HomeMy WebLinkAboutWell New 977 Foster Street Extension CPR-8 Rev.7/95 PERMIT NUMBER'' 1
STATE OF CONNECTICUT 211141
141
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE 81 PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (sfrw) (Lot Number) DATE
S.WINDSOR 977 FOSTER ST.EXT. 2/8/02
OWNER OF WELL
® INDIVIDUAL BUILDER ❑ OTHER(Specify)
OWNER'S ADDRESS
PAGANELLI CONST. P.O. BOX 652 S.WINDSOR
Est.No.of
PROPOSED ® DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
PUBLICAIR
SUP INDUSTRIAL CONDITIONING ETHER 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 12p u
Indicate North
CL
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.
PLFPROVED
) APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
' BY(Town Health OTicerorAgent) DATE
REJECTEDKC10
zaLL
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&PROFESSIONAL TRADES DIVISION• OTHER NO.-
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAIVE ADDRESS
PAGANELLI .CONST. P.O. BOX 652, S.WINDSOR
LOCATION oft s Sheet) (Town) (Lot Number)
OF WELL 977 FOSTER ST.EXT. S.WINDSOR
DOMESTIC BUSINESS Q FARM TEST
PROPOSER 1:1ESTABLISHMENT . WELL
USE OF WELL a' PUBLIC INDUSTRIAL ❑ AIR ® OTHER
SUPPLY - CONDITIONING ABANDOBNMENT
DRILLING ❑ ROTARY a COMPRESSED - CABLE OTHER
EQUIPMENT AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feel) DIAMETER(incites) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS a THREADED WELDED ❑ YES ❑ NO- ❑ YES ❑ NO
YIELD TEST BALED ❑ PUMPED a COMPRESSED AIR HOURS YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feeq DURING YIELD TEST(feet) Depth of Compbted Wee in feet
LEVEL 1 1 5 '
MAKE LENGTH OPEN TO AQUIFER(fast)
SCREEN
'DETAILS SLOT SIZE DIAMETER(hches) IF GRAVEL Diameter of well GRAVEL SIZE(ndm) FROM(feet) TO(feet)
PACKED: including gravel pads
(irtdtes)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well.with distances,to at least two
FEET TO FEET permanent landmarks
0 115 CEMENTED .
ps
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 DRILLER(Signature)
2/10/02 211141 42 5/20/02
- AGENCY