HomeMy WebLinkAboutWell New 42 Robert Drive CPR-8 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT
184702
DEPARTMENT OF CONSUMER PROTECTION -
REAL ESTATE&PROFESSIONAL,TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (W Number) DATE
South Windsor Roberts Dr. 42 111/3/97
OWNER OF WELL
l INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
Estate Of Trash 42 Roberts Rd. South Win ( Deepen Well )
Est.No.of
PROPOSED Q DOMESTIC BUSINESS 1-1 FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELLPUBLIC l
CJ SUPPLY Y INOUSTRUU CONDITIONING (specify)
3
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)
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Indicate North 'f
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Rotit�� Qr
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Approximate number of feet from well to
nearest source of possible contamination: 75 F t .
The undersigned is aware that upon completion of the well,a'Well Completion Repoli'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
the Director of Health or his
APPLICANT(Signature) APPLICANT'S ADDRESS Canton C t. REGISTRATION NO.
Canton Well Drilling Box 222 28
BY(rows Health OA7cecerorAgent) DATE
ElAPPROXED REJECTED ^
REMARKS� �� ��� �
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7(95 136177
NOT I to ,
STATE OF CONNECTICUT , STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION y OTHER NO.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
Estate Of Trash 142 Roberts Dr. South Windsor Ct .
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL 42 Robert;s Dr. South Windsor Ct.
TEST
PROPOSED DOMESTIC,\ a ESTABLISHMENT BUSINES FARM Q WELL
USE OF WELL PUBLIC 1:1THER SUPPLY INDUSTRIAL AIR E]CONDITIONING O(Speci )
DRILLING ROTARY ^' ,,{ COMPRESSED CABLE OTHER
EQUIPMENT t x t AIR PERCUSSION a PERCUSSION (Specify)
CASING LENGTH(feet) - DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS THREADED WELDED t-�
1 O ❑ YES ❑ NO ❑ YES ❑ NO
YIELD TEST a BAILED (-1 PUMPED R COMPRESSED AIR HOURS YIELD(GPM)
U x 8
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL 3. ft.
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
`s
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) :FROM(feet) TO(feet)
PACKED: including gravel pack
(inches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
150 250 Red Rack
,Deepen WeI 100 Ft.
f s
- if yield was tested at different depths tjot.ing drilling,list below
FEET ,!GALLONS PER MINUTE
tt rf
A
oilIl e 45
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT:' WELL DRILLER(SignotM
1117I97 1ZQ2 ( ,
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