HomeMy WebLinkAboutWell Repair 185 West Road CONSUMER PROTECTION
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
cPR-t Rev.II- DEPARTMENT OF CONSUMER PROTECTION 155859
tr , WELL DRILLING PERMIT
165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106
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LOCATION OF (Towe) (Street)
(Lot Number) GATE
OWNER OF WELL
D INDIVIDUAL BUILDER D OTHER(Specify)
OWNER'S ADDRESS
A 5" �. I/l ins-- 13 -
PROPOSED DOMESTIC D UTAKISHMENT ❑,FARM' ❑ WELL People being
TEST Est. No.of
USE Of g
WELL D ❑SKY ❑ INDUSTRIAL CONDITIONING
OTHE served.
NDITIONING � (SpeciRfy)
SKETCH OF WELL LOCATION
Locate well with-respect to at least two roods, showing distance from intersection and froni of lot
Location of lot to of least two roods Well location on lot and to house(if present)
indloase
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j 416V
IJcoTfa Z.
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Approxhim number of feel front well to
nearest source of passible contamination:
The undersigned is aware that upon completion of the well, a .'Weil 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 an the form provided by the
Board.This permit is not valid until all information is filled in and it has((�� B t�/sue{ 6 t t r olth or his agent.
ALI'M (SKI J ArrICANT'S ADDR41 DA C2REGISTRATION NO.
PUTNAM,CT 06260
BY(T•owir Health Officer or Ageet) DATE
0APP&OVED D REJECTED �—
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
' i
WELL COMPLETION REPORT STATE of CONNECTICUT 0 NOT fill in
tx R_oRLv.►► �
DEPARTMENT OF CONSUMER PROTECTI �2 ST w
WELL DRILLING BOARD l�
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 9 R NO.
,ill_ 1
NAME
°tom Darrell Chalou(t ADDRESS
—John Fitch Blv '
(No.L Street) (Taws) DOP (Lot Number)
of wgi West Road South Windsor 2
PROPOM ® DOMESTIC ESTAABLISHMENT El.FARM a TEST WELL
LIRE OF PUBLIC
rfRL SUPPLY El INDUSTRIAL 0 CONDITIONING El((THER Specify)
COMPSSEDiQKILING ROTARY ® AI RCUSSION C� PE LRCU�O El((Sp h)
LENGTH(faeQ DIAMETER(inches) WEIGHT PER FOOT WAS CJ ING TED7
OCEf l 130' 6" 1]• ®THREADED 1:1WELDED YES NO 0 YES NO
YrLD - HOURS YIELD(G.P.M.)
Toy a BAILED El PUMPED El COMPRESSED AIR 4 . 4
WAM MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
LEVEL 10, •30' in
fee th below Lland su face: 300'
MAKE LENGTH OPEN TO AQUIFER(feet)
f�Hl
OETAU ' SLOT SIZE•' DIAMETER(inches) B GRAVEL' Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet
PACKED; grovel Pack(inches):
OEPIH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact laca ion of well with.distances,to at least
FEET TO FEET two permanent landmarks.
0 120 Rocky Soil
120 300 Gray Rock
� r
If yield woos tested.at different deplM during drilling,fist below
FEET GALLONS PER MINUTE 13a.
Nome�0' t�L�c.K
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WEII OR0.LER(Sigrnonrre)
5/6/93 155859 306 5/18/93
BOARD