HomeMy WebLinkAboutWell New 120 Newberry Road CONSUMER PROTECTION LOCO "bpjN f6 PERMIT NUMBER
WELL DRILLING BOARD _• 'STATE,OF CONNECTICUTU
CPR-8 REV.11-B2 DEPARTMENT OF CONSUMER PROTECTION 103339
WELL DRILLING PERMIT
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
SOUTH WIiaDSOR L+EWBENRY ROAD 1 5/30/85
OWNER OF WELL
❑ INDIVIDUAL a BUILDER OTHER(Specify) R.S.K. COLiTRACTORS IMC.
OWNER'S ADDRESS
179WELLIXiGTOli RD. P.O. BOX 701, S. WZLIDSOR'; CT. 644-8761
BUSINESS TEST Est.No.of
PROPOSED D6AAESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF PUBILIC AIR THER served.
WELL ❑ 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 roads Well location on lot and to house (if present)
Indicate North
/;11 P uc GAS c�-F
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Approximate number of feet from well to
nearest source of,possible contamination: 1001{
The undersigned is aware that upon completion of the well, a "Well Completion Report" containing coristruction 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 unfit oil information is'filled in and it has been counter-signed by the Director of Health or his agent.
APPL (Sig ;A:PPLICANT'S ADDRESS REGISTRATION NO.
0en P.O. BOX 111 S. -WILLIl1GTOLY CT. 100
BY(Town Health Officer or Agent) DATE
APPROVED REJECTED
REMARKS
�,�f� 00
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
STATE WELL NO.
WELL DRILLING BOARD
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME ADDRESS 1 r gy�r
OWNER L.S.K.K OO�a'TRACTORS 11.Y i• 1744 E ,IN��r RD. , S o W.��'DS OT•
LOCATION 1 (No. & Street) (TowTn)t (Lot Number)
OF WELL -LiEW p�i.�rRRY ROAD �c• �v I-453ORBUSINESS
� 3,
PROPOSED ® DOMESTIC ESTABLISHMENT FARM " TEST WELL
USE OF
WELL OTHERPUBLIC AIR
SUPPLY INDUSTRIAL CONDITIONING (Specify)
COMPRESSEDDRILLING CABLE OTHER
EQUIPMENT ROTARY AIR PERCUSSION ❑ pec PERCUSSION y)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE S OE wAS CASING GROUTED?
DETAILS 19'04 FKI THREADED 1:1WELDED 2 YES NO YES, NO
YIELD
HOURS YIELD (G.P.M.)
TEST El BAILED El PUMPED b COMPRESSED AIR 6
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 20 2 in feet below Land surface: 300
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):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
FEET TO FEET two permanent landmarks.
O 8 tSvx&_ Gravel
120 'OO B d fla�
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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 WE ILLER(Signature)
DEPT. OF ENVIRONMENTAL PROTECTION-WATER RESOURCES
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