HomeMy WebLinkAboutWell New 81 Beelzebub Road PERMIT NUMBER
CPR-8 Rev.7/95 184008
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Sheet) (lot Number) DATE
SOUTH WINDSOR 81 BEELZEBUB ROAD 11/26/97
OWNER OF WELL
INDIVIDUAL BUILDER ® OTHER(Specify) 749_6176
OWNER'S ADDRESS
STATE LINE CONSTRUCTION CO. 238 SHAKER RD. , ENFIELDD,CT.
PROPOSED El DOMESTIC BUSINESS FARM TEST People ESL No.of tieing
USE OF ESTABLISHMENT WELL served.
WELL
PUBLIC ❑ INDUSTRIAL a AIR ® OTHER Abandon Well
SUPPLY CONDITIONING S )
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,s owing distance from intersection and front of lot
location of lot to at least two roads Well location on to and to house(if present)
Indicate North 6 1 b,O�-s
W J�
Approximate number of feet from well to
nearest source of possible contamination: 75 '
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
jhL-Qinsctor o Health or h' ent.
APP CANT 'natu ) APPLICANT'S ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
BY(Town Health Officer orAgent) DAB
ROVED 0 REJECTED 1 c..1
REMARKS
WELL TO BE ABANDONED ACCORDING TO STATE SPECS.
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7/95
Da NOT fiif
STATE OF CONNECTICUT STATE WELL NO
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING COMPLETION REPORT OTHER N0.
~ ' 165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
STATE LINE CONSTRUCTION COI 238 SHAKER RD. , ENFIELD, CT.
LOCATION (No.BStreet) (Town) (Lot Number)
OF WELL 81 BEEL EBUB ROAD S. WINI SOR
PROPOSED ❑ DOMESTIC BUSINES a ESTABLIS HMENT FARM El TEST
WELL
USE OF WELL PUBLIC INDUSTRIAL AIR ®; OTHER
r c�l �.Z?ftGYIE;�.�.
SUPPLY -ETEl CONDITIONING (Specify)
DRILLING EQUIPMENT a ROTARY ARP PERCUSSIONEl PERCUSSION a COMPRESSED CABLE OTHER
(Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS THREADED 1:1 WELDED ❑ YES ❑ NO ❑ YES ❑ NO
YIELD TEST a BAILED D PUMPED a COMPRESSED AIR HOURS YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: including gravel pack
(inches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
ASAivDON-I"D WELL 1!"'CORDIN%G`
TO STATE SPECS.
7
03
If yield was tested at different depths during drilling,list belowL
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT LLD R gnature)
12/19/97 1 42 12/22/97 -c3 ^.�--
DEPT.OF ENVIRONWENTAL PROTECTION-!R(ATPR M;=1Qn:IRr:F-Q