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HomeMy WebLinkAboutWell New 240 Deming Street (2) ti •S CONSUMER PROTECTION - WELL DRILLING BOARD STObF C��ICUT ' PERMIT NUMBER CPR-9 REV.1-". DEPARTMENT OF CONSUMER PROJECTION WELL DRILLING PERMIT 68123 20 GRAND STREET,HARTFORD,CONNECTICUT 06106 LOCATION OF WELL(Town) (Street) (lot Number) DATE SOUTH WINDSOR DEMING ST. 12/28/81 OWNER OF WELL ❑ INDIVIDUAL ❑ BUILDER OTHER(sp cdy) ITEW CALVARY CI UR CH .CHAT EL OWNER'S ADDRESS DEJjTDIG ST. , S. WINDSOR, CT. PROPOSED BUSINESS TEST Est.No.of DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being USE OF served. WELL . © PUBLIC AIR OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) , SKETCH OF WELL LOCATION Locate well with respect to at least two roads,showing distance from intersection and front of lot - W EL Location of lot to at least two roads Well location-on lot and to house(if pr sent) 1 O _ �ni4 7i7rul� FNo.hIndicatNG .� tY I(�C�tiN G (17` Approximate number of feet from well to ��1 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 25-13) 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 all information is filled In and It has been counter-signed by the Director of Health or.his agent. �2NT APPLICANT'S ADDRESS REGISTRATION NO. 4&eE� a I P.O. 'BOX 1112 S. WILLIINGTON, CT. 100 By(Town Hedkb Officer or Agent) DATE APPROVED ❑REJECTED API 1 c /� REMARKS RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT- STATE OF CONNECTICUT Do NOT fill in CPR-9 REV.9-79 DEPARTMENT OF CONSUMER PROTECTION STATE WELL NO. WELL DRILLING BOARD 20 GRAND STREET HARTFORD,CONNECTICUT 06106 OTHER NO. NAME ADDRESS OWNER NEW CALVARY CHURCH 01HAPEL DR-MG ST. T LOCATION (No.'&Street) (Town) (Lot Number) OF WELL DETIING ST. S. -WINDS0IZ BUSliNESS PROPOSED ❑ DOMESTIC ❑ ESTABLISHMENT - • ❑ FARM ❑ TEST WELL USE OF �[ WELL 1-7 R OTHER SUPPLY ❑ INDUSTRIAL ❑ CNBLIC IONDITIONING ❑(Specify) COMPRESSE EQUIPMENT ® ROTARY ❑ AIRR PERCUUSSION - ElPERCLUSSION ❑((Specify) LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT D S WAS CASING GROUTED? DETAILS. 41, 6 19�Ll S THREADED ❑WELDED. YES. NO ®YES ❑NO YIELD HOURS YIELD(G.P.M.) TEST ❑ BAILED ❑PUMPED ECOMPRESSED AIR 5 25 WATER MEASURE FROM LAND'SURFACE--STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL 30 • 150 in feet below Land surface: 17.5 MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN . DETAI,LS SLOT SIZE DIAMETER(inches) - IF GRAVEL Diameter of well including GRAVEL SIZE.(inches) FROM(feet) TO(feet PACKED: grovel peck(inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distarices,to at least FEET TO FEET two permanent landmarks.. sox 0 2 Topsoil .�6� 2 11 Sand & Gravel 11 31 Clay Q TAfA 31 175 lied flock cdo K If yield w6s tested of different depths during drilling,list below �l FEET GALLONS PER MINUTE (alI`c A'f ' G c1'% GATE WELL COMPLETED PERMIT-NO. REGISTRATION NO. DATE OF REPORF WELL R(Signature) n 12 0 81 68123 100 1 1141182 .- ---- BOARD