HomeMy WebLinkAboutWell New 980 Foster Street Extension • CPR-8 Rev.7A35 PERMIT NUMBER
STATE OF CONNECTICUT 211142
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Cot Number) DATE
_ S.WINDSOR 9809 FOSTER ST.EXT. 2/8/012
OWNER OF WELL
DINDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
PAGANELLI CONST. P.O. BOX *16•, suffield
PROPOSED X Eat No.of
DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL WELL gp�.
'
PUSUC
AIR
SUPPLY INDUSTRIAL CONDITIONING OTHER 4
pecifyj
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 locatiod on to and to house(if present)
Indicate North
aDa 0`��'
c Fos�N �9ST�ti S fi, Eac?
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.
PLICANT(Signatu APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
BY(Town Health Officer orAgent) DATE
PROVED ❑ REJECTED _�—/d—O 2
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CAR-9 Rev.7/95 DO NOT till In'
- STATEOF CONNECTICUT STATE WELL NO,
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE dt PROFESSIONAL TRADES DIVISION OTHER NO.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
PAGANELLI CONST. P.O. BOX 652 SUNFFIELD
LOCATION (Na.a Sheet) (Town) (Lot Number)
OF WELL 9805 FOSTER ST.EXT. S:WINDSOR
DOMESTIC BUSINESS- FARM TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL ❑ PUBLIC INDUSTRIAL a AIR OTHER ABANDONMENT
SUPPLY CONDITIONING (Specify)
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet)=. DIAMETER((ndies) WEIGHT PER DRIVE SHOE WAS CASING GVOUT 007
FOOT
DETAILS In THREADED Q WELDED ❑ YES ❑ NO. ❑ YES ❑ NO
YIELD TEST Q MLED Q PUMPED COMPRESSED AIR HOURS YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TES_T(feet) Depth of Completed Well in feet
LEVEL
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER{inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feel)
PACKED: includaV gravel pads
(inches) .
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
0 85 CEMENTED
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 LLER(Soialure)
211 0/0 2 211142 42 5/20/02
AGENCY