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HomeMy WebLinkAboutWell New 116 Ident Road WELL COMPLETION REPORT STATE Of CONNECTICUT - CPR_Vf1Ev.11-a DEPARTMENT OF CONSUMER PROTECTION NOT fill in " WELL DRILLING BOARD STATE WELL No. of 165 CAPITOL AVE. OTHER NO. HARTFORD,CONNECTICUT 06106 NAME ADDRESS ONINEi - Mar Ellen Charlie Brenna 390 Mapleton Avenue SLIM. e d ROGATION (No.S Street) (Town) (lot Number) Of 1111611 1 16 -Ident. Road South Windsor BUSINESS PROPOELTD © DOMESTIC 0 ESTABLISHMENT FARM TEST.WELL UK or PUBLIC OTHER❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑(Specify) onumn COMPRESSED ABLE OTHER Ei11RTmw El NOTARY PERCUSSION PERCUSSION (Specify CAMM LENGTH(feet DIAMETER(inches) WEIGHT PER FOOT CASING CAOUTE02 DETAILS 101 6 17 XO THREADED ❑WELDED [01VE WAS YES5"t NO 9 YES NO YM HOURS YIELD IG.P.M.) TW -SAAILE6 0 nIwm QX COMPRESSED AIR 15 WAM MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING.YIELD TEST(feet) Depth of Completed Well Uva 151 in feet below Land surface: 223 MAKE LENGTH OPEN TO AQUIFER(feet) SORBN 0"A". SLOT SIZE- DIAMETER(inches) P GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet), TO(feet PACKED: grovel Pock(inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at bast FEET TO FEET two pest wl landmarks. 0 40 Silt 40 60 1 Sandy Silt 60 223 Red Shale WO If Yield was lnfed of diffenso t depth during drifluhg,list below FEET GALLONS PER MINUTE DATE WELL OOMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WEl (Sipnoturo) ' 2/3/93 155491 .126 Z.-q—q3 Sima Drilling Co. BOARD CONSUMER PROTECTION WELL-DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER CPR-B REV.11-e2 DEPARTMENT OF CONSUMER PROTECTION 155491 r,jj� '- (e'WELL DRILLING PERMIT 1755 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 LOCATION OF WELL(T'owtr) (Streel) (Lot Number) DATE OWNER OF WELL Q� Q 1NDIVIOUAL D BUILDER OTHER(SpecifypAP".— OWNER'S ADDRESS 350 : PROPOSED BUSINESS TEST Est. No.of DOMESTK ESTABLISHMENT FARM El WILL People being USE OF served. PUKIC AIR WELL SUPPLY INDUSTRIAL CONDITIONING OPNER) SKETCH OF WELL LOCATION Locate well with reskitl to at least two roods,showing distance from intersection and front of lot Location of lot to of least two roods Well location on lot and to house(if present) ktdlcose North T�b_1Vr xf . . Approttimgfe number of feet from well to L nearest source of possible contominotion. 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 Supplenten! 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 volid until all information is filled in and it has been countersigned by the Director of Health or his agent. AiPlIC11NT(Sig >tl APPLICANT'S D SS - REGISTRATION NO. . BY oenr fled1b Officer or Agent) DATE VED REJKTED 1777 oir r RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD .r _