HomeMy WebLinkAboutWell New 19 Ridge Road CONSUMER PROTECTION
WELL DRILLING BOARD SPkti_OF c''c''it�iNECTICUT PERMIT NUMBER
caw-s REV.»-ex DEPARTMENT OF CONSUMER PROTECTION 135042
WELL DRILLING PERMIT
165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Town) (Street) (Los Number) DATE
S.4IINDSOLi lg ItIDGE nD. 6/5/89
OWNER OF WELL _
® RtIDIVIOUAL .❑ GUILDER OTHER(Speciy) 11MAY P.A.PINY.AU
OWNER'S ADDRESS
19 Aidge lid. , SVV1ndsor S Ct. 1
BUSINES TEST Est.No. of
PROPOSED ® DOMESTICS ❑ ESTAiUSNMENTS ❑ FARM ❑ WELL People being
USE OF Abandon served.
WELL, PUIUC AIR 1-1SUPPLY El INDUSTRIAL ❑ CONDITIONING ® (SOTHpecify)
Well
SKETCH OF WELL LOCATION
Locate well with respect to of least two roods,showing distance from intersection and front of lot -
Location of lot to of 1661 two roods Well location on lot and to house (if present)
Indicate North 1
Seplte,_
XQ M
in,
e Rd
Approximate number of feet from well so -
rtearew source of pouible 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 Board and the Water Resources Commission on the form provided by the
Et cad.This is ntot v til all information is filled in and it has been countersigned by the Director of Health or his agent.
APPLICANT Stj are) APPLICANT'S ADDRESS
P.O. BOX 111 t S.V1ILLINGTON, CT. REGISTTAO No.
BY(Town Health Officer orAgent) DATE
REJECTED
IIi;EMAR1(S - �J
ABANDON EXISTING 41ELL t
RETURN THIS COPY. TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT -- --
CPR-9 Rev.n_az DEPARTMENT OF x""CONSUMER PROTECTION Do NOT fill in
STATE WELL NO.
WELL DRILLING BOARD
165 CAPITOL AVE.
ABANDON =STING WELL HARTFORD, CONNECTICUT 06106 OTHER NO.
NAME ADDRESS -�
OWNER Y PAPIIEA.0 19 -d—IDGE �D.4 S s W.Lz SOI:t! OT.
LOCATION (No. & Street) (own) (Lot Number)
OF WELL 19 xLIDGE .1<0. S. (?Town)
PROPOSED DOMESTIC ESTABLISHMENT ❑ FARM TEST WELL
USE OF Abandon
WELL ❑ SUTHER
PPLY INDUSTRIAL EJ CONDITIONING BLIC AIR �(Specify)(S 1811
DRILLING EQUIPMENT ROTARY ARM RCUSSION PERCU CABLESSION
=�SpecOTHEify)
PERCUSSION
CASING LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT EINVEH WAS CASING GROUTED?
DETAILS m THREADED WELDED YES NO YES F1 NO
YIELD BAILED PUMPED COMPRESSED AIR HOURS YIELD(G.P.M.)
TEST
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL in feet below Land surface:
MAKE LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter k well including GRAVEL SIZE (inches) FROM(feet) TO(feet
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.
t ( t
_.
7, c
If yield was tested at differerp"depths during drilling, list below
FEET GALLONS PER MINUTE fH
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT W RILLER(Signature)
r
DEPT. OF ENVIORNMENTAL PROTECTION-WATER RESOURCES