Loading...
HomeMy WebLinkAboutWell New 75 Maskel Road CONSUMER PROTECTION T^ -75 ' ' `a, L Q WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER CPR-B REV.11-82 DEPARTMENT-dF'CONSUMER PROTECTION 90236 WELL DRILLING PERMIT _ 165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106 South Windsor Maskell Road A LOCATION OF WELL(Town) (Street) aoi Na-ber) DATE R. Veilleux & Son 10-31-84 OWNER OF WELL ❑ INDIVIDUAL BUILDER ❑ OTHER(Specify) , OWNER'S ADDRESS PROPOSED BUSINESS TEST Est.No.of a DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being USE OF served. PUBLIC AIR WELL ElOTHER SUPP Y ❑ 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 at least two roads Well location on lot and to house(if present) indicate North 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 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. I NT(Si tare)�^ APPLICANT'S ADDRESS REGISTRATION NO. r� B n t t tr t • s 6033 DATE 10 PROVED EJECTED l� EMARKS RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE of coNNEcncur'' CPR_9REV.11-82 - _ DEPARTMENT OF CONSUMER PROTECTION 7EELL o NOT fill in WELL DRILLING BOARD NO. 765 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 NAME OWNER ADDRESS 0 LOCATION o. & Street) (Town) OF WELL ��j (Lot Number) ESTABLI ESTABLISHMENT PROPOss SED DOMESTICEl 6uslNe USE OF FARM TEST WELL PUBLIC AIR OTHER WELL SUPPLY INDUSTRIAL CONDITIONING ❑(Specify) DRILLING COMPRESSED CABLE OTHER EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT D I E�HOCASING GRO TED? QETAILS !! THREADED WELDED O YESES NO YIELD HOURS YIELD (G.P.M.)TEST � BAILED � PUMPED COMPRESSED AIR WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) JDURING YIELD TEST(feet) LEVEL Depth of Completed Well in feet below Land surface: © 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. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE s . LL DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) DEPT. �Yt DEPT. OF ENVIRONMFI61TA1 DDATC/^Tir%kl IASATrn n1n....e._e