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Home My WebLink AboutWell New 1105 Strong Road i CPR-9 Rev.7/95 — — STATE OF CONNECTICUT Do NOT fill in y� DEPARTMENT OF CONSUMER PROTECTION STATE WELL NO. REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING COMPLETION REPORT 165 Capitol Avenue,Hartford,Connecticut 06106 OTHER N0. OWNER NAME IADDRESS LOCATION OF WELL (No. Street) �}J~ _ J (Town (Lot Number) t �� J k PROPOSED DOMESTIC BUSINESS k FARM USE OF WELL ESTABLISHMENT Q TEST�� i WELL PUBLIC � INDUSTRIAL Q SUPPLY AIR OTHER DRILLING a ROTARY ® COMPRESSED CONDITIONING EQUIPMENT a CABLE (Specify) AIR PERCUSSION PERCUSSION. OTHER CASING LENGTH(feet) DIAMETER inches (Specify) DETAILS ! t (inches) WEIGHT PER FOOT log , � r r ` DRIVE SHOE lG3 1 9. 1 I � THREADED ® WELDED �t WAS CASING GROUTED? YIELD TEST El BAILED PUMPED E "£ 7 YES ❑ NO. ® COMPRESSED AIR HOURS YES ❑ NO YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) LEVEL 4�t Depth of completed Well fn feet MAKE � SCREEN r7 LENGTH OPEN TO AQUIFER(feet) DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter well GRAVEL SIZE(inches) FROM(feet) TO feet PACKED: including gravel pads DEPTH FROM (inches) (feet) LAND TO SURFACE FORMATION DESCRIPTION FEET TO FEET Sketch exact location of well with tlistantzs,to at least two jjj permanent landmarks I(` �'- \2zv Q cJ If yield was tested at different depths during drilling,list below - PJ CIL FEET GALLONS PER MINUTE DATE WWI.COMPLETED PERMITNO. REGISTRATION NO. DATE OF REPORT `� 44 WELL LER( lure) CPR-9 Rev.7/95 STATE OFCONNECTICUT T NOT fill in' WELL NO.. DEPARTMENT OF CONSUMER PROTECTION STATE REAL ESTATE at PROFESSIONAL TRADES DIVISION �%x 4 „ t„ 1' OTHER NO. WELL DRILLING COMPLETION Fft(EPkkO It ', I S$Capitol Avenue,Hartford,C'n?�iecticttt�.I t76d B E S I NG OWNER NAME .+i, Cs !'1{Gr LLLL lull..... c ADDRESS LOCATION /No.a street] 1EPA ' C (T—) (Lot Number) OF WELL -�- O DOMESTIC BUSINESS f PROPOSED ESTABLISHMENT a FARM BEST Li USE OF WELLU- PUBLIC SPPLY INDUSTRIAL a AIR a OTHER DRILLING ROTARY COMPRESSED C��NING RE EQUIPMENT AIR PERCUSSION PERCUSSION O CASINtai LENGTH(feet) DIAMETER(sidles) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS ' THREADED®WELDED YIELD TEST BYES ❑ NO ® YES ❑ NO BAILED PUMPED ® COMPRESSED AIR HOURS YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Speafy feet) DURING YIELD TEST(leap Depth ComPbted C./� feet t LEVEL t�O well ffi MAKE , r 5 t SCREEN LENGTH OPEN TO AQUIFER(lest) DETAILS SLOT SIZE DIAME F GRAVEL Diameter of wail GRAVEL SIZE(indm) FROM(feet) TO(feet)PACKED: indudmp gre-I pack (inches) DEPTH FROM(AND TO SURFACE FORMATION DESCRIPTION Sketch exact location ofwell with distanoes,to 7 least two FKE7 FEET permanent landmarks o � ro Lk L . 2 . • fa KYield was tested at dif/e►eM depths dufi»g drilliME �.• FEET GALLON DATE WELL COMPLETED . PERMIT NO, —[-j�REGISTRATION NO. DATE OF REPORT WELL ER lure) _ _�. AGENCY s� r PERMIT NUMBER •�rCPR-8 Rev.7(95 r� /� i STATE OF CONNECTICUT . . 2 2 4 O 5 2 DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONALTRADES DIVISION WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 f3�e�c= sneacJ G��Ss/ LOCATION OF WELL (Town) (SOW) (lot Numbs) DATE S.&.t;WM& ;Si"ieo.�vG �CoAo //4S" l 07 kd y-o OWNER OF WELL n INDIVIDUAL BUILDER ® OTHER(Specify) /JUS SHIP✓ C`r OWNER'S ADDRESS Est.No.of PROPO USESF D DOMESTICESTABLISHMENT FARM.- TESWELL Peop�r le being WELL PUBLIC SUPPLY � INDUSTRIAL CIONDITIONING OTHER _ - - 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) r � as' �s= Indiate North `O l 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 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 Sygalth or his agent. = 0—p APPLICANT S ADDRESS Qp� REGISTRATION NO. BY(Town Health OfltCerorAgent) DATE PROVED ❑ REJECTED v Ur- r REMARKS CF3� D ketLAQA� Igo . -.�ao4 "1 o a RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION O*N SFq o� O 011ieSau� ?d c fi u 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 f�OSoR.00 TELEPHONE (860) 644-2511 Dear Homeowner: The Town of South Windsor Health Department's goal is to keep you informed about the status of water quality throughout the town whether you are served by and individual well or by a public water source. In an attempt to better serve you, we have reviewed our files to ensure we have the most recent and accurate information possible. Our review has revealed that we do not have any information regarding how your residence receives its water. We are hopeful that you will take a moment to help us keep our records current. please indicate the type of water service by circling the appropriate entry below and return this letter no later than in February 27, 2009, in the self addressed stamped envelope provided. If you receive your water from a private well, please let us know the location as it relates to your home by providing two measurements from the foundation to the well in the space provided and let us know if the well is used for domestic, lawn and garden, or agricultural use. See example below. Thank you in advance for your cooperation. Any questions can be addressed to the South Windsor Environmental Health Officer, Robert De Vito at 860-644-2511, extension 248. Water service: RECEIVED Circle the appropriate service: WELL MDC CT WATER WELL USE: DOMESTIC LAWN & GARDEN AGRICULTURALSOUTH WINDSOR ENGINEERING DEPT. Well Location {(�� &�-V j W. BACK (l DRAWING: 40FT A B FRONT . r 30F 14FT t WELL STREET _ _ - CA, 2 _