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Home My WebLink AboutWell New 845 Sullivan Avenue PERMIT NUMBER CPRB Rev.7/95 201769 STATE OF CONNECTICUT W DEPARTMENTOF CONSUMER PROTECTION REAL ESTATE Bt PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION OF WELL (Town) (Streetl (Lot Number) DATE South Windsor 845 Sullivan Ave 5/15/2000 OWNER OF WELL Joe rt i enco INDIVIDUAL, BUILDER OTHER(Specify) Adventure Sports OWNER'S ADDRESS 845 Sullivan Ave. ,South Windsor,CT '�,e� + Est.No.01 PROPOSEDBUSINESS USE OF DOMESTIC ls� ESTABLISHMENT FARM ELL A f^J / pesp�being WELL PUBLIC INDUSTRIAL AIR OTHEi� SUPPLY 1:1CONDITIONING ® S ) 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) ` C9 r (.•�G� s7 � . Indicate North Fps �7 • sY 1�� /� �7�pr�- • 1.2 Approximate number of feet from well to rU 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 of Health or his agent. APP ( tune) a O W a n e C APPLICANT'S ADDREMSF—Mi.owane C e I IDr 11.1 Ing REGISTRATION NO. 980ldWmtcRd ,POBox142,Columbi4,CT WCC-66 BY(Town Health Officer or Agent) DATE �OVED ❑ REJECTED k r �v • REMARKS VOW RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION J J .) d CIZR-9 Rev.7)95 Do NOT fill in STATE OF CONNECTICUT STATE WELL NO. DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO. WELL DRILLING COMPLETION REPORT 165 Capitol Avenue,Hartford,Connecticut 06106 OWNER NAME ADDRESS Adventure.S arts 'Je.nco 845 Sullivan Ave Sou LOCATION (ft.3 SOU (T—) (Lot Number) OF WELL 845 Sullivan Ave. South Windsor DOMESTIC BUSINESS Q FARM TEST PROPOSED ESTABLISHMENT 1:1WELL USE OF WELL 1:1 PUBLIC INDUSTRIAL AIR S„pe SUPPLY CONDITIONING ® OTHER t rr-r THER EQUIPMDRILLIEENNT � ROTARY � AICOMPRESSED PERCUSSION � P R USSION � O(Specify) CASING LENGTH(feet) DIAMETER(tndrea) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS 13 0 F t, 6-inch 1 7 Lb. ® THREADED a WELDED RCYES ❑ NO. E�k�i YES ❑ NO YIELD TEST El BAILED Q PUMPED [D COMPRESSED AIR HOURS YIELD(GPM) UL ••!1 4 1 15 G PM WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feat) Depth of Completed Well in feet LEVEL 2Ft, above ground 300Ft . 320Ft . MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(i xfts) IF GRAVEL Diameter of well GRAVEL SIZE(irches) FROM(feel) TO 01060 PACKED: including gavel pads (a�dtes) -DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET pernument landmarks 0 14' Fill �l(4I vF 5�i e �t,ll 14 102 Sand t3ld. 102 120 Gravel 120 320 HedBedrock pa„rki09 If yieM was tested at different depths during drilling.list below FEET GALLONS PER MINUTE SVj_LiVkAI fjvf. , DATE WELL COMPLETED PERMIT NO. REGIST TION NO. DATE OF REPORT WELL DRILLER(Signature) 6/1 2000 201769 WCC-66 CklChowanec AGENCY CPR-9 Rev.7/95 STATE OF CONNECTICUT Do NOT fill In DEPARTMENT OF CONSUMER PROTECTION STATE WELL N0. REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING COMPLETION REPORT OTHER No. I 165 Capitol Avenue,H_artlord,Connecticut o6106 OWNER NAME AdveT4tuneSj3'1!1`rts Jens.} ADDRESS LOCATION (No.&Street) (Town) 845 Sullivall Ave SoutOF WELL h 1 845 Sullivan Ave: (Lot Number) c �rth Windsor PROPOSED DOMESTIC ® BUSINESS ESTABLISHMENT ❑ FARM TEST USE OF WELL WELL ❑ PUBLIC INDUSTRIAL a AIR �DRILLING "I SUPPLY OTHER ElROTARY CONDITIONING (Specify I ✓ EQUIPMENT AIR PERCUSSION PERCUSSION OTHER CASING LENGTH feet (Specify) ( ) DIAMETER(inches) WEIGHT PER FOOT DETAILS f Ti c h 1 7 Lb . THREADED a W DRIVE SHOE ELDED WAS CASING GROUTED? YIELD TEST BAILED a pUMPEO QKYES ❑ NO. COMPRESSED AIR HOURS Q YES ❑ NO YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) LEVEL 2Ft . ISCgI^� r3 b o y e gg r O u n d Depth of Completed Well in feet MAKE ��''�Ir SCREEN 3 2 4 F t LENGTH OPEN TO AQUIFER(feet) DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter well GRAVEL SIZE(inches) FROM(feet) TO feet PACKED: including gravel pack DEPTH FROM LAND TO SURFACE ( ) FORMATION DESCRIPTION (inches) FEET TO FEET Sketch exact location of well with distances,to at least two Permanent landmarks O 14 Fill �l') <iy g f,J t 1 120 320 ReABedf~ If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE � - #r.4 DATE WELL COMPLETED PERMIT NO. L A"�' � 4 mac..REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) r CAI.C'hOwaned DEPT.OF ENVIRONMENTAL PROTECTION-WATER RESOURCES