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HomeMy WebLinkAboutWell New 495 Niederwerfer Road . 'CPR-8 Rev.7l85 PERMIT NUMBER STATE OF CONNECTICUT 2 2 17 9 8 DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION r WELL DRILLING:PERMIT 165 Capitol enµe, artford,Con ecticut 0610 LOCATION OF WELL (Tam) ( / (Lot Number)for pA� OWNE OF WELL 0-1�NDIVIDUAL UILDER OTHER(Specify) OWNER'S ADDRESS a— ?3?/_ & O > Est.No.of �^ PROPOSED rp-DOMESTIC BUSINESS FARM �L P� being , USE OF ESTABLISHMENT WELL PUBILIC INDUSTRIAL CONDITIONINGOTHER SUPPLY 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 resent Indicate North +A' VY� 4' 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 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 e Director of Health or his agent. PLI (signal") APPLICANT'S ADDRESS REGISTRATION NO. AK-1i P�' PPROVED Rp (Town Health cerorAge DATE ❑ Q 0 ll�2v--v3 REMARKS RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION CPO-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 PIERRE GIROUX 1555 GRAIWI RD., SO. WINDSOR, CT 06074 LOCATION (No.s Sheet) (Tow) XW Number) OF WELL NIEDERWEFER RD. SO. W11IDSOR 3 DOMESTIC USINESSa ESTABUSHMENT FARM ' WELL TEST PROPOSED USE OF WELL ❑ U AIR E] OTHER SUB Q INDUSTRIAL CONDITIONING DRILLING COMPRSED CABLE 0 EQUIPMENT Q ROTARY a AIR P RCUSSION PER USSION OTHER (Spe*) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS $0 6 17# IF.] THREADED�WELDED ® YES ❑ NO. 0 YES ❑ NO YIELD TEST ©BAILED a PUMPED E] COMPRESSED AIR HOURS YIELD(GPM) 4 1 20 WATER MEASURE FROM LAND SURFACE-STATIC(Specty feel) DURING YIELD TEST(feet) Depth of Completed Well in(eel LEVEL 50 325 325 MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(Inches) IF GRAVEL D imeter of well GRAVEL SIZE(arches) FROM(feet) TO(feet) PACKED: iwhrding gravel pack (inches) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at(east two FEET TO FEET permanent landmarks 0 72 SAND & GRAVEL 72 325 RED SHALE cc c� 1a° �a If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE •DAjE/T6 f,Qf KETED PERMIT NO. REGISTRATION NU. DATE OF REPORT DRI ( ure) (J[} 221 $ [A ona"11111- 01N M. DUFFO AGENCY