HomeMy WebLinkAboutWell New 165 Berle Road CONSUMER PROTECTION ,. r
WELL DRILLING BOARD STATi.OF CONN -TICUT PERMIT NUMBER
CPR-8 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION 86541
WELL DRILLING PERMIT _
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Town) (Sleet) (Lot Number) DATE
S. WIIVDSOR .165 BERLE RD. 4/30/84
OWNER OF WELL
INDIVIDUAL BUILDER OTHER(Specify) AIVGELA iVEGRON & STEPM GuUSHINSn
OWNER'S ADDRESS
398 iIEVERS ROAD, S. 4TI14DSOR, CT. 644=0175 or 565-2248
PROPOSED _ BUSINESS TEST Est.No.of
DOMESTIC ❑ ESTABLISHMENT FARM WELL People being
USE OF served.
PUBLIC AIR
THEIk
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 least two roads Well location on lot and to house (if present)
Indicate North
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v 6'
• x WE<l � �~
,c.ciG�CE� R°
Approximate number of feet from well to nearest source of possible contamination! 1001
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 Board and the Water Resources Commission on the form provided by the
Board.This permit is not valid until oil information is filled in and it has been counter-signed by the Diiector of Health or his agent.
(Signaturr) APPLICANT'S ADDRESS REGISTRATION NO.
>It P.O. BOX 111 S. WILI,INGTOIv CT. 100
BY(Town Hedtb Officer or Agent DATE
®"APPROVED REJECTED
REMARKS 7
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL "COMPLETION REPORT srnre of coNNEcncur`
CPR-9 alv.„-es DEPARTMENT'DF CONSUMER. PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME s. A
OWNER DDRESS�+xc
151 GRO
LOCATIO OF WELL (No.8 Street) (Town) (Lot Number)
BUSINESS
PROPOSED ® DOMESTIC ESTABLISHMENT FARM
USE OF TEST WELL
WELL PUBLIC AIR SUPPLY ❑.INDUSTRIAL OTHER
CONDITIONING �(Specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER ZT, p IV SHOEWAS CASING GRO
DETAILS +- y��. THREADED WELDED r�YES El NO YES NO
4
YIELD HOURS YIELD (G.P.M.)
TEST BAILED PUMPED r�COMPRESSED AIR
1-0
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
LEVEL G f Depth of Completed Well
6 in feet below Land surface:
MAKE
230
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER (inches) GRAVEL SIZE(inches) FROM(feet) TO(feet
IF GRAVEL Diameter of well including
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE
FEET TO FEET FORMATION.DESCRIPTION Sketch exact location of well with distances, to at least
awo permanent landmarks.
2 Clay
52 ___230 Red Rock
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1 -
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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 WELL DRi (Signature)
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