HomeMy WebLinkAboutWell New 1051 Foster Street Extension CPR-8 Rev.7195 PERMIT NUMBER
STATE OF CONNECTICUT 211714
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING:PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Sheet) (Lot Numba) DATE
S.WINDSOR 1051 FOSTER ST. EXT. 2/25/02
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
PUBLIC INDUSTRIAL AIR OTHER 4
SUPPLY CONDITIONING
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)
Indicate North jJ�ju�Z�
no,
Approximate number of feet from well to ABANDONMENT
nearest source of possible contamination:
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.
PLICAW( APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
V BY(Town Health Officer or Agent) DATE
�APPROVED � REJECTED
REMARKS(/ d
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
r 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 FEM aDOREss
GANELLI CONST. P.O. BOX 652, JURIOXXORK SUFFIELD
LOCATION (w•tt Sk") (Town) (Lof Number)
OF WELL 051 FOSTER=-ST.EXT. S.WINDSOR.
DOMESTIC BUSINESS a FARM El TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL PUBLIC INDUSTRIAL AIR OTHER
SUPPLY a CONDITIONING (s � ABANDONMENT
DRILLING EQUIPMENT ❑ ROTARY ❑ AIRIPRESSED PERCUSS ON CABLE ❑ OTHER
PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS ❑ THREADED El WELDEDg Q NO YES 0 NO
YIELD TEST a BAILED a PUMPED a COMPRESSED AIR HOURS YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL 175
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: including gravel peck
(W*S)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
0 175 CEMENTED
s ' • 4�Eic -.
ff yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED --,PERMIT NO. REGISTRATION NO. DATE OF REPORT ER(Signature)
2/27/02 211714 42 5/20/02
AGENCY