2614 I 10 ( L2/17/7
DEPT. OF ENVIRONMENTAL PROTECTION — WATER RESOURCES