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HomeMy WebLinkAboutWell New 9 Linda Lane Q. Wizta t CONSUMER PROTECTION UILQ WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER FPR-e NO 11-02 DEPARTMENT OF CONSUMER PROTECTION . 158016 WELL DRILLING PERMIT 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 -44 LOCATION OF Wit owr) (SmU) (Lot Nwmber) DATE OWNER OF WEtt If! ewouAL JLDER OTHER(Specify) OWNER'S ADDRESS rs - • � 3 S7�v . UMNESS TEST Est. No.of Pf1OPOSEO TIC ESTABLISHMENT FARM WELL People being USE OF served. PUSUC AIR OTHER WELL SUPPLYINDUSTRIAL CONDITIONING ❑ (specify) SKETCH OF WELL LOCATION Locate well with respect to at least two roads,showing distance from intersection and from of lot Location of lot to at least two roods Well location on lot and to house(if present) Indfeole North 6 p Approximaee number of feet from well to - ` nearest source of possible conbmination: S 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 Board and the Water Resources Commission on -the form provided by the Board.This permit 8 not vold until all information is filled in arxf it has been countersigned by the Director of Health or his agent. APPL )tom ) APPLICANT'S ADDRESS REGISTRATION NO. • BY(T' t H Ojfrtn or Ageet) DATE Elvftn 9 tr R S RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT CPR-9 REV.11-es DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in WELL DRILLING BOARD STATE WELL NO. 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 OTHER NO. OWNER NAME E.ENE 1 LLZU,1C JAWRES55Q F.$,IINGT�IN ROAD SOUTH L�INDSOR CT f)6Q7• MAPLE r'-'A .-CONSTRUCTION r LOCATION (No.& Street) (Town) (Lot Number) OF WILL 6 LINDA LANE SOUTH WINDSOR 6 BUSINESS 12 DOMESTIC ESTABLISHMENT FARM TEST WELL ►ROPOf� � USE OF PUBLIC WEII 0 THER SUPPLY INDUSTRIAL CONDITIONING (specify) ((Specify) DRILLING COMPRESSED CABLE OTHER EQUNWAW I ROTARY E3 AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT JIVE AS CAgN UTED? © R THREADED �`WELDED YES NO YES T NO VNILD HOURS YIELD (G.P.M.) TEST EI BAILED PUMPED EI COMPRESSED AIR 1 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) LEM Depth of Completed Well Q 2 2 5 in feet below Land surface: 225 MAKE LENGTH OPEN TO AQUIFER.(feet) SCRHN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet PACKED: gravel pack (inches): DEPTH FROM LAND SURFACE FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent londmarks. 0 35 225 SAND STONE & RED SHALE t 4�L 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 ;1- FN\T1M4.:DUF ure) 8/4/93 158016 10 9/3/93 ORD CONSUMER PROTECTION WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER RPn-a REtl.11-42 DEPARTMENT OF CONSUMER PROTECTION . 158016 WELL DRILLING PERMIT 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 -404 LOCATION OF WELL owrr) (Sneer) (Lot Number) DATE OWNER OF WELL 01XV DUAL ILDER OTHER(Specify) OWNER'S ADDRESS A n ,�(/Q 3 S7�'v PRAPOSED IUS04VA TEST. Est. No.of . TK ESTABLISHMENT FAQ WELL People being USE OF served. PUBLIC AIR OTHER WELL SUPPLY INDUSTRIAL CONDITIONING (Specify) SKETCH OF WELL LOCATION Locale well with respect to at least two roads, showing distance from intersection and front of lot Location of lot to at least two roods Well location on lot and to house (if present) Indicate Ntrth I. 6 p Approximate number of feet from well to r nearest source of possible contamination: S 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 Board and the Water Resources Commission on the form provided by the Board 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. APPI ijrwr J APPLICANT'S ADDRESS REGISTRATION NO. i4A / a BY(Tow H / Officer or Aeeer) DATE VIA o(Q "1 R RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT.' ' OO NOT fill in .rvR_oaE,f�„ DEPARTMENT OF CONSUMER PROTECTION STATE•WEII NO. WELL DRILLING BOARD 165 CAPITOL AVE. OTHER NO. HARTFORD,CONNECTICUT 06106 NAAIE RENE VIELLEUX Ao1750 ELLINGTON ROAD SOUTH WINDSOR, CT 06074 (No.a street) (TO—) (lot Number) OF sL 6 LINDA LANE SOUTH WINDSOR 6 plOPOggp ® DOMESTIC ESTABLISHMENT FARM TEST WELL UN OF L 0 PUBLIC AIR SUPPLY INDUSTRIAL CONDITIONING 0((Specify) DMILLNG COMPRESSED CABLE OTHER �( t ® ROTARY ® AIR PERCUSSION PERCUSSION El(Specify) LENGTH(feet) DIAMETER(inches) WEKsHT PER FOOT w CASING ,o+ DETAILS 40 6 17 El THREADED WELDED X YES NO 12 YES NO Tow HOURS YIELD(G.P.M.) TEST BAILED El PUMPED a COMPRESSED AIR 4 10 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEM. 20 225 in feet below land surface: 2 2 5 MAKE LENGTH OPEN TO AQUIFER(feet) . fIfRNIF . DIETAR.S SLOT SIZE DLAMTER(btches) IF 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 distantces.'to at least FEET TO FEET two permonent landnarks. 0 35 SAND &• GRAVEL 35 225 SAND STONE & RED SHALE ' M yield woe sasled of different depdts during drilling,list below FEET GALLONS PER MINUTE DATE 8 M 3 D PERMIT W. REcIST�yTwN No. ol�jE QF.R�9 3T I=Ae�t two) J11 J�3/ N M. DUFFORD BOARD