HomeMy WebLinkAboutWell Repair 94 West Road CONSUMER PROTECTION
WELL.DRILLING-BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR4 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION i WELL DRILLING PERMIT 159517
165 CAPITOL AVE.,HARTFORD,CONNE UT 06106
LOCATION Of WE ownl e!n(Street) (Lot Nember) DATE
OWNER OF WELL
DLtpMMAL 1LDER D OTHER(Specify)
OWNER'S ADDRESS
PROPOSEDUSE
OF
1JSf D E -
STA l$PJAENT D FARM D WELL People being
Of _WELL D SSUUDUC All PPLY INDUSTRIAL served.
D D CONDITIONING D (Specify)
SKETCH OF WELL LOCATION
Locate well with respect to of least two roods, showing distance from intersection and front of tot
Location of Ioi to of least two roods Well location on lot and to house(if present)
Irtdiaase Ntxth �
Apprweimote number of feet from well la
nearest same of possible contamination: '
The undersigned is aware that upon completion of the well..a "Well Completion Report• containing construction details and informotion`required under Section
25.131 of Me 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
Boord.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.
APPL ( sOt APPLICANT'S ADDRESS REGISTRATION NO.
or
D
BY(lotwrtrodth fficer or Ageet) DATE
VED
REmAks
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
y WELL COAAPLETfO wNT � � ' STATE Of CONPIEGTICUT - - -- --- --- - — ---- — -- �- • •
OPR-9REV.11412 r 09 1993PEPARTMENT OF CONSUMER.PROTECTION Do NOT fill In
x' •• ��� WELL DRILLING BOARD STATE WELL NO.
LICENSINud�V�'r'?` 165 CAPITOL Ave.
r,, �fARTFORD,CONNECTICUT 06106 OTHER No.
OCCUPk110NA1-Sumer Prote�-lQ
NAME WVYI' ADDRESS ..
owFret '
BILL AMEN 1 WEST ROAD SOUTH WINDSOR CT 06074
LOCATION (No.i Street) (Town) (tot-Number)-
OFWMI 1 WEST ROAD SOUTH WINDSOR 1
SINESS
PROPOSO ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
=OF PUBLIC
WB1 ❑ SUPPLY ❑ INDUSTRIAL ❑ ACONDITIONING ❑(STHE
pecify)
ipllffMRNT El ROTARY ® PERCUSSION SSED El CABLE
PERCUSSION ❑(Specify)
CASM LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT As/S CAS tED9
DETAILi 100 6 17 THREADED [I WELDED] X YES NO 1 YES NO
HOURS YIELD(G.P,M.)
TTm El BAILED ❑PUMPED a COMPRESSED AIR 5 • 3
WATO ME49M FROM LAND SURFACE—STATIC(Specify feet) OURING YIELD TEST(feel) Depth of Completed Well
LBVEI 30 505 in feet below Land surface: 5505
MAKE - LENGTH OPEN TO AQUIFER(feet)
OETAIL>< SLOT SIZE DIAMETER(inches) IF CAAVEL Oiometer of well including GRAVEL SIZE(irKhes) FROM(feet) TO(feet
7 PACKED: grovel pock(inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch enact location of well with distonces, to of least
FRET TO FEET two permanent landn As.
0 95 SAND & GRAVEL & CLAY
95 505 RED SHALE
�10
If Tied was tested at different deptin dwing drilling,list below
FEET GALLONS PER MINUTE
DATE WELL 006tplETED PERMIT NO. REGISRE TRATION NO. DATE OF RE T ORR, (Sigrtotun)
10/29/93 159517 10 11/393
HN M. DUFFORD
BOARD