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Home My WebLink AboutWell New 31 Linda Lane •CONSUMER PROTECTIONWELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER VW-fk&fl-92 DEPARTMENT OF CONSUMER PROTECTION 5 6 3 9 2 WELL DRILLING PERMIT 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 w LOCATION OF WELL(Tounr) (Sneer) (Lot Nymber) DATE OWNER OF W L ❑ INDIVIDUAL 4-z-a-M OTHER(Specify) OWNER'S ADDRESS % PROPOSED WSINESS TEST Est.No.of ��" � ❑ ESTAKISHMENT ❑ FARM ❑ WELL People being USE OF served. PUKkC AIR OTHER WEII ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (specify) 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 of least two tools Well location on lot and to house (if present) Irsdicae North -OTE Approximate number of feel from well to nearest source of possible contamination: The undersigned is aviare 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 ( `eotsr APPItUQNT�'S ADDRESS REGISTRATION NO. BY(Town H`dr�jfrcer or A est DATE v� ❑f1E.1 ��Z„-�� REMARKS lap- RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT ''CPR ORl1 'II•i� DEPARTMENT OF CONSUMER PROTECTION - Do NOT fill in STATE WELL NO. WELL DRILLING BOARD 165 CAPITOL AVE. OTHER NO. HARTFORD,CONNECTICUT 06106 NAM REN6 VE„1A A.E V X ADDRESS OWNERRM-VkEA0AF 60A1JrTRVCrian/ /7-52o 4/ lvvGroN RD, ,Sour# WIN'osaA er Dloo'7X LOCATION (No.IS Sk") (Town) (Lot Number) Of WELL I-iNDh+ LAND sof>TN 44)11vDsoreBUSINESS tl PBOFOSW ® DOMESTIC ❑ EAB ISHMENT ❑ FARM ❑ TEST WELL 1116E Of PUBLIC WELL' ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑OTHER�h) MILLING COMPRESSED lOIAfMENT CABLE OTHER ® ROTARY AIR PERCUSSION ' .: ❑ PERCUSSION ❑(Specify) CASH' L04TH-(fe0 DIAMETER(inches) I WEIGHT PER FOOT AS USING tEOr DETAILS .53 /7 [2 THREADED ❑ WELDED YES NO OYESVWD No. RS YIELD(G.P. TEST ® BAILED ❑PUMPED 19.COMPRESSED AIR HOU '� WATU MEASURE FRW LANDywwACE—STATIC(Specify feet) DURING YIELD TEST(feet) r LWK• 07D o?Q 5 Depth below Lads recces 016.5 MAKE LENGTH OPEN TO AQUIFER(feet) EQESN ' DETAILS SLOT SIZE• DIAMETER(inches) GRAVEI Damerer of well including GRAVEL SIZE(inches) FROM(feel) TO(feet IF PACKED: gravel Pock(inches): DEPTH"M"M SUVACE FORMATION DESCRIPTION Sketch exact location of well with distances. to of least FEET TO FEET two permangnt londniotks. D A& SAND• G'�9 v�,C� .SG Of yield was'a at diffm to deprtn during drilling,list below N FEET GALLONS PER MINUTE NU DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF RE T WELL DRILLER rograhtn) IV I BOARD CONSUMER PROTECTION WELL DRILLING BOARD STATE OF EONNECTICUT PERMIT NUMBER Ems- it*fl-0 ' DEPARTMENT OF CONSUMER PROTECTION 5 6 3 9 2 WELL DRILLING PERMIT 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 LOCATION OF WELI(VOttre) (Snret) (Lot Nsrmber) DATE ^. OWNER OF WELL `J IIBSWMAL WILDER OTHER(Specify) OWNER'S ADDRESS PROPOSED BUSINESS TEST Est.No.of w+wcs'rc ESTABLISHMENT FARM WELL People being USE OF served. WELL SLIMY INDUSTRIAL CONDITIONING (Spe iffy) SKETCH OF WELL LOCATION Locate well with respect to at least two toads,showing distance from intersection and front of lot Location of lot to of least two roads Well location on lot and to house(if present) hdkase North . Approximate number of feet from well to y n*crew source of possible contaminolion: ! The undersigned is swore that upon completion of the well, o "Well Completion Report" containing construction details and information required under Section 25-131 of fhe 1969 Supplement to the General Statutes must be sent to the owner, the Board and the Wafer 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 ( BAY APPItCAQNT�'S ADDRESS REGISTRATION NO. � 114 AF U/ BY(Torrm Health Officer or A ret D�AT^E 9-AVED ❑REI (� 7•-7 Z�'�j REMARKS L RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE OF CONNECTICUT CPR_9 REV.11_82 DEPARTMENT OF CONSUMER PROTECTION Do NOT.fill in- WELL DRILLING BOARD STATE WELL NO. 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 OTHER NO. OWNER NAME Rr<tfl E i/LEI t I�E V�[ ADDRESS trr t < 1-4-41 e-0-AIaheV1if7_1At/ 17,�`D .�AAIN6,rYV IPb, '50urN t�s1e11c St�f2� eT 6164779 LOCATION (No. 8 Street) (Town) OF WILL L J!t/�+ (lot Number) ,54)L7r.1jBUSINESS c�� tpsarz y PROPOSED DOMESTIC ESTABLISHMENT FARM USE OF TEST WELL PUBLIC WELL SUPPLY INDUSTRIAL CIONDITIONING FI((Specify) DRI LING ® COMPRESSED CABLE MOMENT ROTARY ® AIR PERCUSSION PERCUSSION OTHER PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DETANS !r-q ® THREADED WELDED IYES NO WAS SSItvG Grlpu�tEpNO - JI YIKD TEST BAILED � PUMPED 91CCiMPRE55ED AIR HOURS YIELD(G/ WAS MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST (feet) f j� IEVEi o2o Depth of Completed Well MAKE 07 015' in feet below Land surface: 174, SCREEN LENGTH OPEN TO AQUIFER(feet) DETA LS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet} TO{feet DEPTH FROM LAND SURFACE PACKED: gravel pack (inches): FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. -------------- Sit If Yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE V1 v3 DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) 3 DEPT OF ENVIR071INKAPKITAt