HomeMy WebLinkAbout1993-8-25 - 151 Ellington Road - Well Completion ReportMILL GGNIPLETIVN KWGK❑ L� �U v �� A OF CONNECTICUT
CFR_9KV. tl� DEPARTMEN CONSUMER PROTECTION
vo W DRILLING BOARD
• - '• ^ ,4 7 1993 165 CAPITOL AVE.
HARTFO CONNECTICUT 06106
f3SING D101
Do NOT fill. in
STATE WELL HO
OT R NO
OWNER
NAMEJ. W. JONUtpt. Of COnSU
151 ELLINGTON ROAD SOUTHWINDSOR, CT 06074
EOCATIOM
OFW&L
(No. A Srre*1) (Town) (lot Number)
151 ELLINGTON ROAD SOUTHWINDSOR 151
PROPO'd�
1111511 OF
"111111.`
� DOMESTIC ❑ EBSTABLISiNMENT ElNESS p FARM TEST WELL
PUBLIC
❑ SUPPLLY ElINDUSTRIAL p CCONDIVONING p AIR °THE
` )
SQUOMM -
OTHER
In ROTARY P9 AIRSION p PERCUESSION - -- p (Spec h1
CASING
DUARS
LENGTH (feel
155
DIAMETER (inch") I WEIGHT PER FOOT
6 17
WELDED
® THREADED ❑ WEL
t
X YES NO
w h* t U
YES NO
VIIIILD
vm
HOURS
ElBAILED ❑ PUMPED ® COMPRESSED AIR 5
YIELD (G.P.M )
15
WATU
Um
—
AIEASLIRE FROM LAND SURFACX—STATIC (Specify Ieel) DIIRING YIELD TEST lf�i)
.40 325
Depth oI Cornpleted Well
R feel below Land "ace; 3 2 5
4R�f
MAKE
LENGTH OPEN TO AQUIFER (feet)
OlTAllfi
SLOT 5fIE DIAMETER (incites)
IF GRAVEL Diomew of well including
PACKED•. 9 awal pock (inches):
GRAVEL SIZE (inches) FROM i(eetl TO (feel
MTN FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch enact location of well with distances, to at least
.. .
two pemtonent landmarks.
FEET TO FEET
0
150
SAND —CLAY —MUCK
•- old. _
150
325
RED SHALE
M Yield woe teased or el ff"M dttptla during drilling, fist below
NET
"LOW PER MIMITE
DATE ww�LL y aw.raLTEO PERMIT NO. TION NO.
8/�3/93 158023 �
DATE OF REPORT
8/25/93
R (Sig+wwral
#HN M. DUFPOR fjj
BOARD
COMUMER PROTECTION
WELL DRILLING BOARD T E OF CONNECTICUT
CPR-s REV. 11-02 DEPARtMEN CONSUMER PROTECTION
WELL DRILLING PERMIT
t . UUU 165 CAPITOL AVE., HARTFORD, CONNECTICUT 06106
OCCUPATIONAL LICENSING DIVISION
/]opt. of Consumer Protections ,
LOCATION OF WELL rTOLM)
I
WELL
INDM LL WILDER
OTHER (Specify)
PERMIT NUMBER
�158023
(Lot Numbrr) DATE _/ 191 5J?
PROPOSED
BUSINESS
FARM
TEST
Est No. of
ESTAKISHAIENT
WELL
People being
USE OF
served.
WELL
USUPPLY
INDUSTRIAL � CONDITIONING
�
(specify)
f
SKETCH OF WELL LOCATION
Locale well with respect to at least two roods, showing distance from intersection and front of lot
Location of lot to at least two roods IWell location on lot and to house (if present)
IndsooM Ntsrtft
,
Approximate number of feel from well to iy .
nearest source of possible contamination: j
The undersigned is aware *41 upon completion of the well, a "Well Completion Report" containing construction 'details and information required under Section
25131 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 oil information is filled in and it has been counler•signed by the Director of Health or his agent
V19 / a 2-0-13
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD