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HomeMy WebLinkAboutWell New 1414 Main Street PERMIT NUMBER CPR-8 Rev.7/95 t�/� Q STATE OF CONNECTICUT 2 4 5 8 21 DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT 165 CXtol Avenue,Hartford,Connecticut 06106 LOCATION OF WELL (Town) (Street) (Lot Number) DATE OWNER OF WELL INDIVIDUAL BUILDER OTHER(Specify) OWNER'S ADDRESS Est.No.of PROPOSED DOMESTIC BUSINESS FARM TEST People being USE OF ESTABLISHMENT WELL served. WELL PUBLIC 1:1AIR OTHER SUPP Y INDUSTRIAL 1:1CONDITIONING (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 at least two roads Well location on to and to house(if present) 1 Indicate North c U r) r-. V Approximate 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 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 he Director of Health or his agent. APPLIC .T(Signature) V APPLICANT'S ADDRE S REGISTRATION NO. e yt/ BY ow a Officer Agen DATE ❑ APPROVED ❑ JECTED REMARKS DIRECTOR OF HEALTH irww":;,E:»vs'v­n*rvwI:_ ..,._. :-sswse yr cvnns:c�swror _. _ REV.1-71 WELL DRILLING BOARD bo NOT fill in li r State Office Building STATE WELL NO. HARTFORD,CONNECTICUT 06115 OTHER NO. NAME ADDRESS R a" I 114 OLINTO ` DR. S• WIN Ili CONN. )N (No.&Street) (Town) (Lot Number) LL 1414 MAIN ST. SOUTH WINDWR BUSINESS ED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL F ❑ PUBLfC AIR SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ ((Spec fy) INT ❑ ROTARY ❑ AIR PERCUSSION 1•J PERCUSSION ❑ (COMPRESSED CABLE (SpeEfy) G LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? S I aft I I THREADED ❑ WELDED I ❑YES ®NO ❑YES IKI NO G HOURS YIELD(G.P.M.) ElBAILED il PUMPED ❑ COMPRESSED AIR I MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) 2 I Depth of Completed Well 1� ( 26 in feet below Land surface: 2 MAKE LENGTH OPEN TO AQUIFER(feet) Stainless Stea3 Drive Polut I 3 Fta S SLOT SIZE DIAMETER(inches) IF GRAVEL I GRAVEL SIZE(inches)FROM(feet) ITO(feet) 2�y Diameter of well including I 'PACKED: 1 gravel pack(inches): LAND SURFACI Sketch exact location of well with distances,to at least to FEET FORMATION DESCRIPTION two permanent landmarks. 20 Fine 81,1t 26 Gz vel Saad 29 Gravel a ._ .. i l i yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE OMPLETED I PERMIT NO. I REGISTRATION NO. I DATE OF REPORT I WELL' KILLER(Signature) M LOCAL DIRECTOR OF HEALTH . WELL DRILLING BOARD STATE OF C014NECTICUT PERMIT NUMBER WDB,4 11-69 WELL DRILLING PERMIT' 31517 STATE OFFICE BUILDING, HARTFORD CONNECTICUT 06115 LOCATION OF WELL (Town) (Street) (Lot umber) I DATE SOM W331D$O$ 1414 MAIN ST 10/28/75 OWNER OF WELL INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) TN MAS J- D01M Ir OWNER'S ADDRESS. +�� 114 CLINTON DR. . S. WIINDSOR -COMi. PROPOSED` `" BUSINESS FARM TEST Est.No,of © D MESTIC ❑,ESTABLISHMENT ❑ ❑ WELL People being USE OF served. WELL' ' BLIC AIR OTHER ❑ UPPkY` ElINDUSTRIAL ❑ CONDITIONING El (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 at least two roads Well location on lot and to house(if present) Indicate.North I. y y,4I. W '01 w Approximate number of feet from well to nearest source of possible contamination: 120 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. AP CANT natur ) APPLICANT'S ADDRESS REGISTRATION NO. LASS ST. I YMOS CONN. BY own 8eadtk OfjBcer or Agent) I DATE APPROVED ❑ REJECTED REMARKS F DIRECTOR OF HEALTH