HomeMy WebLinkAboutWell Correspondence 364 Deming Street V
WELL COMPLETION REPORT STATE'OF CONNECTICUT Do NOT rill in
WDB-5 12-69 WELL DRILLING BOARD
STATE WELL NO.
State Office Building
HARTFORD,CObNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER MARIO CICERO 376 DEMING ST. 1 13--4 WINDSOR, 'CONN.
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL 3.q DEMING ST. SOUTH WINDSOR
BUSINESS
PROPOSED ®DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DOLLING THER
EQUIPMENT N ROTARY ❑ A R P RCUSSION ❑ P RCUSSION ❑ (Specify)
CASING LENGTH(lest) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHCE WAS C S TED?
DETAILS 40 6 19.45 ® THREADED ❑WELDED ®YES ❑NO ❑YES x NO
YIELD HOURS G.P.M. YIELD(G.P.M.)
TEST ❑BAILED ❑ PUMPED ® COMPRESSED AIR I 4� 4)4
MEASURE FROM LAND SURFACE—STATIC(Specify leef} DURING YIELD TEST(feel)
WATER Depth of Completed Well
LEVEL 25 200 in feet below Land surface: 275
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)
I j PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances, to at least
FEET to FEET FORMATION DESCRIPTION Iwo permanent landmarks.
0 1.2 Sand & Gravel
12 30 Hardpan
30 275 Reddish Rock
o'
YA F, zd�.y
If yield was tested of different depths during drilling, list below t
FEET GALLONS PER MINUTE is)et t' J
FM 1"'j
DATE WELL COMPLETED PERMIT NO, REGISTRATION NO. JDATE OF REPORT ELL I (St g to )
2 81 1 100 1 17/72 �
BOARD
:IL ILIING'BOARD c ' STATE Of CONNECTICUT. PERMIT NUMBER-
w�B a WELL DRILLING PERMIT 1
T STATE`OFFICE BUILDING,HARTFORD,CONNECTICUT D6115
"LOCATION OF WELL(Town), - (Street) (Lot Number) DATE
:.OWNER OF WELL:: r-�
' .INDIVIDUAL.; BUILDER ❑.OTHER(Specify) 'i RIG�J C? �i Esl �
OWNER'S ADDRESS
Nor, PROPOSED# BUSINE TEST
Est. No.of
® DOIOESTIC '❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF ` served.
i WTHER
ELL ❑ SUPPLY ❑:INDUSTRIAL ❑ CONDITIONING ❑ (Specify)PJBLIC
O -
SKETCH OF WELL LOCATION
Locafe well with respect to at least two roads,showing distance from intersection and front of lot
W s
Locohn:ef,:.lo#tp:'at"letisi,fwo.roads Well aocation an lot and to house(if present)
:F..
l
!lam Indicate North,
+ri{J'srir
- l
APprozimate number of:feet from well to
neare3t-source•of.•.possible-contcminationi 75
:.The underskgned:is oware.fliat upon completion.of the well, a"Well Completion Report'-' containing construction details and information required under Section 6 of
k
Publk-:Act-659.must.be:seintto the-owner,the Board and the Water Resources Commission on the form provided by the Board.This permit is not valid until all informs- j
Ikon is•filled in,and it.has been counter-signed by the Director of Health or his agent:
T.(S afuisJ �j�' APPLICANT'S ADDRESS rrt � ,�7 REGISTRATIIO�N NO.
r -'rt +.�•L/.,' L L 3 • W.L'J:S1J.'y l��Y •1�1�0 ; •��0
BY low, .s h Officer or Agent) ` 1 DATE
APPROVED":: ❑ REJECTED
REMARKS.::..
. DIRECTOR.OF HEALTH