HomeMy WebLinkAboutWell New 236 Avery Street WIELC COMPLETION REPORT STATE OF CONNECTICUT '- ;DO NOT fill in
CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION
STATE WELL NO.
WELL DRILLING BOARD
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME ADDRESS
OWNER DAHy- .PAQUES 390 BMZEBUB ROAD,, S a WI-NDSOR j CT.
LOCATION (No. & Street) (Town) (Lot
r (Lot Number)
OF WELL 256 AMY T. S• WUJ.3ic3OR
BUSINESS
PROPOSED E DOMESTIC 0 ESTABLISHMENT FARM , TEST WELL
USE OF
WELL PUBLIC AIR 1:1OTHER SUPPLY INDUSTRIAL CONDITIONING (Specify)
EQUIPMENTDRILLING � COMPRESSED CABLE OTHER
ROTARY AIR PERCUSSION
PERCUSSION �(Specify)-.;.,
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER.FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 21 6 19045 THREADED WELDED r4YES FINO [2`YES NO
YIELD HOURS YIELD(G.P.M.)
TEST BAILED 0 PUMPED COMPRESSED AIR 0
WATER MEASURE FROM LANDSURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL ( 275 in feet below Land surface: i
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 5 Sam G avel %V
5 9 Clay f
300 Bedrock
.,:
//5z;
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
7
a
A-
tii
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WE LLER (Signature)$ s.
DEPT. OF ENVIRONMENTAL PROTECTION-WATER RESOURCES
SUMER PROTECTION
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-8 REV.11-g2 DEPARTMENT OF CONSUMER PROTECTION 101807
3 WELL DRILLING PERMIT
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(TOWN) (Strttt) (Lot Nambtr) DATE
_ SOUTH WIA-41)SOR 236 AVMY ST. 4/22/85
OWNER OF WELL t�
® INDIVIDUAL El BUILDER OTHER(Specify) DMIEV PAQ trET 644-1.160
OWNER'S ADDRESS
390 BEELZEBUB ROAD, S. WIADSOR, CT.
PROPOSED BUSINESS M1 TEST Est. No.of
® DOMESTIC ESTABLISHMENT FARM WELL People being
USE OF served.
WELL a OTHERPUBLIC AIR SUPPLY 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 roods Well location on Jot and to house (if present)
V
Indicate North '_I •
A D,
w
cf,T,
Approximate number of feet from well to
nearest source of possible contamination: Sanitary Sewer
The undersigned is aware that upon completion'of the well, a "Well Completion Report' confotning 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 oil information is filled in and it has been counter-signed by the Director of Health or his agent.
(C�Ilure) APPLICANT'S ADDRESS REGISTRATION NO. -
�• P.0, BOX 111 S. WILLINGTO.U. CT. 100
�/APPROVED
BY(Town Health Officer or Agent) DATE
QREJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD