HomeMy WebLinkAboutWell New 201 Miller Road -CONSUMER PROTECTION
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-8 Rw.f t-62 DEPARTMENT OF CONSUMER PROTECTION 100928
WELL DRILLING PERMIT
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
SOUTH WINDSOR, CONN. MILLER ROAD 201
LOCATION OF WELL(Ybwn) (Street) (Lot Nmmber) DATE
REJEAN DACQUES FEB. 5; 1985
OWNER OF WELL
INDIVIDUAL WILDER OTHER(Specify)
OWNER'S ADDRESS
BUSINESS TEST Est.No.of
PROPOSED DOMESTIC ESTABLISHMENT FARM WELL People being
USE OF served.
PUBLIC AIR
OTH
WELL SUPPLY INDUSTRIAL CONDITIONING (Specify)
SKETCH OF WELL LOCATION
Comte well with iespect to at least two roads,showing distance from intersection and front of lot
Location of lot to at least two roods Well location on lot and to house(if present)
Indicate North `\
J / \
.31
i
l e&. o R o
Approximate number of feet from well to
neorest 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
2-1131 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-sigh �tgAitetppAtf+�1e US hiSpg}NC
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APPLICANT(Signature) APPLICANT'S ADDRESS RR=-- {•+• AVIiNLIFREGISTRATION NO.
NEW KITAIN, CONN, 9605iy, 60
BY(Town Health Officer or Agent) DATE
APPROVED a;-;� 4 ; EJECTED I R. /7��'�/ Q� `r
REMARKS I+ y r/14 � IC O O
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RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL CbMPLETION REPORT STATE OF CONNECTICUT
CPR-9 Rev.11-82 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD srArE WELL No. .
r
165 CAPITOL AVE.
HARTF-ORD—CONNECTICUT-06106 --- [OTHER NO.
NAME ADDRESS
OWNER 1 tst t DA i o-�. LEFAZL B . O. WINDSO Li lY1N. 0€30
74
LOCATION (No. & Street) (Town)
(Lot Number)
OF WELL MILLER ROADS SOUTH WITSOR, CO . 201
BUSINEPROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL OTHERPUBLIC AIR
SUPPLY INDUSTRIAL CONDITIONING (Specify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GRO TED1
DETAILS 26 YE VET 6 in. 17 DDO. � THREADED � WELDED �YES �NO �YES rn NO
YIELD r HOURS YIELD (G.P.M.)
TEST 11 BAILED PUMPED COMPRESSED AIR 4 hOUrS 15 gallons
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL ivater level 40 eet 22d feet in feet below Land surface: 22-0 Feet
MAKE LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) {F 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.
0 18 y AIND
19 220 RED SAND STONE
Lam`
A
If yield was tested at different depths during drilling, list below WO
FEET GALLONS PER MINUTE
APT
lk
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE 5F REPORT WELL DRILLER(Signature)
2 18/8 1Q 28 6 18 8 ,
DEPT. OF ENVIRONMENTAL PROTFrTink!_WAT;:D mcni mrrc
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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
f�Osoe•co` TELEPHONE (860) 644-2511
Dear Homeowner:
The Town of South Windsor Health Department's goal is to keep you informed about the
status of water quality throughout the town whether you are served by and individual well
or by a public water source.
In an attempt to better serve you, we have reviewed our files to ensure we have the
most recent and accurate information possible. Our review has revealed that we do not
have any information regarding how your residence receives its water.
We are hopeful that you will take a moment to help us keep our records current. Please
indicate the type of water service by circling the appropriate entry below and return this
letter no later than in February 27, 2009, in the self addressed stamped envelope
provided.
If you receive your water from a private well, please let us know the location as it relates
to your home by providing two measurements from the foundation to the well in the
space provided and let us know if the well is used for domestic, lawn and garden, or
agricultural use. See example below.
Thank you in advance for your cooperation.
Any questions can be addressed to the South Windsor Environmental Health Officer,
Robert De Vito at 860-644-2511, extension 248.
Water service: -Joh r1 + l au reAq 50nd
Circle the appropriate service: 361 Y)j I I(e1- V
DWELL MDC CT WATER 5G. w f ridsor C7 o(oo-7�
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WELL USE: <!OMESDTICIAWN & GARDEN AGRICULTURAL
Well Location :
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BACK DRAWING: (QO
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40 FT
A FRONT B
30 F 14 FT
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