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HomeMy WebLinkAboutWell New 588 Niederwerfer Road CPR4Rev.7/95 PERMIT NUMBER STATE OF CONNECTICUT 229710 DEPARTMENT OF CONSUMER PROTECTION . REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION OF WELL (Town) (Straw) (Ld-Numb-) [7s/19/05 South Windsor 588 Niederwerfer Rd OWNER OF WELL _ aINDIVIDUAL BUILDER OTHER(Specify) OWNER'S ADDRESS Wilmont Lee Jr %88 Niederwerfer Rd South Windsor PROPOSED ® DOMESTIC BUSINESS a FARM Est No.of TEST People being USE OF ESTABLISHMENT WELL served. WELL SUPPLY S PUBLIC �R 4 IC INDUSTRIAL CONDITIONING ) SKETCH OF WELL LOCATION Locate well with.respect to at least two roads,showing distance from intersection and front of lot location of lotto at least two roads. Well location onto and to house if present Indicate North /,. r J y .` a C 1 -74i n�ede-rwer �ck Approximate number of feet from well to nearest source of possible contamination: 7 5' 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 joreglefof Health or his agent. A (Spnalure) APPLICANTS ADDRESS REGIS TION NO. Stavens P.O. Box 406 Willington 142 BY(Town Health Officer orAgent) DATE . JAPPROVED ❑ REJECTED n a1=.MARKs� _ Gam' G RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION CPR 9 Rev.7)95 c Do NOT fill in STAT£OF CONNECTICUT STATE WELL NO. DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE iY PROFESSIONAL TRADES DIVISION OTHER NO. WELL DRILLING COMPLETION REPORT 185 Capitol Avenue,Hartford,Connecticut 06106 OWNER NAME ADDRESS Wilmont Lee 588 Niederwerfer Rd South Windsor LOCATION ffib.s street) (Town) (cat Number) OF WELL 588 Niederwerfer Rd South Windsor DOMESTIC BUSINESS FARM TEST PROPOSED X ESTABLISHMENT WELL USE OF WELL PUBLICP OTHER SUPPLY INDUSTRIAL CONDITIONING DRILLING ROTARY COMPRESSED CABLE OTHER EQUIPMENT © AIR PERCUSSION1:1 PERCUSSION (Specify) CASINGF (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS THREADED1:1 WELDED 1 6 17 YES ❑ NO. YES ❑ No YIELD TESTBAILED E] PUMPED 000MPRESSEDAIR HOURS YIELD(GPM) WATER FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) 5 Depth of Completed VYWI in feet LEVEL 20 230 245 MAKE LENGTH OPEN TO A UIFER(feel) SCREEN DETAILS SLOT SIZE DIAMETER(inc ") IF GRAVEL Diameter of well I GRAVEL SIZE(inches) FROM(feet) TO(feel) PACKED: akhWirq gravel peck (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 09 Topsoil/gravel 9 88 Hardpan 88 245 Grey bedrock i 40 - 3a If yield was tested at different depths during drilling,fist below FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(S' ) 6 27 0 -Dew. AGENCY