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HomeMy WebLinkAboutWell New 507 Miller Road CPR-9 Rev.7/95 STATE OF CONNECTICUT Do NOT fill in DEPARTMENT OF CONSUMER PROTECTION STATE WELL NO. REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING COMPLETION REPORT OTHER No. 165 Capitol Avenue,Hartford,Connecticut o61 o6 OWNER NAME A7D�DRESS BOX t� 7��r �sA �ar�s WAY NE STE'�i di t3�s Y'l.�i.L3..9 �lY L".O. 130,C1 5��9 S. VY ItV�k7VR, lit LOCATION (lVo. Street) (Town) OF WELL 507 ZLLFt �. � � WIDQ (LotlVumber) DOMESTIC BUSINESS PROPOSED -i ESTABLISHMENT FARM TEST USE OF WELL WELL PUBLIC ❑ INDUSTRIAL SUPPLY El AIR OTHER DRILLING ROTARY CONDITIONING (Specify) EQUIPMENT ® ® A R PERCUSSION PERCUSSION OTHER (Specify) CASING LENGTH(feet) DIAMETER(incGhes) WEIGHT PER FOOT DETAILS 40 V- 11 t7# O THREADED a WELDED DRIVE SHOE WAS CASING GROUTED? YIELD TEST BAILED ❑ PUMPED i� COMPRESSEDAIR HOURS YES NO. © YES ❑ NO YIELD(GPM) WATER 4 'MEASURE FROM LAND SURFACE-STATIC(Specify feet)10 DURING YIELD TEST(feet) � LEVEL // Depth of Completed Well in feet MAKE �'ir� 2�C SCREEN LENGTH OPEN TJO AQUIFER(feet) DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter ofwell GRAVEL SIZE(inches) (feat) PACKED: including gravel pack FROM TO(feet) DEPTH FROM LAND TO SURFACE (inches) FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET permanent landmark O 30 Sand & Gravel If yield was tested at different depths during drilling,list below eta FEET GALLONS PER MINUTE V DATE Wtyff+ETrf E 11Tjl REC�SZI2TION NU. DATE OF REPORT ff ff LL€JJ {{{{jj 12 23R6 WELL DR LE ignaturej DEPT.OF ENVIRONMENTAL PROTECTION-WATF=P Pcenj io.�� CPR-6 Rev.7i95 PERMIT NUMBER STATE OF CONNECTICUT 211366 DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING:PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION OF WELL (Town) (sbvel) (Lot Number) DATE S.WINDSOR 507 MILLER RD. 2/2502 OWNER OF WELL INDIVIDUAL BUILDER OTHER(Specify) OWNER'S ADDRESS PAGANELLI CONST. - P.O. BOX 652, S.WINDSOR Est.No.of PROPOSEDnX DOMESTIC BUSINESS FARM TEST People being USE OF ESTABLISHMENT WELL served. WELL El SUPPLY PLY ElINDUSTRIAL a CAR IONDITIONING ���) 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 present) Y7, Indicate North i-}0�s w ;lot. G IL �A. 170NWI L1 I u-jrti 2o. Approximate number of feet from well to nearest source of possible contamination: ABANDONMENT 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. I PPLI Sign ) APPLICANTS ADDRESS REGISTRATION NO. P.O. BOX 406, WILLINGTON, CT. 42 BY(Town Hea h Officer o 0DATE �PROVEO a REJECTED. nr z REMARKS RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION t , a � 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 NAME ADDRESS PAGANELLI CONSTi, P.O. BOX 652, SUFFIELD LOCATION (AAx s Sfree+) (Town) (Lot Number) OF WELL 507 MIXLLER RD. . S.WINDSOR DOMESTIC BUSINESS FARM TEST PROPOSED- ESTABLISHMENT - WELL USE OF WELL PUBLIC a INDUSTRIAL AIR R OTHER ABAHNNDONMENT SUPPLY CONDITIONING DRILLING ROTARY COMPRESSED- CABLE OTHER EQUIPMENT- AIR PERCUSSION PERCUSSION 1:1 (specify), CASING _095?97 DIAMETER(inches).. WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS THREADED WELDED - a � ❑ YES ❑ NO• ❑. YES ❑ NO YIELD TEST BAILED a PUMPED E] COMPRESSED AIR HOURS- YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feel LEVEL 245 MAKE - - LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(indws) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet) PACKED: indudirp gravel pads (inches) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET permanent landmarks 0 245 CEMENTED �xCt Y7' vtouse If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE rn WA(L DATE WELL COMPLETED PERMIT NO- REGISTRATION NO. DATE OF REPORT LER(Signature) 2127102- 211366 42- 5120/02 AGENCY CPR-9 Rev.7195 Do NOT fill In STATE OF CONNECTICUT STATE WELL NO. M g� DEPARTENT OF CONSUMER PROTECTION slP�i REAL ESTATE&PROFESSIONAL,TRADES DIVISION WELL DRILLING COMPLETION REPORT OTHER NO. 165 Capitol Avenue,Hartford,Connecticut 06106 OWNER NAME ADDRESS A TELLZ ' ?I a`'�'. P.O. BOX 652, FIELD LOCATION (No.&Street) (Town) (Lot Number) OF WELL 507 T IKL.LER RD. S.WIlgd O*xq DOMESTIC BUSINESS FARM TEST PROPOSED Q ESTABLISHMENT WELL USE OF WELL Q PUBLIC INDUSTRIAL a AIR �;2- OTHER ��g��s`�v�v�v`•�Y�s� SUPPLY CONDITIONING (Specify) DRILLING ROTARY COMPRESSED CABLE OTHER EQUIPMENT AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT I DRIVE SHOE WAS CASING GROUTED? DETAILS 0 THREADED 0 WELDED ❑ YES ❑ NO, ❑ YES ❑ NO YIELD TEST Q BAILED ❑ PUMPED a COMPRESSED AIR HOURS YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet LEVEL 243 MAKE SCREEN LENGTH OPEN TO AQUIFER(feet DETAILS SLOT slzE DIAMETER(inches) IF GRAVEL Diameter of well =nches) FROM(feet) TO(feet) PACKED: ncl lame gravel pack (inches) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET permanent landmarks 245 I 4'L 76 If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE [{ t DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. GATE OF REPORT ER(Signature) 2/27102 211366 2 20/02 31,700 CPR-8 Rev.7/95 PERMIT NUMBER •� STATE OF CONNECTICUT 1920 3. DEPARTMENT OF CONSUMER PROTECTION ° REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT .2 M.4 165 Ca 1 Ave ue,I•]a ord, nn ticut O 10 ,J LOCATION OF WELL (T—n) ) (Lot Number) DATE 4!� A� 7_ k OWNER O WELLM-I�NDMDUAL R� � OTHER(Specify) OWNEWS ADDRES91 (� J� Est.No.of PROPOSED Q DOMESTIC BUSINESS FARM TEST People being USE OF ESTABLISHMENT WELL served WELL a PUBLIC Q INDUSTRIAL CAIR ONDITIONING (STHER ) 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) Z, Indicate North + 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 acid information required under Section 2--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 Actor of Health or his agent. A L NT .natu ) APPLICANTS ADDRESS REGIS TION NO. B (Town Health Officer or Ageflo DATE ROVED REJECTED 15' —' 1 Z Z,l-4 REMARKS l RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION /4s Do NOT fill In i! STATE OFCON(NECTICUT STATE WELL NO. DEPARTMENTOF CONSUMER PROTECTION REAL ESTATE It PROFESSIONAL TRADES DIVISION OTHER NO. WELL DRILLING COMPLETION REPORT i r 165 Capitol Avenue,Hartford,Connecticut 06108 OWNER NAME ADDRESS WAYNE GERLT W.C.G. INC. P.O. BOX 559 S. WINDSOR, CT LOCATION (Na 6 SBrW) (Tam) (LW Nufto" OF WELL 507 MILLER RD SOUTH WINDSOR X DOMESTIC uuABL�1SHMEltT FARM v ELL ST PROPOSED USE OF WELL PUBLIC INDUSTRIAL AIR V � O� ',% SUPPLY CONDITIONINGft LE SUER' EQUIPMENT Q DRILLING ROTARY Q AIR PER U C SMON P COMPRESSED ERK USSION L1 (Specify) CASING LENGTH(lest) OIAMETER(rt mi WEIGHT PER FOOT DRIVE SHOE WA S CASM(G GROUTEDI DETAILS 40 6 177! a THREADED� WELDED YES ❑ NO• 0 YES ❑ NO YIELD TEST a MULED PUMPED ®COMPRESSED AIR HOURS YIELD(GPM) 4 20 WATER MEASURE FROM LAND SURFACE-STATIC(Sp; feel) DURLYG YIELD TEST(feet) _ Dam d Completed van in feet LEVEL 10 245 245 MAKE LENGTH OPEN TO AQUIFER(feel) SCREEN DETAILS SLOT SIZE DIAMETER wwcrm) IF GRAVEL DmneW of welt I GRAVEL SIZE(O Ms) FROM=TO(test) PACKED. -dudiV 9-1 PO& (rches) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET pemonent landmarks 0 Sand & Gavel LPG H yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE r� a ' i DATE VjL,Cf2PJEjV8 MUS3 REIS 12T10N N0 T�( EPQf WELL 0 U. Sipnatun) AGENCY