HomeMy WebLinkAboutWell New 26 Long Hill Road R-8 Rev.7t95 �� PERMIT NUMBER
STATE OF CONNECTICUT 220327
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (TO-) (Street) (rot Number) OATS
South Windsor 26 Long Hill Rd 7/25/03
OWNER OF WELL
INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
Terry Thomas 65 Foster St South Windsor
Est No.of
PROPOSED ® DOMESTIC ❑ BUSINESS FARM ❑ TEST People being
USE OF ESTABLISHMENT WELL Served.
WELL
PUBLIC INDUSTRIAL AIR CONDITIONING ❑ IS
ER 4 SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot
location of tot to at least two roads Well location on to and to house(if present)
Indicate North r
Q
7
�.
w�l
r
Approximate number of feet from well to
nearest source of possible contamination: Sanitary Service NA
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 Department of Consumer Protection and the Water
Resources Commission on the form provided by the agency. 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.
jjAPPLICANT(Signature) APPLICANT'S ADDRESS REGISTRATION NO.
P.O. Box 406 Willinciton 42
ROVED REJECTED
BY(Town Health OfterorAgenq DATE
❑ n- ^ ^
(/( (� !1p
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7/95
STATE OF CONNECTICUT DO NOT fill in
DEPARTMENT OF CONSUMER PROTECTION STATE WELL NO_
REAL ESTATE&PROFESSIONAL TRADES DIVISION`
WELL DRILLING COMPLETION REPORT OTHER NO.
165 Capitol Avenue,Hartford,Connecticut 06106
_.• ]OFWELL
NAME
7
ADDRESS
L Foster St South NO.&Street) (Terry Thomas Town) Windsor
WELL (Lot d St7t1'G 1 t2i1{ SOr (Lot Number)
DOMESTIC ESTABLUSINESSHMENT BUSI Lj FARM
P TEST
US Ci WELL
PUBLIC INDUSTRIAL ❑ AIR ❑SUPPLY 0 HER
D a ROTARY CONDITIONING (Specify)
EQUIPMENT COMPRESSED CABLE ❑ OTHER
AIR PERCUSSION PERCUSSION (Specify)
EDE
SING LENGTH(feet) DIAMETER(inches) WEIGHT PER F00T
AILS 40 6 ? ' e THREADED WELDED DRIVE SHOE WAS CASING GROUTED?
TEST Q BAILED PUMPED ❑ YES ❑ NO• ❑ YES ❑ NO
QCOMPRESSED AIR HOURS
Yr YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) 29
LEVEL 201 Depth of Completed Well in feet
MAKE 180 205
SCREEN LENGTH OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL
Diameter v well GRAVEL SIZE(inches) FROM(feet) TO feet
PACKED: including gravel pack (feet)
DEPTH FROM LAND TO SURFACE (inches)
FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
*archvel Topsoil
Hardpan
23- 2-0
Grev
b 1
A
3c>
weA
If yield was tested at different depths during drilling,list below j
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO.
DATE OF REPORT LLD ILL S natur
9/ 2 2 0 3 2 1
e)
42 9/25/ 3
G
DEPT.OF ENVIRONMENTAL PROTECTION-WATER RESOURCES