HomeMy WebLinkAboutWell New 765 North King Street r CONSUMER PROTECTION
WELL DRILLING BOARD STATE OF CONNEcc_QOff PERMIT NUMBER
CPR-B REV.11-82 DEPARTMENT OF CONSUMER PROTECTION 81959
WELL DRILLING PERMIT
165 CAPITOL AVE.,-HARTFORD,CONNECTICUT 06106
South Windsor N. King Street . 746
LOCATION OF WELL(Town) NO&IT aF (Street) (Lot Number) DATE
*60td Dagasse 6-24-83.
OWNER OF WELL
D INDIVIDUAL ❑ Bu1LDER. ❑ OTHER(Specify)
OWNER'S ADDRESS
N. King Street, - So.Windsor
PROPOSED BUSINESS TEST Est.No.of
a DOMESTK Q ESTABLISHMENT ❑ FARM Q WELL People being
USE OF served.
WELL PUBLIC AIR OTHER 4
Q SUPPLY Q INDUSTRIAL Q CONDITIONING Q (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)
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 and informaton-required under Section
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 permit is not volid until all information is filled in and it has been counter-signed by the Director of Health or his agent.
1 ( `afe) InToIsTUT-381 Hebron Ave.Glastonbury,0 REGISTRATION No.
10
BY(Torun Health Officer or A t DALAPPROVED ❑REJECTED �L t�
4;
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUr
CPR-9 REV. 9-79 DEPARTMENT OF CONSUMER PROTECTION DO NOT fill in
WELL -DRILLING BOARD STATE WELL NE
20 GRAND STREET
HARTFORD, CONNECTICUT 06106 OTHER NO.
NAME ADDRESS
OWNER Richard Dagesse 765 Noth King St. SO. Windsor.' Ot. 06074
LOCATION (No.& Street) ( n) Lot Nu
w
OF WELL 765 N. King Street �O ) th Windsor ( nt6 5
BUSINESS
PROPOSED 1 DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL ❑ SUPPLY AIRa INDUSTRIAL CONDITIONING ((SSpecfy)
COMPRESSEDDRILLING
EQUIPM NT El ROTARY ® A R ER USSION PERCUSSION (Specify)
(Specify)
CASING LENGTH feet) DIAMET R(inches) WEI P . OOT DR I E SHO WAS CASING GROUTED?
DETAILS 49. f�� THREADED WELDED ®YES El NO [I YES ®NO
YIELD HOURS YIELD (G.P.M.)
TEST BAILED PUMPED COMPRESSED AIR 20
WATER MEASURE FROM LANDSUStF�CE—STATIC(Specify feet) DURING YIELD TEST(feet)
LEVEL 5 Depth of Completed Well
in feet below Land surface:
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) GRAVEL SIZE(inches) FROM(feet) TO(feet
IF GRAVEL Diameter of well including
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION Sketch exact location of well with distances, to of least
FEET TO FEET two permanent landmarks.
0 141 Sena & gravel
141 149 Granite
149 150 tt
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
41,j .
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT :WELLR(Signature)
8 81959 10 7-P l
DEPT. OF ENVIRONMENTAL PROTECTION - WATER RESOURCES