HomeMy WebLinkAboutWell New 151 Oakland Road CONSUMER PROTECTION
W LL' DRILLING BOARD STATE dF CONNECfICUT PERMIT NUMBER
CPR4 REV.8-n DEPARTMENT OF CONSUMER PROTECTION 66701
WELL DRILLING PERMIT
20 GRAND STREET.HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(To") (Street) (Lot Nu-h-) DATE
OWUER OF WELL
INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify)
OWNER'S ADDRESS
r
BUSINESS TEST Est.No.of
PROPOSED
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
AIR OTHER
WELL ❑ SUPPY ❑ INDUSTRIAL ❑ CONDITIONING El (Specify)
SKETCH OF WELL LOCATION
Locate well with respect to at leas)two roads,showing distance from intersection and front of lot
Location of lot to of least two roads Well location on lot and to house (if present)
`Indicate North
c ` I
o � �
Approximate number of feet from well to LY°iCJr—
nearest source of possible contamination:
The undersigned is awor that pan completion of the well,-0 "Well Completion Report" contoining construction details and information required under Section
25.131 969 Suppl ment o the General Statutes must be sent to•the owner, the Board and the Water Resources Commission on the form•provided by the
Boor his perm is not vo d u it all information is filled in and it has been countersigned the Director of Health or his agent. .
APPLICANT(Sr u J• APPLICANT'S ADDRESS REGISTRATION NO. 1 i�
BY(Town Hedtb Af O er or ge J DATE
(PROVE REJECTED
REMARKS �r
��P ram- •
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTiCUT
CPR-9 REV. 9-79 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
20 GRAND STREET _
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME
OWNER ADDRESS
LOCATION
�6 51 t1 (Nods&Stttrreet)D. a (Town) y3,.,.���pp (Lot Number)
PROPOSED LZ DOMESTIC El ESTABLISHMENT FARM-
USE OF TEST WELL
WELL PUBLIC El AIR SUPPLY INDUSTRIAL OTHER
CONDITIONING �(Specify)
DRILLING ' COMPRESSED _ �-CABLE OTHER
ROTARY
EQUIPMENT AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DR E WAS CASING GROUTED?
DETAILS 3s THREADED WELDED YES 0 NO YES NO
YIELD HOURS YIELD
TEST � BAILED � PUMPED RI COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) . DURING YIELD TEST(feet)
LEVEL Depth of Completed Well
175 in feet below Land surface:
MAKE
LENGTH OPEN TO AQUIFER(feet)
SCREEN_
DETAILS SLOT SIZ::���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 at least
FEET TO FEET two permanent landmarks.
0 31 Sand & Carr
31 20 Bedrock
t
ea-
If yield was tested at different depths during drilling, list below E. Ifs
FEET }
GALLONS PER MINUTE r
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT D IL
DEPT. OF ENVIRONMENTAL PROTECTION - WATER PFsnl III