HomeMy WebLinkAboutWell New 471 Miller Road CPR-8 Rev.7/95
PERMIT NUMBER
STATE OF CONNECTICUT 211693
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING:PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
S.WINDSOR 471 MILLER RD. 2/25/02
OWNER OF WELL
EA INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
PAGANELLI CONST. — P.O. BOX 652, S.WINDSOR
PROPOSED ® Est.No.of
being DOMESTIC a BUSINESS fARM TEST P
USE OF ESTABLISHMENT WELL served.
WELL PUBLIC
SUPPLY S
INDUSTRIAL CONDITIONING a CR 4
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 to and to house if present)
Indicate North
G
Ro,
Bs' w
Approximate number of feet from well to ABANDONMENT
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 Department of Consumer Protection and the Water
Resources Commission on the form provided by the agency. 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.
PLI NT ) APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
BY(Town Health Officer or Agent) DATE
rYAPPROVED REJECTED
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7195 DO NOT fill in
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
PAGANELLI CONST. P.O. BOX 652, SUFFIELD
LOCATION (Wo.a Street) (Town) .(Lot Number)
OF WELL- 471 MILLER RD. S.WINDSOR
DOMESTIC BUSINESS FARM TEST
PROPOSED LJ ESTABLISHMENT WELL
USE OF WELL El PUBLIC a INDUSTRIAL a AIR OTHER
SUPPLY CONDITIONING (SpDRILLING ecify)
ABANDONMENT
RESSED CABLE OTHER
EQUIPMENT ROTARY a AIR PERCUSSION PERCUSSION
(Specify)
CASING - LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASINGGROUTED?
DETAILS THREADED WELDED ❑ YES ❑ NO. ❑ YES NO
YIELD TEST BAILED a PUMPED Q COMPRESSED AIR HOURS YIELD(GPM) -
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL' 85
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(irkhes) FROM(feet) TO(feet)
PACKED: induding gravel pack
Owhes)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to'at least two
FEET TO FEET permanent landmarks
0 85 CEMENTED
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO- REGISTRATION NO.=5/20/02
E OF REPORT I ER(Signature)
2127/02 21-1693 42
AGENCY