HomeMy WebLinkAboutWell New 724 Strong Road CPR-8 Rev.7t95 PERMIT NUMBER
STATE OF CONNECTICUT 181086
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) "Number) 76/25/97
S. WINDSOR 724 STRONG RD.
OWNER OF WELL
EA INDIVIDUAL BUILDER OTHER(Specify) 289-4347'
OWNER'S ADDRESS .
14 GILLMAN RD. , E. HARTFORD4 CT.
Est No.of
PROPOSED ® DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served,
WELL
aSUPPL INDUSTRIAL CONDITIONING STHER 4
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)
G �3Y
Indicate North
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v
• Approximate number of feet from well to
nearest source of possible contamination: 100'+
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 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 o his pgent.
(S(g lute) APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 44
BY(Town Health Ofter or Agent) DATE
PROVED L:r ❑ REJECTED ^ n fJ `
REMARKS n CA
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7/95
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING COMPLETION REPORT OTHER NO.
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
ARTHUR SILVESTRI 14
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL 724 STRONG RD. S. WINDSOR
BUSINES,PROPOSED Q DOMESTIC ESTABLS HMENT FARM Q' WELL
USE OF WELL Q PUBLIC El INDUSTRIAL AIR OTHER
SUPPLY CONDITIONING— (Specify)
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT a AIR PERCUSSION PERCUSSION ® (Specify}
CASING LENGTH{feet} DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS THREADED WELDED
1 x YES Q- NO 1,Q YES ❑ NO
YIELD TEST 9 BAILED a PUMPED COMPRESSED AIR HOURS YIELD(GPM)
12
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL
45
WAKE LA TH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameterof 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
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Our lt� ,
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
4
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT JELL DRIL R(Si to
9 F
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