HomeMy WebLinkAboutWell New 10 Barber Hill Roadf ,
"F PERMIT NUMBER
CPR-8 Rev,7I95
STATE OF CONNECTICUT 211697
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Lotflumbw) DATE
S.WINDSOR 10 BARBER HILL RD. 2/25/02
OWNER OF WELL
aINDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
PAGANELLI CONST. - P.O. BOX 652, S.WINDSOR
Est.No.of
PROPOSED QX DOMESTIC BUSINESSS El FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
SUPPLY BLIC INDUSTRIAL AIR OTHER
CONDITIONING El (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 to and to house(if resent)
Indicate North o1a'
How
$A"e& H 1w. Ito
Approximate Sr
Approximate number of feet from well to ABANDONMENT
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.
PLiC T APPLICANT'S ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
BY(Town Headh Officer or Agent) DATE
PPROVED REJECTED
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7/95 - Do NOT fill in
STATEOF CONNECTICUT STATE WELL NO.
�e DEPARTMENT OF CONSUMER PROTECTION
s>E REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO. -
WELL DRILLING COMPLETION REPORT
'165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
PAGANEL4LI CONST. P.O. BOX 652, suffield
LOCATION 10 B(ARBER' HILL RD. S.VINDSOR (LaAramnei
OF WELL
DOMESTIC BUSINESS ❑ FARM TEST
PROPOSED 1:1EJ ESTABLISHMENT WELL
USE OF WELL PUBLIC INDUSTRIAL AIR OTHER
SUPPLY ❑ CONDITIONING Q ABANDONEMNT
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT ❑ ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING LENGTH((eet) DIAMETER(incites) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS ❑ THREADED❑WELDED ❑ YES ❑ NO• ❑ YES ❑ NO
YIELD TEST ❑BAlLEO ❑ PUMPED ❑ COMPRESSED AIR HOURS YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) I DURING YIELD TEST(feet) Depth of Completed%*It in feet
LEVEL 75
MAIL LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(irches) IF GRAVEL Diameter of well GRAVEL SIZE(atdtes) FROM(feet) TO(feet)
PACKED: irtckAing gravel pads
finches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at(east two
FEET TO FEET permanent landmarks
0 75 CEMENTED -
�01,
CZ RZ
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 VfztMLER(Signature)
2/27/02 - 211697 42 5/20/02
AGENCY