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HomeMy WebLinkAboutWell New 54 Meadow Road CONSUMER PROTECTION WILL DRILLING BOARD F STATVOF_CONNECTICUT �'lLr PERMIT NUMBER CPA-e nelr.sl-az DEPARTMENT OF CONSUMER PROTECTION 1 fi 2 5 9 5 WELL DRILLING PERMIT _ 165 CAPITOL AVE..HARTFORD.CONNECTICUT 06106 - ~ LOCATION OF WELL(Tome) (Smey (Lot Number) DATE SOUTH WINDSOR 54 MEADOW RD. 5/20/94 OWNER OF WELL Q Ifr01AMAL t1UIL0ER ❑ onak(specify) ARTHUR GEER OWNER'S ADDRESS 54 MEADOW RD. , S. WINDSOR, 'GT. WS!l�Sf TEST Elf. No.of PROPOSED OOMEfTic ❑ ESTAKISHMMNT ❑ FARM ❑ WELL People being USE OF .erred. PUKIC WELL ❑ SUPPLY ❑ WIMISTRIAL ❑ ONWTIONINO ❑ O�EfY) 2 SKETCH OF WELL LOCATION Locate well with respect to a least two roads. show.ng distance from intersection and front of lot Loco-ion of kit to of loos:two roads Well location an lot and to house Gf present) 0 MtCN dlcafe North • I pa w rip, Approai to number of fees from well to neared source of possible contamination: 7 5 .' The undersigned is aware that upon completion of the well. o -Well Completion Report*- conaininq cons!ruction details and inforrnohon required under Section 25131 of fhs 1969 Supplement to the Generol Statutes must be sent •a the owner, the Board and the Water Resources Commission on the form provided by the (bard. This permit q rat valid until oil informorlori is filled in aid it has been covnter•signed by the Director of Health or his•ogent. e=(Sgisairre) APPLICANT'S ADDRESS REGISTRATION NO. ',- 0q4�� -. -✓}- 1,0 1 P.O. BOX 405, WILL_I•NGTON, CT. 44 � 11E:fKTED BY(Tommu Ne,(rh Officer or Aaeerj DATE iLPPROVEo ❑ REMARKS DEEPEN EXISTING WELL RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE of coNNEcncuT CPR-°REV.I142 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in WELL DRILLING BOARD STATE WELL NO 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 OTHER NO DEEPEN EXISTING WELL OWNER NAME ARTI-IUR DEER 5+4 � � - t LEAJJO RD. , S. WINDSOR, CT. LOCATION (No. 6 Street) (Town) (Lot Number) OF WELL 54 MEADOW RD. S.WINDSOR BUSINESS PROPOSED © DOMESTIC ESTABLISHMENT FARM USE OF TEST WELL WELL PUBLIC AIR OTHER. SUPPLY INDUSTRIAL CONDITIONING (Specify) DRILLING n COMPRESSED CABLE OTHER EQUI/MENT `ems' ROTARY AIR PERCUSSION PERCUSSION ❑(Specify) CASINO LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT 1 WAS CASING GROUTED,DET THREADED YES NO YES NO YIELD ��IWELDED TEST BAILED PUMPED COMPRESSED AIR c- YIEID (GPM _� 20 WATES MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIEID TFST (feel) LEVEL Depth of Completed Well .10 8 0 to feet below Land surface 2>r- MAKE scamLENGTH OPEN TO AQUIFER (feet) DETAUf SLOT SIZE DIAMETER(inches) GRAVEL SIZE (inches} FROM(leer} TO(feet =IFVEL Diameter of wll includingD: grovel pock (inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to of least FEET TO FEET two permanent landmarks. 102 - 325 Bedrock ,t If Yi*W war Tested of different depths during drilling,list below FEET GALLONS PER MINUTE440 DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. =DATEOF WELT'6 MIL (Signal re) 0A ��