HomeMy WebLinkAboutWell Repair 9 Windshire Drive -CONSUMER PROTECTION Windshi re Ik
WELL DRILLING BOARD STATE oFcONNECTiCUT PERMIT NUMBER
cPR•e REV.bT4 DEPARTMENT OF CONSUMER PROTECTION 62807
WELL DRILLING PERMIT
20 GRAND STREET,HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(T-OWN) (Sheet)OWNER OF WELL (Lot Number) DATE
S. WINDSOR WINDSHM DR. 13 1/4/83
❑ INDIVIDUAL ® BUILDER ❑ OTHER(Specify) R.S.K. . CONTRACTORS, INC.
OWNER'S ADDRESS
P.O. BOX 7019 S. WINDSOR, CT.
PROPOSED ® DOMESTIC _ ❑ BUSINESS ❑ FARM ❑ TEST Est.No.of
USE OF
ESTABLISHMENT WELL People being
WELL ❑ PUBLIC
❑ INDUSTRIAL AIR OTHER - served.
SUPPLYCONDITIONING ❑ (Specify) 4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from iniersection'.and front of lot
Location of lot to at least two roads Well location on lot and to house (if present)
o
Indicate North
PRIVC WAY
Ilk
. I
14)cut losl4mi
Approximate number of feet from well.to
nearest source of possible contamination: 75 a,I,
The undersigned is aware-that-upon completion of the well,-a-'*ell Completion-Report"•conlaining 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.
APPL sire 01 .AOORESS
REGISTRATION NO.
P.O. BOX 1119 S. WILLINGTON, CT. 100
BY(Town Health Officer or A eat) DATE
RrAPPROVED ❑REJECTED r
REMARKS
?av/ 1 ° C,lke i 32 51;
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME #gyp ADDRESS
OWNER a eYk rtl'.xL3sv P.O.£ �jgr^�� FF;���yy
.130z3. � 01 �#.t3CT.LOCATION g- (No.& Street) (Town) (Lot Number)
OF WELL I. DR e #�s.: ���
13
BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT FARM TEST WELL
USE OF
WELL PUBLIC AIR FJ SUPPLY INDUSTRIAL CONDITIONING (Spfecify)
DRILLING COMPRESSED CABLE OTHER
EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEfGHi PER FOOT DRIVE SHOE W S CASING GROUTED?
DETAILS q THREADED `WELDED :0 YES 11 NO YES ONO
YIELD L n HOURS YIELD(G.P.M.)
TEST BAILED PUMPED a COMPRESSED AIR
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 10,. 150 in feet below Land surface: 20Q
m EKE _ LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances_, to at least
--- .
FEET TO:.FEET two permanent landmarks.
21 200 1 Red Bedrock
od
U
x
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT 1WXEL ER (Signature)
R 'i
DEPT. OF ENVIR0NMFNTAL.PR0TFCTI0N WATIV orenI wrrc