HomeMy WebLinkAboutWell New 00 Abbe Road Extension (5) WELL COMPLETION REPORT STATE OF CONNECTICUT t Do NOT fill in _
WOB 69 s 12. REV.9.71 WELL DKIL•LING"BOARD
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER.NO.
NAME ADDRESS
OWNER SOUTH WIN•DSOR BUILDMI, ITC. 49 ROSEMARY LANE S. INDSOR CONK
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL ABBY ROAD EXT. S. WInSOR
DOMESTIC ❑ ESTABLISHMENT ❑ FARM
BUSINESS
PROPOSED ❑ TEST WELL
USE OF
WELL ❑ PUBLIC AIR OTHER
SUPPLY ❑ INDUSTRIAL
❑
❑
DRILLING (� OTHER
CONDITIONING (Specify)
EQUIPMENT ROTARY ❑ AIR MPERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 1 ( I045 I lid THREADED ❑ WELDED I (IRYES ❑NO ❑YES ®NO
YIELD nHOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED 12 COMPRESSED AIR 4 12
WATER
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
5 90
LEVEL 1 I in feet below land surface: lOO
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including I GRAVEL SIZE(inches)FROM(feel) TO(feet)
I PACKED: , gravel pack(inches):
DEPTH FROM LAND SURFAC FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET, two permanent landmarks.
0 9 Sand & Clay
9 100 Bedrock -
70"/
z�
If yield was tested at different depths during drilling,list below 7v
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL LLER Signatu )
5/9/79 - 58917 100 5/15/79
BOARD
WELL DRIWNG BOARD STATE OF CONNECTICUT PERMIT NUMBER
tND" 11-69 WELL DRILLING PERMIT 58917
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (8treet) (Lot Number) DATE
SOUTH WINDSOR ABBY ROAD EXT. 7 I 4/19/79
OWNER OF WELL
0 INDIVIDUAL ❑X BUILDER [] OTHER(Specify) SOUTH WINDSOR BUILDERS, INC.
OWNER'S ADDRESS
49 ROSEMARY LANE, S. WINDSOR, CONN. 6BUSINESS
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ � Peopkebei g
USE OF served.
WELL PUBLIC❑ SUPPLYElINDUSTRIAL ❑ CiR OTHER
ONDITIONING ❑ (Specify) 4
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 I and to house Of present)
JI
Indicate North
• X I
Approximate number of feet from well to
nearest source of possible contamination: ' 751
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 countersigned by.the Director of Health or his agent.
APP (B APPLICANT'S ADDRESS REGISTRATION NO.
GJ , LAKE ST. , VERNON, CONN. 100
Jr BY(Town Sealth Officer or ent)AP DATE
PROVED El REJECTED
J I
REMARKS _
Pam•
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD