HomeMy WebLinkAboutWell New 365 Barber Hill Road CONSUMER PROTECTION
WELL DRILLING BOARD STATE OF CO4NE61ZUT PERMIT NUMBER
CPR-8 REV.e•79 DEPARTMENT OF CONSUMER PROTECTION 70160
WELL DRILLING PERMIT
20 GRAND STREET,HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Town) (Sheet) (Lot Number) DATE
Be WINDSOR 365 BARBER HILL RD. 7/30/82
OWNER OF WELL
a INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) MICHAEL DZEN (644-0424)
OWNER'S ADDRESS
204- BARBER HILL ROAD S. WINDSOR9 CT.
PROPOSED ® DOMESTIC ❑ BUSINESS ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
AIR OTHER
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)
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Indicate North
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Approximate number of feet from well to
nearest source of possible contamination: 781
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 Suppiement.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 all information is filled in and it has been counter-signed by the Director of Health or his agent.
( gn tare) APPLICANT'S ADDRESS REGISTRATION NO.
Q, P.O. Box 111, S. Willington, Ct: 100
04
APPROVED
BY(Town Nealib Officer or Agent) DATE
REJECTED All
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REMARKS
t3/8's'v
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNEmcUT ----
CPR-9 REV,9-79 DEPARTMENT OF CONSUMER PROTECTION NOT fill in
WELL DRILLING BOARD STATE WELLLL NO.
20 GRAND STREET OTHER NO.
HARTFORD,CONNECTICUT 06106
NAME ADDRESS _
OWNER HICHAEZ DZEN 2% BARBER HILL RD. , S. WINDSOR, CT.
LOCATION -"(No.•&.Street) (Town) (Lot Number)
OF WELL 365 BARBER HILL RD. S. WINDSOR
BUSINESS
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM' PROPOSED ❑ TEST WELL ,
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑(specify)
DRILLING
OTHER
ECUIPIMENT ROTARY ❑ AIR PERCUSSION
❑CABLE ❑(Specify)
PERCUSSION
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT 1 G4SING FA?
DETAILS 40 6 19�45 ®THREADED ❑ WELDED YES No S YES NO
YET ❑ BAILED ❑PUMPED lid COMPRESSED AIR HOURS 4YIELD(G.P1Vl.) �5
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feel) Depth of Completed Well
LEVEL 10 100 in feet below Land surface.. 130
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet
PACKED; grovel pack(inches);
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to of least
FEET TO FEET two permanent landmarks.
0 5 Sand & Gravel
5 301 Clay
30 - 130 Red Rock
/ (Of .
If yield was tested of different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WE ILLER(Signature)
8/11/82 70160 100 8/16/82
-BOARD