HomeMy WebLinkAbout1974-9-19 - 1562 Main Street - Well Completion ReportWEIL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER ‘
WDH “-69 WELL DRILLING PERMIT ':2 6 0 4 8-
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 b9
LOCATION OF W L (Town)~(Strdt)(Lot Number)DATE
OWNER OF E
INDIVIDUAL D Butmsn D 07m (specify)
OW'VIEYS ADDRESS
PROPOSE
USE OF
WELL
DOMES‘HC BUSINESSESTABLISHMENT D ‘rAm TEST
WELL
PUBLIC
SUPPLY D ~B éIORNDITIONING (SPeCIfY)
OTHERINDUSTRIAL
E51.No.of
People being
sewed.
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showmg distance from Intersection and from of Io?
Locahon 0f lot to at least two roads
Indicaie North
Approximate number‘o’flfeef frornl well to ‘..
nearest squrce of possible contaminition:>’I‘V.
The undemgned us aware that upon completion of the well a "Well Complehon port”oontaxmng construction details and information reqmred under Sectron '
25431 of the 1969 V-Iement to the Genet tutes must be sent to the owner,the Board and the Water Resources Comrmsslon on the form provnded by the
gned b the Duredor ofu.l 1':_.
APPROVED
REGISTRATION NO.
DATE7
REMARKS t
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD-
.1
WELL COMPLETION REPORT ‘..'‘‘‘wow 12$REV 971 "..;WEI.l DRILLING BOARD ‘:‘-
.'‘‘
.State Office Bunldm "-':r.HARTFORD CONNECTICUT 061 15 ‘‘-‘~-
's'rAtE or éIONNEctIcuI:‘Do NOT fi“invSTA‘TE WELL No .'‘'5’.‘'
‘omgk No.\‘
OWNER
IOCATION
OF WELL.
‘
_-..
.-..Roma-husaor,"-.f.r.'wm‘-
g DOMS”?,—,.BusINEss
E AausHMENT
'
$.-‘.Hi‘I.‘-f ‘v ;,''.'
supply
PuBLIC'».,.'E .'NDU5‘R'AL“V 7 -_.AIR
CONDITIONING ,.(Speufy),
‘Dmilme ',
I.EdulPMEm ‘
'
E ROTARY AIR
COMPREsSED
PERCUSSION .“t ‘
.
.
l'm (Specify)
OTHER
.V .-I t -
-.'..'
MICASING ’I'.oEtAILs r
EN TH (feet)§IAMHER (inches)7--.WEIGHT)PER
_i I DRIVE SHOE A f.t ‘
YE?NO
_r 'r WAS CASLNG GROUTEQ?”_.‘~.,.Y.E§I N9.:...-'VIEL0(6.P.M:)'
w "‘
Wen
surface..
'
'
V-B BAILED '
MEASURE FWM
._.
LA5 -‘e
,In
oeplh
feehbelow
.Completed
Land5‘
I.
'.__:I'4 ..:I‘-‘l I '‘A .I '"i 0-.‘'
LENGTH OPEN To AQUIFERuem)
"‘-’v'I
I
I"-[:7IEGRAVEL‘“PAQKEDE i
'-"‘-'Dlammr ofwe"mdudmg .
ravel pack ('nches)'
‘.-uGRAVELsIZE(mdm)FROM (feet)"Team”.'i I .
.x I ‘H
E :k ._
.PEPTH'FR.OM l‘AfIDfSURFgCIE .
i Sketch exact loéahon of wall with dastances,Io at leastMo‘permane landmarks
'‘u FEEIf _Iio IFI‘EET ~~
;l .yleld was tested at dliferent depths durlng dr'FEET w "
km?"‘