HomeMy WebLinkAboutWell New 225 Abbe Road CONSUMER PROTECTION 22-5 PbLA ('
WELL DRILLING BOARD }STATE OF.CONNECTICUT PERMIT NUMBER
CPR-$Rev.11-92 DEPARTMENT OF CONSUMER PROTECTION 90234
WELL DRILLING PERMIT _
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
Soutb Windgnr Abbey Road
LOCATION OF WELL(Torun) _ (Street) (Lot Number) DATE
R. Veilleux & Son 10-31-84
OWNER OF WELL
❑ INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
IIUSINESS TEST Est.N of
PROPOSED DOMESTIC ESTABLISHMENT FARM ;WELL People being
USE OF
served
PUBLIC AIR OTHER
WELL SUPPLY El INDUSTRIAL �.CONDITIONING (Specify) 4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roods,showing distance from intersection and front of lot.
Location of lot to at least two roads Well location on lot and to house(if present)
GW
Indicate North
f4v
,\
Y
. 5E
Approximate number of feet from well to
nearest source of possible contamination:
7
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 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 fille in and it has been counter-signed by the Director of Health or his agent.
I (Sig are) ` APPLICANT'S ADDRESS REGISTRATION NO.
'/V Box 109-381' Hebron Ave.Glastonbur ,Ct. 06033 10
BY(T•ow#Health cer or at) DATE
APPROVED REJECTED �, 8
MARKS I
C ,0 1
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
}
WELL COMPLETION REPORT
STATE'tOFCONNECTICUT
cPR_9 REV.,,_as DEPARTMENT OF CONSUMER PROTECTION
Do NOT fill in
7
WELL DRILLING BOARD 7STATEWELL NO.
165 CAPITOL AVE. -
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME
OWNER 7TADDKt,,S
LOCATION (No. &Street)
OF WELL (Town) ,
n (Lot Number)
PROPOSED SE OF DOMESTIC ESTABLISHMENT FARM l
WELL PUBLIC Cl TEST WELL
SUPPLY INDUSTRIAL AIR CONDITIONING OTHER
DRILLING COMPRESSED
EQUIPMENT ROTARY AIR PERCUSSION CABLE OTHER
PERCUSSION
LENGTH feet (Specify)
CASING ( ) DIAMETER(inches) WEIGHT PER FOOT
DETAILS D V .H AS CASING GROUTED?-
•276 THREADED WELDED YES _ NO YES NO--
YIELD �Ul HOURS TEST BAILED PUMPED COMPRESSED AIR YIELD (G.P.M.)
WATER MEASURE FROM LAND SURFACE—STATIC(Specify""f���eeI) DURING YIELD TEST(feet)
LEVEL Depth of Completed Well
MAKE in feet below Land surface:
SCREEN LENGTW OPEN TO At1UIFER(feet)
DETAILS SLOT SIZE DIAMETER (inches)
IF GRAVEL Diameter of well including GRAVEL SITE(inches) FROM(feet) TO(feet
DEPTH FROM LAND SURFACE PACKED: gravel pack(inches):
.
FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to of least
two permanent landmarks.
—!4 G'a
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
SATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT ✓
ELL LLER (Signature)
DEPT. OF ENVIRONMENTAL PROTECTION _ WATED 1Aecnr g�,.�A