HomeMy WebLinkAboutWell New 795 Chapel Road rpfi 0,a PERMIT NUMBER
CPR$Rev.7I95 w r`,y qn, ®6
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treasurer, c!
STATE OF CONNECTICUT ��cc" �� -. oor
DEPARTMENT OF CONSUMER PROTECTION fora'DC0'001
REAL ESTATE&PROFESSIONAL TRADES DIVISION JAN 3 a 1998
WELL DRILLING PERMIT
'=WN 165 Capitol Avenue,Hartford,Connecticut 061060
LOCATION OF WELL (Town) (Stma (Lot Number) Accf7���2/1317n
SOUTH WINDSOR 795 CHAPEL RD.
OWNER OF WELL
® INDIVIDUAL ❑ BUILDER OTHER(Specify) 6 5 8-7 3 21
OWNER'S ADDRESS p
TIMOTHY 19 HUNTING RIDGE, SIMSBURY, CT.
Est No.of
PROPOSED ® DOMESTIC BUSINESS El FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
PUBLIC SUPPLY INDUSTRIAL AIR a CONDITIONING (SEER 4
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 O Ni, ,
x �
�46�7 L
Approximate number of feet from well to
nearest source of possible contamination: Banitary Sewers
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
thwQirector of Healft or his agent.
P CANT APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
BY(Town Health OfterorAgent) DATE
PROVED ❑ REJECTED n� 1 ZY�,6-�
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7/95
Do NOT fill in
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING COMPLETION DEPORT f OTHER NO.
165 Capitol Avenue,Hartford,Connecticut106106
OWNER NAME
ADDRESS r r �
THY PLOSZAJ 13 �
TIMOTHY
LOCATION (No.&Street) (Town) (Lot Number) `
OF WELL 795 CHAPEL RD. S. WINDSOR
P.
PROPOSED DOMESTIC a TEST-
EBUSINESTABLISHMENT FARM ❑ V EE kL
USE OF WELL
PUBLIC ❑ INDUSTRIAL AIR CONDITIONING ElOSpec )
SUPPLY
DRILTHER
LING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT ® El AIR PERCUSSION Lj PERCUSSION a"'--(Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS x, ' _' THREADED1:1 WELDED
`5 t-' �, f . �� I t -�-I YES � NO � :� YES ❑ NO
YIELD TEST (�FAILED PUPrtPED COMPRESSED AIR HOURS YIELD(GPM)
�-`i
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL 2_
400
MAKE
SCREEN LENGTH OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(fret) 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
0 it Topsoil & Sand
50 Ci a
425 Dec"roCk
c----------------
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 DRIL re)
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