HomeMy WebLinkAboutWell New 56 Beelzebub Road CONSUMER PROTECTION
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-B REV.11-f12 DEPARTMENT OF CONSUMER PROTECTION 144613
WELL DRILLING PERMIT
165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
SOUTH W:I:NDSOR 56 BEELZEBUB RD. 11/21/90
OWNER of WELL
DIVIDUAL BUILDER E• OTHER(Specify) PiRID BLACK® IN
OWNER'S ADDRESS
56 BEELZEBUB RD. , S. WiNDSOR, CT.
BUSINESS TEST Est. No.of
PROPOSED OOM"TIC ESTABLISHMENT FARM WELL People being
USE OF Abandon served.
WELL wMy AIR ER
INDUSTRIAL CONDITIONING (5pe ) Well
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 of least two roads Well location on lot and to house (if present)
10
North IL
t X
Approsimab number of feet from well to
nearest source of possible contamination:
The undersigned is.aware.that.upon,completion of the well. o "Well Completion.,Repoit-containing construction details'and information required'under Section
25131 of she 1969 Supplemenj-ta, the-General.Statutes must be sent.vo••the owner; the Board,and.the Water Resources Commission'on he form proJided 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:'
NT 04— 1t) APPLICANT'S-ADDRESS REGISTRATION NO. .
P.O. BOX 111 S.WILLINGTON CT. 1.00
BY(rorcn Hedtb Offiker or Agent) DAB Q
f rrPROVN� REJECTED G 101?4
.. . REMARKS - -• - - .
ABANDON WELL.
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
STATE WELL NO.
WELL DRILLING BOARD
165 CAPITOL AVE.
r HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME ADDRESS
OWNER FREED BTA 0K 56 B k LZEBUB RD s � S e WiErDSOR s OT.
LOCATION (No. 8 Street) (Town) (Lot Number)
OF WELL 56 B f Z i UB RD m S s WINDSOR
BUSINESS
PROPOSED F1 DOMESTIC El ESTABLISHMENT FARM ❑ TEST WELL
USE OF Abandon
WELL PUBLIC SUPPLY OTHER LY INDUSTRIAL CONDITIONING Zj(Speci r .
(Specify)U
THER
EQUIPMIENT ROTARY AIDRUNG RMCOMPRESSED
PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT `-- [JIVEWAS CASING GROUTED?
DETAILS THREADED E .WELDED... YES �NO n YES �NO
YEW HOURS YIELD G.P.M.)
TEST BAILED PUMPED COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL in feet below Land surface:
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: gravel pock (inches):
DEPTH FROM LAND SURFACE, FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET TO FEET two permanent landmarks.
reel.l aE a!:I'F ,3ae-d
to Sltate regulations. f�tM,Z�.P
I
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 W l ER (Si,
z'
DEPT.OF ENVIRONMENTAL PROTECTION-WATER RESOURCES