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HomeMy WebLinkAboutWell New 21 Linda Lane CONSUMER PROTECTION a l WELT.bRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER CPR4 REV./1-u DEPARTMENT OF CONSUMER PROTECTION 153290 WELL DRILLING PERMIT 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 e . LOCATION OF WELL(Town) (Strcty (Lot Nrrnrber) DATE q- - 5Z WELL WADER ❑.OTHER(Specify)II�IVIDUAL ' OWNER'S ADDRESS PROPOSED EUSINESS TEST Est.No.of U """""'� ❑ ESTMLISNMENT ❑ FAQ ❑ WELL People being USE OF served, AIR WELL Q S,�jpHy ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER (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) $a trt� Si E45 dpvb Qli 61 V A 'Apprrnr le number of feet from well to j n.orw samce of possible.contominotiom.- - r The undersigned is.aware:that.-upon,compkiion•of;the•.well,•d 'GWell-Completion-Report'•"containing construction,details-and inforination-fequired'u Se itder, ction'-'•':: ;::.45171".of;the T969.Supplement to •the General-Statutes.must>be•senteto the.ower n , the-Board:'and=.the:Water•Resources Gommi"idn'do'the•-Fo.m-poGided''by-the ` - .•.Board.Thi permit is not.volid,until oll•information is fil -n and•it-lws•.been counter-signed by the'Director of'Heahh or•his ogeiitr _ - -• -. •+ ,. .._. _ - _ APPI I: =':•,:..•.- APPLiCJ1N!'S-ADDRE r:.,-.-,: •.+•.'-::= REGI .. .. . . STRAiION NO' By(fawn Hes{ib O/frcn'or�[� 1 " : DATF•. .. RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD 1viELL- COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in CPR-9 REV.It-82 DEPARTMENT OF CONSUMER PROTECTION STATE WELL NO. WELL DRILLING BOARD 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 OTHER NO. NAME ADDRESS OWNER iqefv'G fi l l L-'tJ �v UT f�+rrY l�.58 t LOCATION (No. & Street) (Town) (Lot Number) OF WELL ,�f N b,g ie-'I ` 5"v�7`-ff u7 rsvb SofZ_ S' BUSINESS PROPOSED ®DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL PUBLIC�- SUPPLY INDUSTRIAL CI OTHER CONDITIONING (Specify) DRILLING EQUIPNLENT ® ROTARY © AIR RC PRESSSION D CABLE PERCUSSION . OTHER CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT IV WAS CASING G UTED? DETAILS 60 `#� / 7 ® THREADED � WELDED YES NO ®YES NO YIELDTEST Q COMPRESSED AIR HOURS YIELD (G.P1.) TAT BAILED PUMPED � �.2 pth of Completed Well WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) De LEVEL �( n feet below Land surface: MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM(feet) TO(feet PACKED: gravel pack (inches): 7 DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least FEET TO FEET two permanent landmarks. � .�.,� .:`jT'fiP•� F' t`i��f:.Gl-,- .�dU7t% 5!�'. .i� IQ l t P s 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 WELL DRILLER ;nature) DEPT.OF ENVIRONMENTAL PROTECTION-WATER RESOURCES