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HomeMy WebLinkAboutWell New 1102 Sullivan Avenue CPR-%Rev.7/95, PERMIT NUMBER STATE OFCONNECTICUT 238907 DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION 29� r S HtCE'lVED WELL-DRILLING PERMIT Su R0� (Avenue artf rd,Connecti ut 06106 r. At v LOCATION OF WELL (Town) (Street) (Lot Number) DATE a - E OWNER OF MLL INDIVIDUAL BUILDER El OTHER(Specify) OWNER'S ADDRESS Est.No.of PROPOSED DOMESTIC BUSINESS FARM TEST Peon being USE OF WELL ESTABLISHMENT WELL served SUPPLY . ❑ INDUSTRIAL CAIR ONDITIONING OTHER( f1 SKETCH OF WELL LOCATION 7 Locate well with respect to at least two roads,s owing distance from intersection and front of lot location of lot to at least two roads Well location on to and to house(f present) 0 Indicate North 3j` 5 A "le!l' Approximate number of feet from well toL�--- nearest source of possible contamination: J / 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 e Director of Health or his agent. PLICA (Signature) APPLICANT' ADDRESS w� ! /12-Z � REGISTRATION NO.32O S i S ' !J lQ BY(Town He /th Officer or Agent) DATE A PPROVED ❑ J TED REMARKSI�i RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION `CAA-9 Re,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 N^ME MARIO GIROUX 84EWESTVIEW DR. BROADBROOK, CT 06016 LOCATION (W.a S11001) (Town) (Lot Aluml)er) OF WELL 1102 SULLIVAN AVE. SO. WINDSOR 9A DOMESTIC BUSINESS FARM TEST PROPOSED X ESTABLISHMENT WELL USE OF WELL D PUBLICa INDUSTRIAL AIR CONDITIONING OTHER SUP DRILLING a ROTARY a COMPRESSED CABLE OTHER EQUIPMENT AIR PERCUSSION Li PERCUSSION1:1 (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER F00T DRIVE SHOE �W7AS CASING GROUTED? DETAILS 80 6 1 ]# © THREADED WELDED ® YES ❑ NO.- El YES ❑ NO YIELD TEST [X BAILED ❑ PUMPED © COMPRESSED AIR HOURS 4 YIELD(GPM) 20 WATER MEASURE FROM LAND SURFACE-STATIC(Specify feeQ DURING YIELD TEST(feet) Depth of Completed Well in feet LEVEL 20 225 225 MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet) PACKED: including gravel pads (inch") DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at(east two FEET TO FEET pennanent landmarks 0 65 SAND & GRAVEL �uU�Vun 65 225 LEDGE �DhG If yield was tested at different depths during drilling,list below .mot f FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT wEL RIL fR ature) 2/12/07 238907 102 3 14 07 OHN M. buWRD AGENCY