HomeMy WebLinkAboutWell New 401 Abbe Road CONSUMER PROTECTION
WEtl DRKLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-6 REV.11-92 DEPARTMENT OF CONSUMER PROTECTION 141972
WELL DRILLING PERMIT
165 CAPITOL AVE.HAR46RD,CONNECTICLIT 06106
LOCATION OF (Ioww//� II (Strew (Lot Number) DATE
OWNER OF WELL `
HARP WUAL 'WILDER OTHER(Specify) --LA oer
OWNER'S ADDRESS
ESS TEST Est.No.of
PROPOSED 01DOMESTIC EST NARLKNAAENT FARM ❑ WILL People being
USE OF PUDLIC AIR served.
WELL a SIIJPFL INDUSTRIAL CONDITIONING ((Spec iR) 7
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 bt and to house(if present)
Indicate North .
FF1J#j NE r39"
. 3a
j
e
Q
Approximate number of feet from well to t5
1 nearest source of possible contominotion: 7
The undersigned is aware that upon•completion of the well, a "Well Completion Report" containing construction details and information required under Section
the 1%9 emtn! to the General Stotutes must be sent to the owner. the Board and the Water Resources Commission on the form provided by the
i ` r l t un it all infor o filled i 't has been counter-signed by the Director of Health or his agent.
AFFUC4NT'S ADDRESS REGISTRATION NO.
1431 q/6/r Gr Q 606G 3a Y
11.1 BY(7'awff Health Office or Agent) DATE
C'APPROVED ❑REJECTED -
REMARKS AA �
OLCI
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
k
WELL COMPLETION REPORT STATE OF CONNECTICUT
CPR-9REV.'F:-e2 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
STATE WELL NO.
WELL DRILLING BOARD
165 CAPITOL AVE.
HARTFORD, CONNECTICUT 06106 OTHER NO.
NAME ADDRESS
OWNER Allen Bergero 401. Xbbe ROaa, South Windsor, CT 06074
LOCATION (No. & Street) (Town) (Lot Number)
OF WELL 401 Abbe Road South Windsor
BUSINESS
PROPOSED LJ DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL PUBLIC AIR SUPPLY INDUSTRIAL CONDITIONING ❑(Specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT ROTARY R AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feETER (inches) WEIGHT PER FOOT IV H WAS CASING GROUTED?
DETAILS '7S! 7761,
17# o THREADED O WELDED [i]YES [:]NO [YES �NO
YIELD HOURS YIELD (G.P.M-)
TEST BAILED PUMPED 5; COMPRESSED AIR 20
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 60, 204, in feet below Land surface: t
MAKE LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM(feet) TO(feet
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET TO FEET two permanent landmarks.
0 40 SAn6 clx* Gr woL
40 60 Clav
60 205 Saind S-to: s-
t
i
f t
` L` � f
If yield was tested of different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT W7, ("LLER(Signa.tur�
(
DEPT. OF ENVIORNMENTAL PROTECTION-WATER RESOURCES