HomeMy WebLinkAboutWell New 967 Chapel Road CPR-8 Rev.7)95. PERMIT NUMBER
� 187996
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
�umy� WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (L&Number) DATE
SOUTH WINDSOR 967 CHAPEL RD. 8/13/98
OWNER OF WELL
INDIVIDUAL ® BUILDER OTHER(Specify) 742-9997
OWNER'S ADDRESS 8 00—9 71—0 0 04
AFFORDABLE BUILDERS L.L.C. 467 FLA DERS RD. , COVENTRY CT.
Est.No.of
PROPOSED ® DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
SUPPLY OT PUBLIC INDUSTRIAL AIR
CONDITIONING (Specify)HER
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 to and to house if present)
Indicate North
L)CS
X.
?<
Approximate number of feet from well to 7 8
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 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
Uxellirector,of Hea r Wagent.
�PPIOCA Signs APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
7,12
BY(Town Hee!!N OfterorAgent)" DATE
r-IWPROVED REJECTED
REMARKS
L17'rIL?
RETURN THIS COPY TO DEPARTMENT OF CONSUM.ER 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 OTHER NO.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER- NAME ADDRESS
AFFORDABLE BUILDERS, L.L.0 467 FLANDERS RD. , COVENTRY, CT.
LOCATION (M.s Street) (Town) (LW Number)
OF WELL 967 CHAPEL ROAD S. WINDSOR
DOMESTIC BUSINESS FARM TEST
PROPOSED X ESTABLISHMENT EJ WELL
USE OF WELL a SUPPLY CONDITIONING
AIR CONDITIONING OTHER
)
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT a' AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 20 6 17.00 [] THREADED� WELDED J�a
YES ❑ NO, YES ❑ NO
YIELD TEST ❑BAILED []'PUMPED ® COMPRESSEDAIR HOURS YIELD(GPM)
6 20
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL 30 125 145
MAKE EFRRWP;;F7
TH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SUE DIAMETER(i dees nches) IF GRAVEL Diameter of well GRAVEL SIZE(in ) (feeQ
• - - PACKED: inckiding gravel pack -
(srches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at Least two
FEET TO FEET permanent landmarks
0 9 Topsoil & Hardpan _
9 145 Gray Bedrock
W r
15 Of
„LJ_L_
If yield was tested at different depths during drilling,tilt below
FEET GALLONS PER MINUTE
� 'el
DATE WELL COMPLETED PERMIT NO. REGISTRATION No. DATE OF REPORT ature)
9/23/98 187996 42 9 28 98 la- -�-
AGENCY