HomeMy WebLinkAboutWell New 252 Long Hill Road CONSUMER PROTECTION a
WELL DRILLING BOARD STAn6F LTICUT PERMIT NUMBER
CPR-8 REV.11-82 ,DEPARTMENT OF CONSUMER PROTECTION 90425
WELL DRILLING PERMIT _
165 CAPITOL AVE,-HARTFORD,CONNECTICUT Ot5106
LOCATION OF WELL(Toms) (S-et) (Lot Namber). DATE
SOUTH WINDSOR MIG HILL RD. 10/16/84
OWNER OF WELL t irt�p
INDIVIDUAL 9 BUILDER EltrDtiMM OTHER(Specify) S & S i.nS (GILLES •CLAVET)
OWNER'S ADDRESS
96 BRELOX DR. VER1r01i 1 CT.. . ��t3-0,'A
PROPOSED BUSINESS TEST EsL No.of
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM WELL People being
USE OF served.
WELL SUBLIICY INDUSTRIAL AIR OTHER
❑ ❑ ❑ CONDITIONING ❑ (Specify) 4
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 Last two roads Well location on lot and to,�22(if present)
�! t�A��
Indicate North /R
X/%
�bf
L.
aN RIO
Approximate number of feet from well to
nearest source of possible contamination: 100,
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•Generol 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 6f Health or his agent.
I ( satyr ) APPLICANT'S ADDRESS REGISTRATION NO.
P.O. BOX 111, S. WILLIlS 1 CT.- 100
GMS1
BY(lows Health O ter or Ag t) DATE
OVED ❑REJECTED
REMARKS
jrj 7—
" RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
. .
WAL COMPLETION REPORT
STATE OF•,CONNECTICUT
CPR-9 Rev.„-ez _DEPARTMENT OF CONSUMER PROTECTION 7WE
o NOT fill in
WELL DRILLING BOARD STANO.
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
OWNER NAME ADDRESS
LOCATION (No.&Street) (Town)
OF WELL iytfy . (Lot Number)
:H1LL RD S- W&DWR
BUSINESS
PROPOSED DOMESTIC ESTABLISHMENT 1:1FARM
USE OF TEST WELL
PUBLIC
WELL SUPPLY INDUSTRIAL CONDITIONING (AIR (THER
Specify)
DRILLING COMPRESSED CABLE
EQUIPMENT ROTARY AIR PERCUSSION OTHER
PERCUSSION (Specify)
(H feet C IVE H
CASING LENGTH ) DIAMETER(inches) WEIGHT PER FOOT 'III WAS CAS ING GRO
DETAILS 1 UTeD?
YIELD 9 4 . THREADED O WELDED YES NO YES NO
:J i
HOURS
TEST BAILED PUMPED COMPRESSED AIR YIELD (G.P.M.)
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
LEVEL50 Depth of Completed Well
Oin feet below Land surface: 180
MAKE
SCREEN
LENGTH OPEN TO AQUIFER(feet)
DETAILS SLOT SIZE DIAMETER(inches)
TIF 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 landmarks.
2- is«,r :
O Clav
10 1 0 RAd ool.-
tY
.400
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
y
DATE WELL COMPLETED PER NO. REGISTRATION NO. DATE OF REPORT 1
WELL ER(Signature)
inn
DEPT. OF ENVIRONMENTAL PR0TFrTlnnl-UUATCO