HomeMy WebLinkAboutWell New 235 Buckland Road CONSUMER PROTECTION ' off .-EMJard Qd
WELL DRILLING BOARD ' STATE OF CONNECTICUT PERMIT NUMBER .
CPA-8 REv.,,-ez DEPARTMENT OF CONSUMER PROTECTION 9 O 3 4 WELL DRILLING PERMIT
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Town) (StreeQ -•_ (Lot Number) DATE
S. WINDSOR BUCKLA11D RD. 11/9/84
OWNER OF WELL
❑ INDIVIDUAL M lid BUILDER ❑ OTHER(Specify)" QUATTROPA14I & COO= %9-2410
OWNER'S ADDRESS -
57 RIDGEWOOD RD. , E. HARTFORD, CT. 06118 /'`
. 1. W Yt Cuna>:r
PROPOSED BUSINESS TEST Est.No.of
R DOMESTIC ❑ ESTABLISHMENT ❑ FAWN ❑ WELL People being
USE OF served.
WELL ❑ PUBLIC
❑ INDUSTRIAL ❑ CONDITIONING El (AIR (
THER
SUPPLY (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 o house (if present)
Indicate North
\. of
�)y
• .G C!` �9 N 0 ��
Approximate number of feet from well to 90
nearest source of possible contamination:
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 countersigned by the Directorof Health or his agent.
( rtatu ) APPLICANT'S ADDRESS _. REGISTRATION NO.
EQAy
P BO 111 ' S. WILiIIlIGTO4 CT. 100
Y own ealtb O u or Agent) DATE
APPROVED ❑REJECTED
REMARKS
RETURN THIS COON TO CONNECTICUT WELL DRILLING BOARD
i
WELL COMPLETION REPORT
STATE OF CONNECTICUT
cPR_9Rty. ".es DEPARTMENT OF CONSUMER PROTECTION Do_NOT fill in'
WELL DRILLING BOARD STATE WELL NO.
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 _ OTHER NO.
NAMEAE
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EOF
WNER -ADDRESS
l {sLt [� �7t3rJRD. , 'a eiL' O a
ATION (No.&Street) (Town)
WELL (Lot Number)
S a WI DSOR 04R=t , OWNER)
PROPOSED �t DOMESTIC ESTABLI HMENT BUSINESS FARM
USE OF El TEST WELL
WELL ❑ PUBLIC AIR
SUPPLY ❑ INDUSTRIAL OTHER
El CONDITIONING (Specify)
DRILLING COMPRESSED CABLE
EQUIPMENT ROTARY ❑ AIR PERCUSSION PERCUSSION ❑(OSpecRY)
LENGTH feet D I _ O
DETAIL (feet) DIAMETER (inches) WEIGHT PER FOOT CASWG GROUTED?
DETAILS � THREADED � WELDED YES �NO YES �NO
4
YIELD HOURS
TEST BAILED PUMPED COMPRESSED AIR _ YIELD(G.P.M.)
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) 12
LEVEL 60. Depth of Completed Well
in feet below Land surface: 155
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 pack (inches):
DEPTH FROM LAND SURFACE
FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
two permanent landmarks.
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46 Clay
g drock
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If yield was tested at different depths during drilling, list below tp
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO: REGISTRATION NO. DATE OF REPORT
WEL LER(Signature)
93
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DEPT.'OF ENVIRONMENTAL PROTECTION _ WAT9:D MCcem ine•r�