HomeMy WebLinkAboutWell New 50 Barber Hill Road CPR-8 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT 196426
DEPARTMENT OF CONSUMER PROTECTION
t REAL ESTATE&PROFESSIONAL TRADES DIVISION '
WELL DRILLING PERMIT
165 Capitol;Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Cot Number) DATE
SOUTH WINDSOR 50 BARBER HILL ROAD 9/30/99
OWNER OF WELL
INDIVIDUAL BUILDER OTHER(Specify) 648-0554
OWNER'S ADDRESS
DZEN BROS. , INC. 50 BARBER H
Est.No.of •
PROPOSED DOMESTIC BUSINESS '® FARM E: TEST People being
USE OF ESTABLISHMENT WELL served.
WELL.
SUPPLY AIR OER
PUBLIC INDUSTRIAL a CONDITIONING Spe
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot.
location of tot to at least two roads Well location on to and to house(if present)
Indicate North .
Approximate number of feet from well to
nearest source of possible contamination: 10 0'.+
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
R rces Commiss' on form provided by the agency. This permit is not valid until all information is filled in and it has been counter-signed by
t 1 i actor of Health hi t.
PL T( nature) APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
VA BY(Town Health Officer orAgent) DATE
PROVED REJECTED
❑ ��^/3��
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7/95 a
_ Do NOT fill in
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO.
ma's WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
DZEN BROS. , INC. 50 BARBER HILL RD. , S. WINDSOR, CT.
LOCATION (Ab.6Street) (Tam) (LdNumtrer)
'OF WELL 50 BARBER HILL ROAD S.WINDSOR
DOMESTIC BUSINESS FARM TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL Q PUBLICINDUSTRIAL CONDITIONING OTHER
SUPPLY
)
DRILlNG EQUIPMENTENT ® ROTARY a AIR-PERCUSSION PERESSED R LE OTHER
PERCUSSION (Specify)
CASING LENGTH(feet) I DIAMETER(Inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS. 21 8 27.00 0 THREADED 11 WELDED ® YES ❑ NO. ® YES ❑ NO
YIELD TEST a BAILED ❑ PUMPED ® COMPRESSED AIR HOURS 8 YIELD(GPM) 6 0
WATER MEASURE FROM LAND SURFACE_-STATIC(Spedry feet) DURING YIELD TEST(feet) Depth of Completed Wall in feet
LEVEL 15 300 420
MAKE LENGTH OPEN TO AQUIFER peep
SCREEN-
DETAILS SLOT SIZE DIAMETER(indrea) IF GRAVEL Diameter of well, GRAVEL SIZE(i xtm) FROM(feet) • TO(feet)
PACKED: including gravel pads
(nd>as)
-DEPTH FROM LAND TO SURFACE- FORMATION DESCRIPTION Sketch exact bcation of well with distances,to at least two
FEET TO FEET permanent landmarks
0 8 Topsoil & Sand
8 420• Bedrock
1 '
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO' 'REGISTRATION N0. DATE OF REPORT L DRIL (S' ure)
2/16/00 196426 42 2/21/00
AGENCY