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HomeMy WebLinkAboutWell New 501 Miller Road s . PERMIT NUMBER CPR-6 Rev.7/95 211692 • STATE OF CONNECTICUT 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 501 MILLER RD. 2/25/02 OWNER OF WELL © INDIVIDUAL BUILDER OTHER(Specify) OWNER'S ADDRESS PAGANELLI CONST. — P.O. BOX 652, S.WINDSOR EsL No.of PROPOSED ® DOMESTIC BUSINESS FARM TEST People being USE OF ESTABLISHMENT WELL served. WELL a SUPP Y a INDUSTRIAL AIR O CONDITIONING SEER 4 SKETCH OF WELL LOCATION Locate well with respect to at least two roads,s owing distance from intersection and front of lot location of lot to at least two roads Well location on to and to house(if resent) ` v/L Indicate North • � F170 w e- TR; 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. PPLICA ( "rat ) APPLICANTS ADDRESS REGISTRATION NO. P.O. BOX 406, WILLINGTON, CT. 42 BY(town Health Officer or Agent) DATE ROVED ❑ REJECTED REMARKS RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION CPR-9,Rev.7/95 - Do NOT fill in STATE OFCONNECTICUT 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 E ADDRESS PAGANELLI CONST. P.O. BOX 652, SUFFIELD LOCATION (No.6Sltreet) (Town) (Lot Number) OF WELL 5 11 MILLER RD.- S.WINDSOR DOMESTIC BUSINESS FARM a TEST PROPOSED ESTABLISHMENT WELL USE OF WELL PUBLIC INDUSTRIAL AIR OTHER SUPPLY CONDITIONING . X❑ )'ABANDONMENT DRILLING ROTARY COMPRESSED CABLE OTHER EQUIPMENT ❑ ❑ AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS THREADED WELDED • '❑YES ❑ NO. c O YES ❑ NO YIELD TEST a BAILED [:]-PUMPED ❑ COMPRESSED AIR HOURS YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feel) Depth of Completed WON in feet LEVEL 1 300 MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(1-0 PACKED: inducing gravel pack (irhd—) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,lb at least two FEET TO FEET Permanent landmarks 0 300 CEMENTED W OD Of 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 ILLER(Signature) 2127/02 2116 42 5/20/02 AGENCY r 7 .� CPR-9 Rev.7/95 I Do NOT fill in STATE OF CONNECTICUT STATE WELL NO. gLPi� DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING COMPLETION REPORT OTHER NO. 165 Capitol Avenue,Hartford,Connecticut 06108 OWNER NAME Y�T�� �t�Ttv7•�T �4't ADDRESS L� �•• +� ��ss Z'CSGaR`bLn.CaLLI CO a?�-�. _ P e 0 e. B0 L9�G p s7�1�"�'����� LOCATION (No.&Street) (Town) (Lot Number) OF WELL 501 MILLER Rb S:T4V O S Q DOMESTIC BUSINESS FARM TEST PROPOSED ESTABLISHMENT WELL USE OF WELL PUBLIC a INDUSTRIAL AIR X OTHER ASAMvfD0ivMENT SUPPLY CONDITIONING DRILLING ROTARY COMPRESSED CABLE THE(Spe ) EQUIPMENT El AIR PERCUSSION . PERCUSSION OTHER (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT 7LENGTH WAS CASING GROUTED? DETAILS ❑ THREADED WELDE 0. ❑ YES ❑ NO YIELD TEST Q BAILED PUMPED �.COMPRESSED AIR HOURS - D(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) ed Wll in feet LEVEL 00 MAKE SCREEN H OPEN TO AQUIFER(feet) DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVFROM(fee=TO PACKED: including gravel pack (inches) DEPTH FROM tAND TO SURFACE FOR DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET permanent landmarks 0 300 CENEEITED 40 f If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT N0. REGISTRATION N0. DATE OF REPORT ILLER(Signature) 2/27IO2 2116992 42