HomeMy WebLinkAboutWell New 35 Ferry Lane CONSUMER PROTECTION,
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-$REV.11_82 DEPARTMENT OF CONSUMER PROTECTION . 171695
WELL DRILLING PERMIT
165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106
W/ °�
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LOCATION OF WELL MO") (Surer (Lot Nxmber) DATE
OW
Of WELL
UMVIDUAL 0 &Ulu= El OTHER(Specify)
OWNER'S ADDRESS
35- %er Lahe saar4 INl;ftds,7-- �1
PROPOSED Wmnl1 ESTABLISHMENT FARM WELL People TEST Est.Nbo ng
LOSE OF served.
PUNLIC All
WELL SUPPLY INDUSTRIAL CONDITIONING OTHER)
SKETCH OF WELL LOCATION
Locate well with respect to at least two roods,showing distance from intersection and front of lot
Location of lot to at least two roods Well tocotion on lot and to house(if present)
O
Indioase North
r r1r4 LAne-
� ! 1
t
Approximate number of feet from well to 7y I
nearest source of possible contamination: /�
The undersigned is aware that upon completion of the well. a "Well Completion Report" contoininq construction details and information requited 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
Boor This pgO, it t I'td until of iq hmq rpnis filled in and it has been covnter-signed by+he Director of Health or his agent. i
AM Sit xn) / APPLICAPT'S ESS REGISTRATION NO.
1'"•0 d� 503 lT awl z?7 /3
BY(Town Hea(tb Officer or Atext) FATE
ROVEo [�REJECTED
REMARKS � C � ,/ � l
CP it
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
CPR-9 Rev.T195 1
Do NOT-fiII°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 NAM I ADDRESS
Ott P/' Co /'err s e ���4 5 ar CST
LOCATION (No.d Street) (town) (totNumaed
OF WELL 5- FeO-r- L4,4,' &W /,1 4W C.n
T
DOMESTIC USINESS FARM TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL ❑ SPUBLIC UPPLY INDUSTRIAL OTHER
CONDITIONING
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT Ln AIR PERCUSSION PERCUSSION (Spa*)
CASING (�) DIAMETER(hd=) WEIGHT PER FOOT SHOE WAS ING GROUTED?
DETAILS •� THREADED 11 WELDED
/ ` � CJ YES ❑ NO YES ❑ NO
YIELD TEST a PUMPED PRESSED AIR HOURS YIELD(GPM)
WATER MEASURE FROM LAND SUE-STATIC(Specify feet' DURING YIELD TEST(teat) Depth of Completed WON in feel
LEVEL RFACa a s Gass
MARE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(bletM) IF GRAVEL Olemeter of weN GRAVEL SIZE(itid�ee) FROM(reef) TO(feel)
PACKED: Indudmp gravel peck
(vKfres)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances•to at(east two
FEET TO FEET permanent landmarks
O /30
H yield was tested at different depths during drilling.list below
FEET GALLONS PER MINUTE
TE)NELL COMPLETED PERMIT N0. REGISTRATI 157 DATE OF REPORT Vjq4 DP!LEROlftstuy
AGENCY