HomeMy WebLinkAboutWell New 118 Troy Road CONSUMER PROTECTION
WELL DRILLING BOARD
CPR-8 REV. 8.79 STNNECTICUT PERMIT NUMBER
DEPARTMENT OF CONSUMER PROTECTION 6 78 �9
WELL DRILLING PERMIT O L
20 GRAND STREET,HARTFORD,CONNECTICUT 06106
SOUTH WINDSOR TROY ROAD R.F. D 118
LOCATION OF WELtLLrf ownn)1 t (Street) (Lot Number) DATE�9 } p e�
S.J. ISNESKI Jl 2�Q 1 ,
OWNER OF WELL
®' INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
PROPOSED ® ❑DOMESTIC FARM BUSINESS Est. No.of
USE OF ESTABLISHMENT WELL
People being
PUBLIC
WELL SUPPLY INDUSTRIAL ❑ AIR OTHER served.
CONDITIONING El (Specify)
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 lot and to house (if present)
Indicate North
t
a�
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 Board and the Water Resources Commission on the form provided by the
Board. 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.
APPLICANT(Sr naturst) EA E . APPLICANT'S ADDRESS
REGISTRATION NO.
BY(Town Health34
O cer or A nt) ..
gAP- DATE PROVED REJECTED 02
REMARKS " fir/ C�
RETURN.THIS COPY TO CONNECTICUT WFI I nDn I inter De-1AM-
WELL COMPLETION REPORT srarE CrCoNniEcticuT
WDB-5 1269 REV.9-71 WELL DRILLING BOARD Do NOT fill in
State Office Building STATE WELL NO.
-- HARTFORD,CONNECTICUT 06115
OTHER NO.
OWNER NAME I ADDRESS
LOCATION
S. J. Wisneski 118 Troy Road South Windsor, CT OF WELL (No.&Street) Crown)
1].8 TroyRoad (Lot Number)
South Windsor, CT
BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT
USE OF ❑ FARM TEST WELL
WELL PUBLIC
❑ SUPPLY ❑ INDUSTRIAL ❑ AIR ❑ OTHER
CONDITIONING (Specify)
DRILLING ❑ ROTARY ❑ COMPRESSED CABLE
EQUIPMENT AIR PERCUSSION ❑ PERCUSSION ❑ OTHER
(Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT
DETAILS 150 I 6n (9-45 I THREADED ❑ WELDED DRIVE
®YESSHOE WAS CASING GROUTED?
YIELD I ❑NO YES ❑NO
HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED ®' COMPRESSED AIR I �, I 60
WATER MASUREM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet) 6
LEVEL 12 ( Depth of Completed Well
1gg
7 in feet below Land surface: 200
MAKE
SCREEN
I LENGTH OPEN TO AQUIFER(feet)
DETAILS SIZE'Iches)
IF GRAVEL Diameter of well including I GRAVEL SIZE(inches)IFROM(feet) TO(feet)
PACKED: gravel pack(inches):
DEPTH FROM LAND SURFAC --
FEET to FEET FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
two permanent landmarks.
0 150
150 200 Granite
fi
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF kEPORT Eastern Dri11 Co.
10/12/81 I 6 8 2 I 34 110/22/81 I WELL DRILLER(Signature)
79
BOARD