HomeMy WebLinkAbout1975-11-6 - 1414 Main Street - Well Completion ReportLOCAL DIRECTOR OF HEALTH
WELE COMPLETION REPORT STATE OF CONNECTICUT
WDB.5 12-69 REV.$71 5 WELL DRILLING BOARD
State Office Building
HARTFORD,CONNECTICUT 061 I5'
Do NOT fill in
STATE WELL NO.
OTHER NO.
OWNER NAME W-;?l:_c.3‘}E 7‘g-ADDRESS
11%§L§§i§i§3 33:3.,$.‘a‘iigihggg,$3$§§.
LOCATION
OF WELL
(No.&Street)(Town)(Lot Number)l§~l$xwxa 53$.Igwim amma
PROPOSED
USE OF
WELL
BUSINESS %§DOMESTIC ESTABLISHMENT FARM TEST WELL
SUPPLY
PUBLIC D [NbusTRIAL AIR
CONDITIONING D OTHER
(Specify)
DRILLING
EQUIPMENT D ROTARY AIR
COMPRESSED
PERCUSSION
CABLE
PERCUSSION gm
OTHER
(Specify)
CASING
DETAILS
LENGTH (feet)DIAMETER (inches)
2
WEIGHT PER FOOT E THREADED E WELDED
DRIVE SHOE
EYES ENO
WAS CASING GROUTED?
YES NO
YIELD
TEST
HOURSBBAILEDPUMPEDDCOMPREsSEDAIR g.YIELD (G.P.M.)2O
WATER
LEVEL
MEASURE FROM LAND SURFACE‘STATIC (Specify feef)DURING YIELD TEST (feef)Depfh
in feet
of
below
Completed
Land surface:
Well 29 E I
SCREEN v
DETAILS
MAKEEtameaa 3tml Ikiva Eemi;
g
LENGTH QPEN TO AQUIFER (feet)‘e
SLOT SIZE
I m
DIAMETER (inches)IF GRAVEL’PACKED:Diameter of well includin
gravel pack (inches):
GRAVEL SIZE (inches)FROM (feet)TO (feet)
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact Iocation of well with distances,to at least
two permanent Iandmarks.FEET to FEET
3i}ifi‘me ei’iw
Rar5,
W iii?
I far:’
3e eyewa,c;emu:
e :2 {'ieevel
If yield was tested at different depths during drilling,I‘ist below
FEET GALLONS PER MINUTE
.$5
DATE WELL COMPLETED
4.1 -'igl’ig
PERMIT NO.
an.52;?
REGISTRATION NO.
1%
DATE OF REPORT
3 3‘gig/at;
WELL 'DRILLER (Signatvre)
I a.m
WELL-"DRILHNG BOARD
WDB-4 11-69 r
PERMIT NUMBER
31517STATEOFCONNECTICUT
WELL DRILLING PERMIT
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town)
SOUTH WHDSOR $
OWNER OF WELL
BUILDER
OWNER'S ADDREss
DOMESTIC
J
PUBLIC
SUPPLY
E INDIVIDUAL
114 CLHTC
PROPOSED
USE OF
WELL
(Street)(Lot Numb er)DATE
41M-MAIE,ST.
OTHER (Specify)
19/28/75
J ,7,—‘T‘HOM A §
v--r_p gmmV TEST Est.No.of
WELL People being
served.
4
BUSINESSESTABLISHMENT
INDUSTRIAL D AIR
CONDITIONING
SKETCH OF WELL LOCATION
D FARM D
B OTHER
(Specify)
Locate well with respect to at least two roads,showing distance from intersection and front of lot
Location of Iof to at Ieast two roads Well location on Iof and to house (if present)
Ifv/AT/aw ,4 V6
Approximate number of fee?from well to
nearesf 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 i969 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 agent.
AP PLICANT'S ADDR ESS REGISTRATI ON NO.
LAE ‘i‘n WOIT g COM.
[m ?I/V\/.r /
vv/-v
12G
D REJECTED
l
AP 1’cANT mm”)
(r44,
.I
APPROVED
REMARKS
E5 paa'4i@ GIVE/x,/69#/
DATE,own Health,Officer or Agent)
DI RECTOR OF HEALTH
3w”\2
vé,
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