HomeMy WebLinkAboutWell New 726 Avery Street PERMIT NUMBER
FR-8rR11v.-7I95 W,
STATE OF CONNECTICUT 219130
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION,,;,'1 V G J
WELLDRILLING PERMIT._:. iZ PROTECTION
165 Capitol Avenue,Hartford,Connecticut 061Lo6'PROF LICENSINGLOCATION OF WELL (Town) (street) (Cot Number) 103 AM — p
South Windsor 726 Avery St /13/03
OWNER OF WELL
XD INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
Stacey Winter 726 Avery St South Windsor
Est.No.of
PROPOSED Xa DOMESTIC• BUSINESS El FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
aPUBLIC Q INDUSTRIAL ElAIR OTHER 4
SUPPLY CONDITIONING S
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 to and to house(if resent)
Ingicate North
ve-s Sit I>cwii,, 3� `
T \ s er+t 6 40 c
A v e.L S
Approximate number of feet from well to 5 5'
nearest source of possible contamination:
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 Department of Consumer Protection and the Water
Resources Commission on the form provided by the agency. 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.
AP P T na APPLICANTS ADDRESS REGISTRATION NO.
P.O. Box 406 Willington 42
BY(Town Health Officer or Agent) DATE
6-*PR
OVED ❑ REJECTED
6-zo-as
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
yr - — ._-f -- -
CPR-9 Rev.7/95
-, STATE OF CONNECTICUT Do'NOT fill in
DEPARTMENT OF CONSUMER PROTECTION STATE WELL N0.
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING COMPLETION REPORT oTHER No.
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME
ADDRESS
M7AVery
7intg726
LOCATION street) Avery st• SOtt-h Wind80r.
OF WELL (Town) (Lot Number)
72�i t South Windsor
DOMESTIC BUSINESS a FARM TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL
aPUBLIC INDUSTRIAL
SUPPLY AIR OTHER
DRILLING ROTARY CONDITIONING (Specify)
EQUIPMENT a COMPRESSED CABLE OTHER
AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT
DETAILS ❑ THREADED WELDED ❑ DRIVE Srr--HOE WAS CASING GROUTED?
YFELD TEST BAILED PUMPED ❑ COMPRESSED AIR HOURS YES LJ N0 ❑ YES ❑ NO
YIELD(GPM)
60
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet11, ) DURING YIELD TEST(feet)
LEVEL Depth of completed well in feet
20
MAKE 245
SCREEN LENGTH OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well I GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: including gravel pack
(inches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION
Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
135 245 Sandstone
I
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE �� 1 Sv` -
V(,.t,
DATE WELL COMPLETED PERMIT N0. REGISTRATION N0. DATE OF REPORT
7/1 1/0 3 219130 l iLLER ignature)
DEPT.OF ENVIRONMENTAL PROTECTION-WATER RESOURCES