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HomeMy WebLinkAboutWell New 939 Foster Street Extension CPR-5 Rev.7/95 PERMIT NUMBER STATE OF CONNECTICUT 211362 DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION OF WELL (Town) (Street) (lot Numbed DATE S.WINDSOR 939 FOSTER ST.EXT. 2/25/02 OWNER OF WELL ER INDIVIDUAL BUILDER OTHER(Specify) OWNER'S ADDRESS ��((�� PAGANELLI CONST. — P.O. BOX ', SUFFIELD PROPOSED ®X Est.No.of DOMESTIC BUSINESS FARM TEST People being USE OF ESTABLISHMENT WELL served. WELL PUBLIC 1:1SUPPLY INDUSTRIAL CONDITIONING SAIR EER) 4 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 present) 0 Indicate North TONC" � F0 Approximate number of feet from well to nearest source of possible contamination: ABANDONMENT The undersigned is aware that upon completion of the well, a'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 Department of Consumer Protection and the Water Resources Commission on the form provided 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 or his agent. JkPPLICANT( 'na ) APPLICANT'S ADDRESS REGISTRATION NO. P.O. BOX 406, WILLINGTON, CT. 42 BY(Town Health Officer orAgent) DATE �PPROVED ❑ REJECTED REMARKS 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 let PROFESSIONAL TRADES DIVISIO14 WELL DRILLING COMPLETION REPORT OTHER No. 165 Capitol Avenue,Hartford,Connecticut 06106- OWNER NAME PAGANELLI CONST. ADDRESS BOX 652, SUFFIELD LOCATION /No.&Stnw) (Town). (Lot Number) OF WELL 939 FOSTER ST.EXT. S.WINDSOR DOMESTIC BUSINESS FARM TEST PROPOSED 1:1ESTABLISHMENT WELL USE OF WELL PUBLIC El INDUSTRIAL ❑ AIR © OTHERABANDONEMT. SUPPLY. _ CONDITIONING (Specify) DRILLING •' ROTARY COMPRESSED CABLE OTHER . EQUIPMENT CJ AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH(feel) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?. DETAILS a THREADED WELDED t YES ❑ NO• O YES ❑ NO YIELD TEST ❑SAILED a PUMPED [] CCU PRESSED AIR HOURS LJ YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) DepWaf Completed Well in feet LEVEL 110, MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well- GRAVEL SIZE(incfres) FROM(feet) TO(feet) PACKED: irOxIng gravel pads DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION. Sketch exact location of well with'distanoes,to at least two FEET TO FEET Permanent landmarks 0 110 CEMENTED If yield was tested at different depths during drilling,list below. FEET GALLONS PER MINUTE WIN DATE WELL COMPLETED PERMIT NO. REGISTRATION N0. DATE OF REPORT LL R(SigWum) 2127102 211362 42 5/20/02 AGENCY