HomeMy WebLinkAboutWell New 710 Avery Street CONSUMER PROTECTION �. ja►
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-8 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION 89653
WELL DRILLING PERMIT _
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Town) (Street) pot Number) DATE
S. WIDIDSOR 710 AVERY -ST. 9/20/84
OWNER OF WELL
GI INDIVIDUAL � BUILDER El OTHER(Specify) AkMIA BDOZIE EjL}L. —0928
OWNER'S ADDRESS
710 AVERY ST. , S. WIMDSOR, CT.
BUSINEThS TEST Est.No,of
PROPOSED
DOMESTIC ESTABLISHMENT FARM WELL People being
USE OF
PUBLIC AIR OTHER served.
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 feast two roads Well location on lot and to house(if present)
Indicate North
Ad. 401
3
e��
Approximate number of feet from well to
nearest source of possible contamination: f�•
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 oil information is filled in and it has been countersigned by the Director of Health or his agent.
NT S'natur J APPLicmrS ADDRESS REGISTRATION NO.
P.O. BOX 111 S. WImiaGTON ' CT. 100 -
' BY(T'orvn Health O iAUnl, DATE
PROVED WEMD /rn Ail-
s
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT 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.
=PMED' =SMG Wt
NAME Z. ADDRESS
OWNER AMIA. BW
LOCATION (No. & Street) T( (Lot Number)
�o g�
OF WELL 71 A =T gwn).: S. 7 XAD��e 3V
BUSINESS
PROPOSED
a DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
PUBLIC AIR
WELL THER
SUPPLY INDUSTRIAL CONDITIONING (OSpecf y)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT I-IMI ROTARY AIR PERCUSSION PERCUSSION El (Specify)
CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT RIV SHOE W S CASING GRO TED?
DETAILS THREADED WELDED F YES IN I YES NO
YIELD HOURS {= YIELD (G.P.M.)
TEST ❑ BAILED PUMPED �COMPRESSED AIR 4'
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) FinfehetcbeClow
f ompleted Well
LEVEL Land surface: >
MAKE LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE" DIAMETER (inches) GRAVEL SIZE (inches) FROM(feet) TO(feet
IF GRAVEL Diameter of well including
PACKED: gravel pack (inches):
DEPTH FROM LAND,SFEET FORMATION DESCRIPTION URFACE Sketch exact location of well with distances, to at least
FEET TO FEET two permanent landmarks.
.60 Red Rock
szr
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO_. DATE OF REPORT WEL LLER.($ig'nature
4 8