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HomeMy WebLinkAboutWell New 560 Deming Street CONSUMER PROTECTION .WELL,DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER M-B REV.11-N DEPARTMENT OF CONSUMER PROTECTION 166428 WELL DRILLING PERMIT 16S CAPITOL AVE..HARTFORD,COWCTICUT 061oe LOCATIO=OF (TO ) (Sneer/ (Lo+Number) DATE OP ❑ BWLOEB ❑ OTHER(Specify) OWNER'S ADDRESS BUSINESS TEST Est.No.of PROPOSED TIC ❑ ESTABLISHMENT ❑ PAPA El WELL People being USE OF Gserved. WELL ❑ PUBLIC DUST Y ❑ INRIAL ❑ CONDITIONING ❑ (AIR OSpecrTHEl) I SKETCH OF WELL LOCATION Locate well with respect to at least two roods.showing d.slo�ce from inrersectior.and front of lot Location of lot to of(easy two roads Well location on lot andto house(if present) fl MdImN North UUU 0EC 6 '1"4 octxsParIot+Al 1{ r�anii�OI�tlSlON s Dept.of Co mer Protection Aj tmale number of feet from well to no~source of possible contamination: 7s^~ The undersigned is aware that upon completion of the well. o "Well Completion Repor- contoininR construction details and information required under Section 25-131 of rho 1969 Supplement to the General Statutes must be sent to the owner, the Board and the Water Resources Commission on the form prowrded by the Board.This permit rs not valid until oil informotton is filled in and it.has been counter-signed by the Director of Health at his agent. APPI=SM— ) APPLICANT'S ADDRESS REGISTRATION NO. BY(Town Health Officer or Agree) GATE va ❑ ROAMICS RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT _ cPR-° V 11-92 DEPARTMENT OF CONSUMER PROTECTION 7STATEWELL OT fill in WELL DRILLING BOARD 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 NAME OWNER ADDRESS Sue Rowe Deming St., South Uindsr�rD CT t?6UU? LOCATION (No. R Street) (Town) OF WELL 560 Deming St, (Lot NUmbe,) BUSIWSS Southd��indsor 560 f+ROfEp ® DOMESTIC ESTABLISHMENT ARM ABLISHMENT F USE OF � TEST WELL PUBLIC WELL SUPPLY INDUSTRIAL CIONDITIONING ((SSpeci y) DMILLING COMPRESSED EQUNAIENT ® ROTARY ,� AIR PERCUSSION CABLE OTHER PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT DETAILS 40 THREADED WED WAS CASING GROUTED D YES NO YNW TEST © BAILED Fl PUMPED COMPRESSED AIR HOURS YIELD (G P M WATH MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feeq i 5 LEVEL � Depth of Completed Well in feet below Land surface. MAKE LENGTH OPEN TO AQUIFER (feet) fCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well indudrng GRAVEL SIZE(inches) FROM(feet) TO(feet PACKED: grovel pock (inches): DEPTH FROM LAND SURFACE FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. C cf Sit & e:rrve1 8 35 Lecge With Fractures 35 J Red ~rSal)G'{S tone _ f If Yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE r oyo DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER16 (Signature) John M. Du forof MOT r)= CAI\SIDnkMAMI%MAA e.._._—_ —_ ..