HomeMy WebLinkAboutWell New 200 Nevers Road Ko%_CQWAAER PROTECTION WELL DRILLING BOARD :.STATE of CONNECTICIJT" PERMIT NUMBER
of►f1-9 REV.1111•62 DEPARTMENT OF..CONSVMER PROTECTION 152784
WELL GRILLING PERMIT
165 CAPITOL AVE.,-HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(lorrarJ (SrrrerJ �� (Lon Number) DATE
So LA 14 IJ(A5 C)r ?oo A/e.vfs g — .75-- le2
OWNER OF WELL
0 WInnDUAL wam El. OTHER(Specify) 6Cdt / (� Alt JOA b8t17
OWNER'S ADDRESS}
e�slJ 1�ove�5 �Ou� . JCM I(t �✓i�4dI C7
PROPOSEDBUSINESS TEST Est.No.of
n ESTABLISHMENT Q FARM WELL People being
USE OF served.
C AIR OTHER
WELL mY El fNDUSTRAI 1:1CONDMONING (Specify)
SKETCH OF WELL LOCATION
Locate well with respect to at least two roods•showing distance from intersection and front of lot
Location of lot to at least two roods Well location on lot and to house (if present)
Qbid
itdioote North � ��
to'
Rot
ko�
x
ntvers R�• """`'1
fever S Rd% I
Approximate number of feet from well to
nearest source of possible contamination: /�0
The undersigned is aware that upon completion of the well, a "Well Completion Report" containing construction details and information required under Seclian
25•131 of the 1969 Supplement to the General Statutes must be sent to the owner, the Board and the Water Resources Commission on the form provided by the
Board.This pe id until oil information is filled in and it has been countersigned by the Director of Health or his agent.
APPLICMIi mJ •" T'S ADDRESS - - � REGISTRATION NO.
BY(Torre Hedth 0&er or Agent) DATE
ArrRovEo RE,ECT110
REMARKS OJ &.pil"F
DIRECTOR OF HEALTH
/ `%lLL COMPLETION REPORT STATE OF CONNECTICUT
-f' CPa-°REV.11-es DEPARTMENT OF CONSUMER PROTECTION 7WELL
fill in
WELL DRILLING BOARD
165 CAPITOL AVE.
DEEPEN EXISTING WELL. HARTFORD,CONNECTICUT 06 106
i
NAME OWNER ADDRESS
GEORG-E CHARLTON258 NEVERS
LOCATION t� (No.& Street)
OF WELL 200 NIVERS RIB.. (Town) (lot Number)
SOUTH WINDSOR
BUSINESS
FROFpUp DOMESTIC ESTABLISHMENT FARM
USE OF TEST WELL
PUBLIC n
WEII SUPPLY INDUSTRIAL CIONDITIONING El((THER Specify)
DMILUNG
EQLIMMENT ROTARY AICOMPRESSED
M RCU PERCUSSION PERCLUSSION OTHER
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT WAS CASING GRQE p?
DETA0.f THREADED WELDED YES NO YES NO
YaO HOURS
TUT ❑ BAILED PUMPED1 COMPRESSED AIR YIELD(G.P.M.)
s
WATO MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
LEYU 2g 2�J{} _Depth of Completed Well
in feet below Land surface: 2
05
MAKE
LENGTH OPEN TO AQUIFER (feet)
fCRUN
OETALLt SLOT SIZE DIAMMAETER�(inches) GRAVEL SIZE(inches) FROM(feet) TO(feet
�IFGRAVEL Diameter of well includingCKED: gravel pock(inches):
DEPTH FROM LAND SURFACE
FEET TO FEET FORMATION DESCRIPTION Sketch exact location Of well with distances, to at least
two permanent landrnorks.
C 29 TOPSOil a Clay
29 285 BedrOCk
1 v
t
79
r t
If Yield was tested of different depths during drilling, list below
FEET GALLONS PER MINUTE
> c,rlit,a .
DATE WELL COMPLETED PERMIT NO. REGISTRATION td0: DA_T
TE Of REPORT
WEL ER(Signature)