HomeMy WebLinkAboutWell New 583 Foster Street CONSUMER PROTECTION -
WELL DRILLING BOARD STATE_ 'C6NNECTICUT PERMIT NUMBER
CPR4 REV.is-V DEPARTMENT OF CONSUMER PROTECTION 134487
.
WELL DRILLING PERMIT
165 CAPITOL AVE., HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(lbtva) (Sneeq (Lot Number) DATE
SOUTH WINDSOA 553 FOSTFd ST. 4/20/89
OWNER OF WELL
lid1NWVIDUAL 1:1BUI DER. El OTHER(Specify) VIVIAN HEAAN 644-9654
289-0271
OWNER'S ADDRESS
583 FOSTEL ST. , S. WINDSOA, CT.
PROPOSED _ BUSINESS TEST Est No.of
DOMESTIC ESTABLISHMENT FARM WELL People being
USE OF
served.
PUBLIC AIR THER
WELL SUPPLY INDUSTRIAL CONDITIONING ElSpeecif) 2
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 location on lot and to house (if present)
G
Indicate North
LF
� f.�.,✓ Dom-
av ►-
Approximate number of feet from well to r Sanita Sew@"8
nearest source of possible contamination: y
The undersigned is aware that upon completion of the well. o "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 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 covnter-signed by the Director of Heolth or his agent.
APPI (Std�ty APPLICANT'S ADDRESS
_ REGISTRATION NO.
P.O. BOX JL119 S.WILLINGTON, CT. UO
BY(Town Hedtb Officer or A6eet) DATE
ETAPPROVED El REJECTED
REMARKS D /f s'
pdol;p/P CGu.'�/� f Y-P 20 0-
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT_._
STATE OF CONNECTICUT
CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
165 CAPITOL AVE.
HARTFORD, CONNECTICUT 06106 OTHER NO.
OWNER NAMEff ADDRESS
IV_
IICA�N� 3 FO -T d ST. $ S. WIND 0a, CT.
LOCATION (No. & Street) (Town)
aWI
OF WELL 3 PO TEji T• i �on (Lot Number)
ii
PROPOSED kUSAj DOMESTIC ESTABLISHMENTI FARM
NESS
USE OF � TEST WELL
WELL PUBLIC
❑ SUPPLY INDUSTRIAL AIR OTHER
CONDITIONING (specify)
DRILLING COMPRESSED CABLE
EQUIPMENT ROTARY AIR PERCUSSION OTHER
PERCUSSION D (Specify)
LENGTH feet
CASING (feet) DIAMETER (inches) WEfGHT PER FOOT IV H wA5 C1 SiNG GROuIED�
DETAILS 2 6 7 THREADED WELDED YES _:: NO YES NO
YIELD L #
HOURS YIELD (G.P.M.)
TEST BAILED PUMPED COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) 2�
LEVEL 2� Depth of Completed Well
MAKE 150 n feet below Land surface: 180
SCREEN
LENGTH OPEN TO AQUIFER (feet)
DETAILS SLOT SIZE DIAMETER (inches)
=IFGRAVEL Diameter of well including GRAVEL SIZE (inches) FROM(feet) TO(feet
gravel pack (inches):
DEPTH FROM LAND SURFACE
FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
two permanent landmarks.
0 8 Topsoil Clay
8 180 Bad.-ock
X74
0
,t7
7�
,l �V
If Yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO.
DATE OF REPORT I W _ LLER(Signature}
DEPT. OF ENVIORNMENTAL PROTECTION-WATER RESOURCES
I