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HomeMy WebLinkAboutWell New 455 Foster Road CPR-8 Rev.7)95 PERMIT NUMBER STATE OF CONNECTICUT 221912 DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION $ WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 Seu7-N /(/iN.d SD/2 OSTE2 92 6 5 S LOCATION OF WELL (Town) (Sheet) J=Numben DATE /` 1101- FE,t?!LA fit:Lv //� OWNER OF WELL C(a/1NDIVIDUAL BUILDER OTHER(Specify) OWNER'S ADDRESS ASS e,,S o ca T-V all S eit Est No.of WELL se PROPOSED DOMESTIC 11 BUSINESS FARM TEST people being USE OF ESTABLISHMENT. w, WELL PUBLIC AIR OTHER Y INDUSTRIAL CONDITIONING SUPPLY ) i 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 resent) (D Indicate North Seti r1i r_y sewer, NG A✓ 1s. , X OA�rRw tsc• �os?Sf` R-►� dxr "« r'o},vf FosTC/2. ,2j Approximate number of feet from well to 7S/ nearest source of possible contamination: The undersigned is awa that upon completion of the well,a Well Completion Report"containing construction details and information required under Section 25-131 of the t 9 Supp nt to the General Statutes must be sent to the owner,the Department of Consumer Protection and the Water Resources Commission fo vided by the agency. This permit is not valid until all information is filled in and it has been counter-signed by the Director of Health o s n. APPLICANT(Signature) APPLICANTS ADDRESS REGISTRATION NO. rASIESIAN WFLL CO. MC. f�oN� ANt= E�o5T LdrJ6/'/1FA�Cv/!?,+ O/o7� 3v BY(Town Heafth Ofter or Agent) DATE ROVE � REJECTEDLL-r - . REMARKS � / o= � 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 OTHER NO. WELL DRILLING COMPLETION REPORT 165 Capitol Avenue,Hartford,Connecticut 06106 OYVNER NAME ADDRESS IAL r`e.4A0-�l-0 4S3 ras C7- LOCATION (No.a ) (town) (Lot Number) OF WELL •yss !'os+eA &D 5o�'�h LJrUd StA , C`f- . DOMESTIC BUSINESS FARM TEST PROPOSED ❑ ESTABLISHMENT ❑ WELL USE OF WELL ❑ SPUBLIC UPPLY ❑ INDUSTRIAL ❑ AIR CONDITIONING ❑ OTHER DRILLING ❑ ROTARY COMPRESSED ❑ CABLE ❑ OTHER EQUIPMENT (_^J AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH&M) DIAIJlETER(k%d.)_j WEIGHT PER FOOT I DRIVE SHOE WAS CASING GROUTED? DETAILS pa, lo"—ZB ,OC/—7 112 THREADED Q WELDED ® YES ❑ NO• 0 YES ❑ NO YIELD TEST ❑BALM [:j PUMPED © COMPRESSED AIR HOURS� YIELD(GPM) 1 9 WATER MEASURE FROM LAND SURFACE-STATIC(Specxy feeq DURING YIELD TEST(feet) Depth Of Campleled Well in fee LEVEL / %.57� Sd-2� MAKE LENGTH OPEN TO AQUIFER(fast) SCREEN" DETAILS SLOT SIZE DIAMETER(indws) IF GRAVEL Diameter of well I GRAVEL SIZE(inches) FROM(fast) TO(feet) PACKED: WCOXIIIV we-[Pads (inches) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at(east two FEET TO FEET permanent landmarks O p,2 I S&,/ LD 90 If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT NO- REGISTRATION NO. DATE 9-F REPORT VWLER(Signature) AGENCY