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HomeMy WebLinkAboutWell New 50 Ash Road FSC) ���^ CONSUMER PROTECTION WELL DRILLING BOARD STATE(4r CONNECTICUT PERMIT NUMBER CPR-8 REV.11-92 DEPARTMENT OF CONSUMER PROTECTION 87460 WELL DRILLING PERMIT 165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106 LOCATION OF WELL —) tSmer, (Lot Nrrm DATE Rene-Vegteux -^t OWNER OF WELL - ❑ INDIVIDUAL 4 BUILDER ❑ OTHER(Specify) OWNER'S ADDRESS 40 SheMn Ave. Went Haart4ond, Ct. -� BUSINESS TEST Est.No.of PROPOSED I _-I DOMESTIC ❑ ESTABUSHMENT ❑ FARM ❑ WELL People being USE OF `7C served. WELL PUBLIC AIR OTHER ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) 4 SKETCH OF WELL LOCATION Locate well with respect to at least two roads,showing distance from intersection and front of lot Location of Jot to at least two roods Well location on lot and to house (if present) Indicate North . J App nearest sour number of feet-from well to .� „�. � � nearest source of possible conromination: � 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 filled in and it has been counter-signed by the Director of Health or his agent. (Srg ure) APPLICANT'S ADDRESS REGISTRATION NO. P-O.Box 109-387 He6non Ave.Gtaaton Ct. 10 BY(Town Health Officer or Agent) DATE APPROVED ❑REJECTED 11- REMARKS RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION dQ NOT fill in • STATE WELL NO. WELL DRILLING-BOARD 165 CAPITOL AVE. - HARTFORD,CONNECTICUT 06106 OTHER NO: NAM OWNER• R. VeWeaux 6 Son �40 Shetton Ave. pleat HaxtboAd,Ct, 06110 LOCATION (No.8 Street) �,/ (Town) a _,• (Lot�llftuber) OF WELL Ash Road South (#in&oltBUSINESS 1(/ PROPOSED �.DOMESTIC -ESTABLISHMENT a FARM ❑ TEST WELL USE OF WELL ❑ PUBLIC THER SUPPLY INDUSTRIAL CIONDITIONING (Specify) DRILLING El ® COMPRESSED ❑ CABLE OTHER EQUIPMENT ROTARY PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT I AS CASING TEDP DETAILS 60. 6 1 &THREADED � WELDED YES NO fl YES NO YIELD HOURS YIELD(G.P.M.)TEST BAILED PUMPED ®COMPRESSED AIR 15. WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feeQ Fmpleted of Co Well LEVEL 30 t below Land surface: 200 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 pock(inches): DEPTH FROM LAND SURFACE Sketch exact location o FORMATION DESCRIPTION f well with distances,to at least FEET TO FEET two permanent landmarks. 0 52 band 6 payee © v 52 60 guni to 60 200 gunit¢ 3° If yield was tested at different depths during drilling,list.below FEET GALLONS PER MINUTE 04 (� D DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL ILLER(Signature) 4-26-84 87460 10 5-22-84 BOARD