HomeMy WebLinkAbout1985-3-18 - 201 Miller Road - Well Completion ReportBOARD
WELL COMPLETION REPORT srA'rE or CONNEcncuT '
,cpk‘vnsv n 32 DEPARTMENT OF CONSUMER PROTECIION
WELL DRILLING BOARD
.165 CAPITOL AVE.'HARTFORD,CONNECTICUT 06106 I
Do NOT fill in
SIAIE WELL No.‘
'OIHER N0.‘
.owun
F
NAME
REJEAN DACQUES
Amness
21 LEFAEL BLVD SO WINDSOR .CONN .06074
"Locmou'0s wm'
(No &Skeet)..(Town)(L01 Number)
MILLER ROAD,WOU‘I‘H WINDSOR CONN .4 20 l
now-kwus:0§
WELL
.DOMESTIC
'
{SIABLISHMENT
BUSINESS
_D FARM ‘D rEst WEu‘
PUBLIC
sUPPLY D INDusrRIAL"CONDITIONING
AIR
(Specify)
OTHER
DRILLING
E'QuIPMENT E ROTARV
COMPRESSED CABLE OTHER
AIR PERCUSSION PERCUSSION (Specify)
''-CASING
DETAILS
LENGTH (feel)26 FEET
DIAMETER (inches)
6 1n .
WEIGHT PER FOOT
17 lbs I ‘Q THREADED D WELDED;
I -IVE SHOE
YES D No
WAS CASING GROUTED"
EYES No
VIELo'I TESTA
HOURSDaAILEDDPUMPED-E‘COMPRESSED AIR it hours l YIELD (GEM)15 gallons
WATER
'-
LEVEL
MEASURE FROM LAND SURFACE—STATIC (specify Teen'water le'vel‘4O feet
DURING YIELD TEST (feet)220 feet Deplh of COmpIeied Well
in feéi belgw Land surface:220 feet
SCREEN
DETAILS
MAKE LENGTH OPEN To AOUIEER (Teen
SLOT SIN’DIAMETER Iinches)IE GRAVEL
PACKED:
Diomelet of We“including
grave!pack (inches):
GRAVEI.SIZE (inche's)FROM (feei)TO (feei
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Skeich exact location of well wilh disTances,To OT leasi
.two permanent Iandmarks.FEET TO FEET
A
O 18 SAND
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./\Va.-
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a S +9 U‘
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19 .>220.RED SAND STONE
lf yield was Tested ul-diffevem depths during drilling,lisl below'FEET 'GALLONS Fm MINUTE.
DATE WELL OMPL TED2188 5
PERMIT NO.lO 0 9 28 REGISTRATION No.DATE REPORT 'l 8 5 WELL DRILLER (SIgnaTure)Ié;1‘:.d 1414 4"]I
CONS’JMER PROTECTION
WELI.DRII.LING BOARD
CPR-8 RW.11-32
r
SOUTH WINDSOR,CONN .
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
WEll DRILLING PERMIT
RMIT NUMBER100928
165 CAPITOL AVE.,-HARTFORD,CONNECTICUT 06106
MILLER ROAD
(Street)
20.1
(Lot Numb")LOCATION OF WELL (Town)
REJEAN DACQUES
DATE
FEB .5‘,1985
{acme well with 'resped Io a1 Ieast Mo roads,showing djslance from inlersec'ion and from of Io!
Locaiion of lo!to a!IeOSI Mo mods Well locavion on Int and Io house (if present)
MN
PpI/
/q.9/'\\73
/
fi'oMW2,“Heia.~fM1/‘Ieie.[(1)0 {awdv
Approximme number of feet from well Io i f
4 nearest source of possible contuminofion:/y.’
The undersigned'is aware the!upon complelion of the well,a
25D}of The 1969 Supplemen'Io 1he General Slolules mus!be sen!Io the owner The Board and the WOVer Resovrces Commission on Ihe form'provided by the
Board This permut Is not volld unlrl all mforrnotnon us fulled In and II hos been counlersrg wew Lsogmc
containing construclicn details and information required under Section"Well Complelion Repon"
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RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
We MW%V/¢——
OWNER OF wm D DINDIVIDUAI
OWNER‘S Aoonsss
nuunsn omEn (Specify)
#3,;mmf.
PROPOSED
.nmm ,grmrm WTNnsnRf.mNN .0607i»
E Domssnc nusmessEstAsusHMEm Q WM
'tssr
wsu
Est.No.
People being
USE or
WELL SUPPLYwwc D mousmAL couomoumcAIR D 0min
(Specify)
sewed.
APPLICANT (5tgnaturz)r.,./
APPLIQNT S ADDRESS Naw BRI‘RINV CONN 06051 REGISTRATION NO.
60’£0.3y (Town Had/lb Ofnctr or Agent)DATE
%VED g/f f5 FJECTED 2-i—8r
REMARKS '
DEPT,OF ENVIRONMENTAL EROTECTEON —‘#LTEQ QE$OHT§CE§
STATE OF CONNECTICUT
CPR-3 REV,Ili82 DEPARTMENT OF CONSUMER PROTECTION
WELL DRILLING BOARD
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106
Do NOT fill in
STATE WELL NO.
OTHER NO,
OWNER
NAME
njiJli$JTT3“1 ‘1 QACQUES
ADDRESS
21 TEFA3L BLVD .SG T WENDSUR ,GONN .0667i;
LOCATION
OF WELL
(No.&Street)(Town)(Lot Number)\WEI.LEE EGiiE ,EQLTTE‘T E‘TEE‘TESOR ,{3mm .2.01
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ESTABLI$HMENT E FARM D TEST WELL
SUPPLY
PUBLIC D INDUSTRIAL AIR
CONDITIONING E OTHER
(Specify)
£331i‘a'n'iir COMPRESSED CABLE OTHER
ROTARY AIR PERCUSSION PERCUSSION (Specify)
CASING
DETAILS
LENGTH (feet)26
DIAMETER (inches)
6 in.
WEIGHT PER FOOT
1 m 1 1 Q THREADED D WELDED
DRIVE SHOE
YEs No1L
‘WA$CASING GROUTED?
A YES NO
YIELD
TEST D AILED COMPREssED AIR
HOURS
PUMPED :EC‘LELE:
WELD (GPA/L)
T i3 liOT LET
WATER
LEVEL
MEASURE FROM LAND SURFACEISTATIC (Specify feel)
water level E?fEEt
DURING YIELD TEST (feet)
22D feDE Depth of Compleled Well
in feet below Land surface:223 feet
SCREEN
DETAILS
MAKE LENGTH OPEN TO AQUIFER (feet)
SLOT SIZE DIAMETER (inches)IF GRAVEL
PACKED:
Diameter of we“including
grovel pack (inches):
GRAVEL SIZE (inches)'FROM (feet)TO (feet
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Skelch exact Iocmion of well with distances)to at least
two permanent landmarks)FEET TO FEET
LV 1 1‘
“Lg,
f’I’t x f7€fz K c.ML
l?22D
If Yield was Iested a!different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED
2f18x’8 3
PERMIT NO.
l6092§
REGISTRATION NO.DATE OF REPORT
3/18/8 ‘3'WELL DRILLER (Signature)
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