HomeMy WebLinkAboutWell New 00 Smith Street (3) WELL•DRILLING BOARD WD&4 1149 STATE OF CONNECTICUT PERMIT NUMBER
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WELL DRILLING PERMIT 2 3 3 71
STATE OFFICE BUILDING,HARTFORD,CONNEGTICUT 06115
'7 a
LOCATION'OF WELL (Town) (Lot Number) DATE
OWNER OF WELL
® INDIVIDUAL ❑ BUILDER OTHER(Specify) ,
PROPOSEDDOMESTIC ❑ �ABLISHMEW ❑ FARM ❑ WELL Est e of
• USE OFFPeople-being
- WELL ❑ PUBLIC ❑ INDUSTRIAL ❑ CAlitONDITIONING ❑ OTHER served.
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from inrs teection and front of lot _ .. .
Location of lot 10 at least two roads Well location on lot and to house(f present)
ORNK kt.
Indicate North Y
Approximate number of feet from well to
nearest source of possible contamination: V cat
The undersigned Is aware.that upon completion-of the well,a"Well Completion ReporW containing construction details and information required under Section
25 131 of the 1964 Supplement to the Genera)Statutes must:be'sent to the owner,the Board and the Water Resources Commission the form provided by the
Board. is permit Is lid until l,ilrf mation Is filled In and it h been nfersigned the Director of Heal or age
4 15
APP.LICANT,(8tynatttra) I APPLICANT'S REGIS TIONNQ:
R
BY .Health or or dpent)
i APPROVED REJECTED
RETURN THIS COPY TO CONNECTfCUl:WELLDRILLINGBOARD
WELL COMPLETION REPORT STATE OF CONNECrICUT -Do NOT fill in
WDBS 12-M*~REV.971 WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER B. .Maksymiuk I 32 Lincoln St ltfd.
LOCATION (No.6 Street) (Town) (Lot Number) .
OF WELL 188 Smith St S. Windsor
BUSINESS
PROPOSED
❑ DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
'
USE OF'WELL ❑ PUBLIC AIR OTHER
SUPPLY• ❑ INDUSTRIAL ❑ CONDITIONING ❑ (specify)
CABLE. OTHER
DRILLING ❑ ROTARY LwI.A RMPERCUSSION . 0 PERCUSSION ❑ (specify)
EQUIPMENT
LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS.CASING GROUTED?
CASING
DETAILS 221 6 I 19 THREADED ❑ 1K 1 WELDED YES ❑NO ❑YES ❑NO
( HOURS YIELD(G.P.M.)
YIELD
TEST ❑ BAILED ❑ PUMPED ® COMPRESSED AIR 4 .8
MEASURE FROM--LAND SURFACE—STATIC(specify-reet) DURING YIELD.TEST(feet)
WATER 80 1 375 -T I In feat below Band sUrfacet 375
LEVEL IIII I LENGTH OPEN TO AQUIFER(feet)
MAKE
DErais Sior SIZE DIA R(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches)FROM(feet) TO(feet)
(PACKED: I gravel.pack(inches): ( I
DEPTH FROM LAND SURFACf FORMATION DESCRIPTION Sketch'.exact location of well with distances,to at least
FEET to FEET two permanent landmarks.
0 211.- sand,clay,gravel..
T-- 211 375 red rock.
If-yield was tested at different depths during drilling;list below _ -
FEET GALLONS PER MINUTE
e 91.
DATE WELL'.COMPLETED.- PERMIT NO:.. REGISTRATION..NO.. DATE OF REPORT. ----.
11-6-74 . I 23371 I 7 12--5-74
BOARD
r
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV. 9-71 WELL DRILLING BOARD Do NOT fill in
State Office Building STATE WELL NO.
USGS s � � �eARTFORD,CONNECTICUT 06175 �W 7�F
!` OTHER NO.
NAME ADDRESS
OWNER B. iKfp 7 r § {
LOCATION (No. &Street) (Town) (Lot Number)
Y
OF WELL 1 smith St S. Windsor
BUSINESS
fj DOMESTIC ❑ ESTABLISHMENT SHMENT ❑ FARM PROPOSED El TEST WELL
USE OF
WELL PUBLIC AIR❑ SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING PRESSED CABLE OTHER
EQUIPMENT +—I ROTARY AIR r�PERCUSSION LJ-PERCUSSION ❑ (Specify) ^
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT
CASING DRIVE SHOE WAS CASING-GROUTED?
221 1 THREADED
DETAILS ( I ❑ WELDED I �-YES ❑NO ❑YES ❑NO
YIELD HOURS YIELD(G.P.M.) �"-
TEST BAILED ❑ PUMPED ❑ COMPRESSED AIR 4
MEASURE FROM LAND SURFACE—STATIC(Specify fee t)I-DURING YIELD TEST(feet)
WATER Depth of Completed Well _
LEVEL 375 in feet below Land surface: 375
MAKE
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL es I GRAVEL SIZE(inches)(FROM(feet) 1T0(feet)
Diameter of well including
PACKED: gravel pack(inch ):
DEPTH FROM LAND SURFAC Sketch exact location of well with distances,to at least _
FEET to FEET FORMATION DESCRIPTION
two permanent landmarks.
11 375 red rack-
I � 4
too
A,-
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE — "---'--'-
whc"e(GY.S) -
7
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Si naturej,r f;
— � F ( g s I j I IU o5— i