HomeMy WebLinkAboutWell New 67Maskel Road Maskel Road CONSUMER PROTECTION
WELL DRILLING BOARD STATEZF CONNfCTICUT PERMIT NUMBER
CPR-8 REV.11-82 DEPARTMENT OF'CONSUMER PROTECTION 89182
WELL DRILLING PERMIT _
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
South Windsor '` -Maskel Roadt.,
10
LOCATION OF WELL(lows) (Street) Of Nam btr) DATE
Rene Vei l leux & Son $ �-R4
OWNER OF WELL
❑ INDIVIDUAL BUILDER ❑ OTHER(Specify)
OWNER'S ADDRESS
PROPOSED a DOMESTIC ❑ BUSINESS TEST Est;No.of
ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
PUBLIC AIR
THER
WELL ❑SUPPLY INDUSTRIAL ❑ CONDITIONING ❑ (OSpectfy) 4 .
SKETCH OF WELL LOCATION '
Locate well with respect to at least two roods,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)
r
Indicate North
4
Approximate number of feet from well to 7
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-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 countersigned by the Director of Health or his agent.
APPLI (SIB re) APPLICANT'S ADDRESS REGISTRATION NO.
n Ave.Glastonbur Ct. .06033 10
BY(Town Health Officer r Agent) DATE
D�kROVED REJ TED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
_WN.
ELL COMPLETION REPORT
STATE OF CONNECTICUT
caR_s REV.11_62 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING'BOARD STATE WELL NO.
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME
OWNER ', ADDRESS
R. Vef 1 euxa
IO 4 testarfzrd,C ,LOCATN (No &'Stfeet)
OF WELL (Town) (Lot Number)
Nfas Road Sa,{ tstr g
PROPOSED DOMESTIC
ESTABLISHMENT FARM
USE OF TEST WELL
WELL PUBLIC
SUPPLY
'INDUSTRIAL AIR OTHER
CONDITION WG (Specify)
DRILLINGEl COMPRESSED CABLE EQUIPMENT ROTARY n AIR PERCUSSIONEl OTHER
yt- PERCUSSION CASING LENGTH (Specify)
(feet)) DIAMETER-(inches) WEIGHT PER FOOT D IV SHO DETAILS W S CASING GROUTED?
20 d 7 -— ,THREADED � WELDED �YES �NO in YES �NO
YIELD
TEST BAILED PUMPED COMPRESSED AIR HOURS YIELD (G.P.M.)
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet);
to
LEVEL � Depth of Completed Well
in feet below Land surface: 20D
MAKE
SCREEN -
LENGTH OPEN TO AQUIFER(feet)
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
FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least
two permanent landmarks..
0 12 sand R! gravel
12 20
A�
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'
WELL DRILLER (Signature)
82 101
DEPT. OF ENVIRONMENTAL:PROTFr-Tints_ %A®ATen®Cc.,r