HomeMy WebLinkAboutWell New 20 Barber Hill Road CPR-8 Rev.7/85
PERMIT NUMBER
STATE OF CONNECTICUT 211137
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DMSION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Streetl (Lor Numbed DATE
S.WINDSOR 91 20 BARBER HILL RD. 2/7/02
OWNER OF WELL
® INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
PAGANELLI CONST. P.O. BOX 652 SUFFIELD
Est.No.of
PROPOSED DOMESTIC BUSINESS FARM a TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
PUBLIC OTHER
SUPPLY INDUSTRIAL ElCONDITIONING (Seal 4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,a owing distance from intersection and front of lot
ration of lot to at least two roads Well location on to and to house(if present)
Indicate North t- f
.bl�rl.
HI►.L � �
d�
-Max �t u"
ra sT i3il-
S
Approximate number of feet from well to
nearest source of possible contamination: N/A. ABANDON
.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.
PLICANT(Sig ) APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
BY(Town Heafth Officer orAgent) DATE
J. —DAPPROVED ❑ REJECTED /
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
' CPR-9 Rev.7/95 DO NOT fill In
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER.PROTECTION
REAL.ESTATE 81 PROFESSIONAL TRADES DIVISION OTHER NO.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
PAGANELLI CONST. P.O. BOX 652, SUFFIELD
LOCATION (No.6 Street) (Town) (Lot Number)
kJa
OF WELL 20 BARBER HILL RD. S.WINDSOR
DOMESTIC BUSINESS FARM TEST
• PROPOSED ESTABLISHMENT. WELL
USE OF WELL Pusuc INDUSTRIAL a AIR 0 OTHER ABANDORNMENT
SUPPLY CONDITIONING S
DRILLING 'ROTARY COMPRESSED CABLE OTHER
EQUIPMENT AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS THREADED ❑ WELDED O YES ❑ NO• ❑ YES ❑ NO
YIELD TEST BAILED a PUMPED a COMPRESSED AIR HOURS YIELD(GPM)'
. r
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Won in feet
LEVEL 8 5 .
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(indm) IF GRAVEL Diameter of well• GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: indudng gravel Pads
(�,-)
DEPTH'FROM.LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location Orwell with distances,.to at least two
FEET TO FEET permanent landmarks
0 85 CEMENTED
9
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE` LL COMMPL TED PERMIT NO. REGISTRATION NO- DATE OF REPORT WELL DR ER(Signature)
2 10lOZ 211137 42 5/20/02
AGENCY