HomeMy WebLinkAboutPublic Health New 571 Avery Street CONSUMER PROTECTION � - -
WELI. DRILLING BOARD 'STATE of'mNNEc ICUT
PERMIT NUMBER. .
CPR-8 REV.1142 DEPARTMENT OF CONSUMER PROTECTION !� (]
WELL DRILLING PERMIT 91039
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Torun) (Street) - (Lot Na' DATE 11�15�84
S.. W_INDSOR AVERY ST.
OWNER OF WELL
INDIVIDUAL ® BUILDER OTHER(Specify) JAYLAND CONTRAOTORS (Kirby Holcomb)
OWNER'S ADDRESS _
45 VALLEY VIEW DR-. , S. WDiDSOR, CT.
PROPOSED BUSINDOMESTIC El ESTABLLIISHMENT FARM WELL People being
USE OF served.
PUSLIC AIR OTHER
WELL 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 lot to at least two roads Well location on lot and to house(if prisent)
" I
Indicate North
1�'If
t
,s v
19(1 F
Approximote number of feet from well to
nearest source of possible contamination: 75 E+
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 thi Director of Health or his agent.
APpll�gfT(Signo/rem APPLICANT'S ADDRESS •- REGISTRATION NO.
t//y/(7�I�F�I/—(� �• •. �e.v�o P.O BOX-Ill, " S. WTLLIAGTON CT. 100
" altb Offtter r Agent) DATE
APPROVED REJECTEDA=9&
REMARKS.
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT. STA�CONNECTIC
CPR-9 REV.11-82 DEPARTMENT OF,CONSUMER PROTECTION Do NOT fill in
WELL'DRILLING BOARD STATE WELL NO.
165 CAPITOL AVE.
HARTFORD, CONNECTICUT 06106 OTHER NO.
NAME 7x�t !t ? ltftt�+ 3 C2c ADDRESS tT r Y� �- y C 7T C y p�fti
OWNER UAYLAND r"TRA[J:�`ORS '=#",f" �l ALL—E.L �W .f R 61 Si 11,1f3DSOR 4- C3:.
LOCATION (No. & Street) (Town) a�q� (Lot Number)
OF WELL AV f_,3 • S• WIxiD OR
BUSINESS
PROPOSED
DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
PUBLIC AIR D
WELL SUPP Y a INDUSTRIAL CONDITIONING (Specify)
THER DRILLINGDRILLING COMPRESSED CABLE OTHER
EQUIPMENT ® ROTARY AIR PERCUSSION PERCUSSION El(Specify)
CASING LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 4 1 ,4r, �THREADED WELDED YES1:1 NO YES. NO
YIELD I HOURS YIELD (G.P.M.) _
TEST El BAILED PUMPED COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 20 O in feet below Land surface: 230
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.
O 11 Sax-d Cry,''rel
11 33 , clay
r
23O € Ot'.Ts:' �c i
, d /11
vr
t
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
U.6�X V-7
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL ER(Signatur f}
zas 1 .
DEBT. OF ENVIRONMENTAL PROTECTION-WATER RESOURCES