HomeMy WebLinkAboutWell New 88 Nevers Road CPR-8 Rev.7i95
PERMIT NUMBER
. STATE OF CONNECTICUT
199497
DEPARTMENT OF..CONSUMER PROTECTION...
REAL.ESTATE&PROFE35IONAL'CRADES DIVISION'.'
WELL DRILLINGVERMIT
165 Ca Rot rtlo Avenue,H d,Cone ut 06106
S'9 11 l -
LOCATION OF WELL (Town) (Street) _ (tot Number) DATE
OWNER OF WELL
I l� INDIVIDUAL a BUILDER OTHER(Specify)
OWNER'S ADDRESS
Est.No.of.
PROPOSED Q DOMESTIC 11 BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL ,served
WELL
aPUBLIC ❑ INDUSTRIAL a AIR OTHER I
SUPPLY CONDITIONING /
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)
Q
�q4,o.t
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r e his
Indicate Norm
V.
e y vp V.
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
Director of Health or his agent.
5010,
Signature) APPLICANTS ADDRESS REGISTRATION NO.
(Town H aRh Oltiiceror en!) DATEROVED - tfREJECTEDBY V
3
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
M
CPS-9 Rev.7/95 DO NOT fill in
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
�3e1 REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING COMPLETION REPORTS R.No.r"=
185 Capitol Avenue,Hartford,Connecticut 08108 ••t:•/r•.
OWNER NAME ADDRESS
THOMAS THEROUX 88 NEVERS RD. , SO. WINDSdRJ " T, 06074
LOCATION (No.6 SIM0 (Town) (Lot Namber) •
OF WELL 88, NEVERS ROAD SOUTH WINDSOR
DOMESTIC BUSINESS FARM -TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL PUBLIC INDUSTRIAL AIR OTHER
SUPPLY n CONDITIONING 0 S Irrigation Well
DRILLING ® ROTARY ® COMPRESSED a CABLE a OTHER
EQUIPMENT
AIR PERCUSSION . PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(Indies) WEIGHT PER`F00T DRIVE SHOE WAS CASING GROUTED!
DETAILS S O 6 17�r ® THREADED a WELDED YES ❑ NO. Q YES ❑ NO
YIELD TEST BAILED ❑ PUMPED ® COMPRESSED AIR HOURS YIELD(GPM)
4 1 20
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feel
LEVEL 40 245 245
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN -
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(hdree) FROM OW—) TO qw)
PACKED: including pave[peck
(indiee)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
0 30 SAND & GRAVEL
30 245 GRANITE K1.
blot
If yield was tested at different depths during drilling,list below - l
FEET GALLONS PER MINUTE t/' t� C�-•,ram
GATE WELL COMPLETED PERMIT NO-• REGISTRATION NO DATE OF REPORT L AM7
lure)
4/14/00 199497 102 5 1 00
OHN M. D#9FORD •
AGENCY