Loading...
HomeMy WebLinkAboutWell New 10 Linda Lane CONSUMER PROTECTION IO WELL DIMMING BOARD STATE.OF — -PERMIT NUMBER —C►n=s ryryw.1T_e2 DEPARTMENT OF CONSUMER PROTECTION 156394 WELL DRILLING PERMIT 165 CAPITOL'AVE.,HARTFORD,CONNECTICUT 06106 �.� QOGK LOCATION OF WELL(Tatars) •(Stnret) (Lor Ari tuber) DATE r �r OWNER OF WELL J {/ 0 MOIVMAL dER OTHER(Specify) OWNER'S ADDRESS IMNUS TEST Est.N of PROPOSED (�.--uv ethic ESTABLISHMENT FARM WILL People Ling USE OF served. PUKIC AIR WELL 11 SUPPLY INDUSTRIAL CONDITIONING ((SSpe if) SKETCH OF WELL LOCATION Locate well with respect to of least two roads,showing distance from intersection and front of dot Lacotion of lot to at kost two roads Well location on [of and to house (if present) Ind'—se North App"wimale number of feet from well to 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 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.APPL= . a/ REGISTRATION NO. APPIL BY(Tmm Hedtb Offrca Age J DATE Rr VED 0 CTED S=1 Z 3 RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE Of CONNECTICUT cat-9 REV.11-ez DEPARTMENT OF CONSUMER PROTECTION 7WELL T fill in WELL DRILLING BOARD 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 OWNER NAME d �+1/L /G L. u ADDRESS MlgtAt�l_ /'ontff—Z11 Tart f7 `r� r �r�sr R�, sc�vr' rt1A sa c'T duo�y LOCATION (No. & Street) T OF WRL /nl.�/fi �RNc (Town) (Lot Number) BUSINESS .L Sgv7'f� ac✓fnx.�.SolZr f PROPOSM DOMESTIC ESTABLISHMENT FARM 11.1111 OFTEST WELL PUBLIC WILL SUPPLY INDUSTRIAL CtONDITIONING ((Specify) DMI LING COMPRESSED LQYMtlifiN' T ® OTHER ROTARY AIR PERCUSSION CAPERCBLE OTHER El(specify) CAUNG LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DETAILS WAS CASING GROUTED? Jr �'7 THREADED WELDED YES NO ©YES YIMD TEST BAILED a PUMPED COMPRESSED AIR HOURS YIELD (G. NO P.M.) WATU MEASURE FROM LAND SURFACE—STATIC y ) 0(Spe7i feet DURING YIELD TEST(feet) LEVEL lQ o?a� Depth of Completed Well in feet below Land surface: p2 0 7 MAKE SCEEEI�1 LENGTH OPEN TO AQUIFER (feet) DETAN.S SLOT SIZE DIAMETER(inches) 1F GRAVEL Diameter of well including GRAVEL SIZE(inches) (FROM(feet) ITO(feet PACKED: grovel pock (inches): DEPTH FROM LAND SURFACE FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. 73` M Yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE QQ �E DATE WEII COMPLETED PERMIT W. REGISTRATION NO: DATE OF REPORT 7 WELL DRILLER(Signature) DEPT OF ENVIRONMENTAf P�C1T�e^TIr9Lst_urwTr:, -- CONSUMER PROTECTION WELL,DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER "DPR-s P--v.11-82 DEPARTMENT OF CONSUMER PROTECTION 156394 WELL DRILLING PERMIT - 165 CAPITOL'AVE.,HARTFORD,CONNECTICUT 06106 LOCATION OF WELL(/bran) 0fteet) (Lot Number) DATE x �j OWNER OF WELL ❑ NIDIVIOUALgi-01—w—ER ❑ OTHER(Specify) OWNER'S ADDRESS NESS TEST Est.No.of PROPOSED zp gryc �u ANT ❑ FARM ❑ WILL People being USE OF served. PUKIC AIR OTHER WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (specify) SKETCH OF WELL LOCATION Locate well with respect to at least two roods.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) Ittdloo/e North 1 I Apprortimote number of feet from well to neared source of possible contomiration: The undersigned is aware that upon completion.of the well, a "Well Completion Report" contoining 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 Baard.This permit is not valid until all information is filled in and it has been countersigned by the Director of Health or his agent. - APPL !sierra 1 �ors AooR/� d REGISTRATION NO. BY(Tows Health Offerer Age J DATE VIED ❑RMCT1101 r D 1Z- 3 RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD W_EL4 COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in CM-9,4IIV.1.1412 DEPARTMENT OF CONSUMER PROTECTION STATE WELL NO. WELL DRILLING BOARD 165 CAPITOL AVE. OTHER NO. HARTFORD,CONNECTICUT 06106 ow"M NAIVE R6,V6 V 4fl",5 U K ADDRESS MAj4dA.&AF. 1 17.0 4AX110;A0v AD. .sour# 4P,NbJ0J C7' 90607y touTlDPI (No.6 Street) (Town) (Lot Number) Of WRIL W-INbA f-ANE SouTif w<�.Solz.. / NESS /1Rp pNp ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL UN OF PUBLIC <<fLLl ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑((THER Specify) EI;tUNR1ENi ROTARY 13 AID RRCUSSION ❑ PERCUSSION ❑(Specify) CASM LENGTH(teat) DIAMETER(inches) WEIGHT PER FOOT w CASINGTED? DETAILS AF/ 1 7 ©THREADED ❑WELDED WYESRKX No RYES No vow HOURS YIELD(G.P.M.) TW © RAN ❑ PUMPED ©COMPRESSED AIR �R :30 WATO MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVQ /O p�L2,.� in feet below Land surface: o?OS MAKE LENGTH OPEN TO AQUIFER(Feet) f1tr�IP1 DETAIL: SLOT SIZE j DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet PACKED: grovel pock(inches): WI M FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances•to at kcst FEET'TO FEET two permanent landnmAs. d 34 3(, doh RED SftAI..� -73- a I yitdd woe lesled as different depths dud%drilling,lief bttlow FEET GALLONS PER MINLM DATE Vfiu COMPLETED 17FEMRM;T NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) 93 /s"6 3 5?'�4 �a ,s"�9 3 '4 x . BOARD