HomeMy WebLinkAboutWell New 28 Brookfield Street _ 11ER PROTECTION T
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR'l REV.11.92 DEPARTMENT OF CONSUMER PROTECTION 167352
f WELL DRILLING PERMIT
165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106
1
$UUTIdly�N193o2 �8 QfZacY[�'tE[-b �'
LOCATION OF WELL(Torun) (Streel) (Lot Number) DATE
aoffri STllP.L1+4�to 3- /6- T.5-
OWNER OF WELL -
UMOIVIDUAL ❑ WILDER ❑ OTHER(Specify)
OWNER'S ADDRESS
3� QR13owFJZ(�LL'� S�' Sau'r W U-0 CD r{N
PROPOSED L J � ❑ a AT KIISHMENT ❑ FARM ❑ WELL People be ng
USE OF served.
WELL U"YL 11 INDUSTRIAL El CONDITIONING ❑ (AIR Specify)
)
SKETCH OF WELL LOCATION
Locate well with respect to of least two roods,showing distance from imersection and front of lot
Location of lot to of bast two roods Wet]location on lot and to house(if present)
lrtdioase North
BRoetc�l�
+aE� Ito
S v1�ly N I¢v�
(3AOoif`+LrLI^J OJT ;
Approximate number of feet from well to
nearest source of possible conlominotion:
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 Director of Health or his agent.
APPLICANT V J—%
APPLICANT'S ADDRESS REGISTRATION NO.
CMECTM TAUH ARTESIAN WELL CO. 1 0•$0` kst merfl...orL wle-i(Dow Pw otaa.r 4F;Lq 02
BY Crown Heakb Officer or A�tet DATE
gA'PNOVEO ❑REJECTED �,
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL-COMPLETION REPORT STATE OF CONNECTICUT
CV!-•REV.It42 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill to �
i
F STATE WELL NO
q, WELL DRILLING BOARD
Y 165 CAPITOL AVE. OTHER NO
06106
OYYNER NAME JUN ADDRESS'j
t
LOCATION (Nd.street) (Town) I (lot Number)
OF WRL a o . o U • c
(� BIt31NE5S
FROFOiEO ILY DOMESTIC ❑ ESTABLISHMENT � ❑ TEST WEIt
IFS OF _
L ❑ SUPPLY ElINDUSTRIAL ❑ CONDITIONING ❑((Specify)
DMLNEO COMPRESSED CABLE OTHER
oauwA f f ❑ ROTARY AIR PERCUSSION ❑ PERCUSSION ❑(Specify)
CASM AAS LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT 19THREADED ❑ WELDED YES 0 NO ®ES J NO
VIIILD HOURS YIELD(G
TNT ❑ BAILED ❑PUMPED COMPRESSED AIR -1
1 '7. 5
ATO MEASURE FROM LAND SURFACE—STATIC(Specify feet) pURING YIELD TEST(feet)
wLEM 9 a, 1 3 in feet beloepth of w land surface.ted Well � y al!
MAKE LENGTH OPEN TO AQUIFER(feer)
OETAU SLOT SIZE DIAMETER(inches) IF GRAVEL Oameter of vvw11 including GRAVEL SIZE finches) FROM(feet) TO(feet
PACKED: grovel pock(Inches):
OWN FROM LAID SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances. to at least
FEET TO FEET two permanent landmarks.
V �; , ,A- A r
l p C
�17 It �{o `
T/` u
IL
If yield was hissed of different depths dwing drilling,list below
FEET GALLONS PER MINUTE
DATE WELL OOMRETED PERMIT NO. REGISTRATION NO. DATE OF REPORT i—fi ORRL e)
BOARD