HomeMy WebLinkAbout1975-10-28 - 1475 Main Street - Well Completion ReportN75 mCLLLk Emm-
WELL DRlLlING BOARD sTATé‘OF CONNECTICUT
WDB-4 11-69 WELL BRILLING PERMIT
STAIE OFFICE BUILDING,HARTFORD,CONNECTICUT 06ll5
PERMIT NUMBER31517.
/
111+CLINTON DR..S,IWINDSOR,’CONN
PROPOSED
‘USE OF
WELL
BUSINESS
INDUSTRIAL
Locafe well with respecf to at least two roads‘,showing distance from intersection and front of Ioi
Well location on lot and to house (if present)
U
Indicate North w/(pab/4uL 32":\’J
qo
\
,/H/H/u rfl
nearest squrce of possible contamination:
The undersigned is aware that upon‘oomplefion of the We",a ”Well Complefion Report”containing construction details and information required under Seaion
2543]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 filledin and it has been counter-signed by the Director of Health or his agent.
REGISTRATI ON NO.
IOO
LI NT imam )"3
.
-I.I
APPLICANr's ADDRessLAKEST.,.JRNON,CONN-
APPROVED
REMARKS
Dram
R'EI'URN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
Est.No.of
2W7!
é
\
IOCATION OF WELL (Town)(Street)-(Lot Number)DATE
_SOUTH WINDSOR 1414 MAIN ST .10/28/75
OWNER OF WELLEINDIVIDUAL ‘‘I D'Buimaa D om (specify)_THOMAS J L nDmI-ETJIY JPOWNER'S ADDRESS
W'EEI €QM?LET§C§N RE?O¢§T STAIE OF CONNECT‘CUT
\NDB»5 1269 REV.9-71 \NELL tEREillN$BQARQ
Staie Office Building
HARTFORD,CONNECTICUT 061 ‘5
NAME ADDRESSOWNER133‘‘Z’L‘éC‘E Elig‘i 31::I g S '
Do NOT ‘hll in
STATE W'ELL NO.{UM igé
OTHER NO.
LOCA’HON
OF \NELL
(No.&Sfreer)(Lo?Number)
1%l$s gi?t Q
PRO?OSEU
USE OF
WELL
DOMESTIC BUSINESS
ESTABLISHMENT D FARM D TEST WELL
{“3L.._J SUPPLY
PUBUC B INbusTRlAL D AIR
CONDlTiONXNG D OTHER
(Specify)
cgtLLthiG
EGdEPMcNT D ROTARY AIR
COMPRESSED
PERCUSSION E §§RBé§ssm D (8pecify)
OTHER
WAS CASING GROUTED?
DYEs NoCASING
DETAILS
YTEI.§7£5I
WATER
LEVEL
LENGTH (fee?)L DIAMETER (inches)i I \NELGHT PER FOOT
THREADED D WELDED
DRIVE
EYEs
SHOE"
NO}I
HOURSDBAILEDPUMPEDECOMPRESSEDAIRIEII
YIELD (_G.P.M.)“If“?(ZN!
MEASURE FROM LAND SURFACE—STATIC (Specify feef)if;DURING YIELD TEST (fee?)f\‘p>I d Well
SJ‘IEEN
53 T.&IL5
MAKE
i ’3EEQE E?:¥v w&*i$
LENGTH OPEN TO AQUIFER (feef)
SLOT SIZE
é:
‘DIAMETéR (Inch€5)E ’H;PACKED
GRAVE!-DIameTer of well includlng GRAVEL SIZE finches)FROM (fwf)TO ffeaf)
I gravel pack (inches):I
DEDTH FROM LAND SURFACE
FEET to FEET FORMATION DESCRIPTION Skefch exac‘r Iocafion of weil wifh distances,to a‘r Ieasf
fwo permanent landmarks.
f:ww-P;@ILE gilE
.JU.y"
3ir§v%l
If yield was Tes’red a’r differenf depths during drilling,list below
GALLONS PER MINUTEFEET
DATE WELL COMPLETED
1w if Kw:
PERMIT NO.REGISTRATION NO.DATE OF REPORT wrt’pizgLER‘(Signaggg)1/3\k.»
BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB~5 1269 REV.9—7l WELL DRILLING BOARD
Stale Office Building -
1 HARTFORD,CONNECTICUT 061 I5-
Do NOT fill in
STATE WELL NO.
OTHER NO.
OWNER
LOCATION'.
OF WELL
NAME ‘ADDREss.
.RAE DONI‘TELLY .114 CLINTON DR..SJ;WINDSOR,CONN.
~(Na.&sgreel)(Town)(Lot Number)51414-‘MALIN ST .“‘SOUTH WINDSOR
PROPOSED
USE OF .
WELL I
E BUSINESS
ESTABLISHMENT
..E]FARM B TEST WELL
-
DOMESTIC
SUPPLY
PUBLIC D INDUSTRIAL AIR
CONDITIONING D OTHE-R
(SPeCIfY)
DRILLING
EQUIPMENT D ROTARY >..AIR
COMPRE$5ED
PERCUSSION
CABLE
PERCUSSION ‘D OTHER
(Speafy)
CASING
DETAILS
LENGTN (feet)
26%,PIAMETH!(inches)
2
WEIGHT 'PER FooT E THREADED D WELDED
'DRIVE SHOE
Eves No
WAS CASING GROUTED?
EYES ENO
YIIEEstTD HOURSDBAILEDEPUMPEDBCOMPRESSEDAIR LI.YIELD (G-P.M.)2O
WATER
LEVEL
MEASURE FROM LAND SURFACE—STATIC (Specify ieel)15 'DURING VIELD IEsT (keg)26 29%
SCREEN
DETAILS
MAKEStainless Steel Drive.Point 'I IENGTH OPEN TO AQUIFER (fact)3 Ft.
SLOT SIZE 6 .DIAMETER (inches)2 IF GRAVEL‘PACKED:
’'Diameier
of well including.
gravel pack (inches):
GRAVEL SIZE (inches)FROM (fee!)TO (fee!)
DEPTH FROM LAND SURFACE
FEET 1o FEET .FORMATION DESCRIPTION two
Sketch
permanent
exact louiion
Iandmgrks.e
f w ll with distances,to at least
O 2O Fine Silt
2O 26 Gravel 8:,Sand
26 29 Gravel'
If yield was tested at different depths during drilling;list below
FEET '.—GALLONS PER MINUTE J
M I4I°AJ J 7-
'‘DAIE WELL COMPLETED .
11/6 /’7 5
PERMIT No.'‘
31 517
REGISTRATION NO..7 T
‘1 00
DATE OF REPORT ’
11/18/75
W LL (Signa re)
VP .v'I 7r