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HomeMy WebLinkAboutWell Repair 39 Windshire Drive CONSUMER PROTECTION WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER CPR-8 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION 8 7 712 WELL DRILLING PERMIT 165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106 LOCATION OF WELL(lows) (Street) (Lot Narnberl DATE S. 'WIVIISOR •• WDSIDSHM DR-. 11 6/28/84 OWNER OF WELL a INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) WILLIAM KEOHAlIE 242-7769 OWNER'S ADDRESS 149 QUARRY BROOK DR. , S. WIIDSOR, CT. 06074 PROPOSED BUSINESS 1 TEST Est.No.of ® DOMESTIC ❑ ESTABLISHMENT "❑ FARM ElWELL People being USE OF WELL PUBLIC AIR OTHER served. ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONINO ❑ (Specify) 4 SKETCH OF WELL LOCATION Locate well with respect to of least two roads,showing distance from intersection and front of lot Location of lot to at least two roads An Well location on lot and to house(if present) Indicate North Gam. x i i9b�Y i N©cl�fi/eF ,U�? Approximate number of feet from well to 901 nearest source of possible contamination: The undersigned is aware that upon completion of the well, a "Well Completion Report' .containing construction details and irformation 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 oil information is filled in and it has been counter-signed by the Director of Health or his agent. ICAN (S-sratare) APPLICANT'S ADDRESS REGISTRATION NO. P.O. BOX 111 S. WILLIIVGT01i, CT. 100 BY(lbwn-Heoltb Officer or eat) DATE APPROVED ❑REJECTED REMARKS RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT STATE of coNNEcrlcur CPR-9 aev.„_es DEPARTMENT OF CONSUMER PROTECTION 7EE o NOT,fill in WELL DRILLWG BOARD WELLNo. 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 NAME OWNER { ADDRESS M? ypy T 3 Tr j SO jq j LOCATION (No;& Street) (Town) OF WELL WI14DSHIn DR. (Lot Number)BUSINESS 3- W1101SOR. y PROPOSED DOMESTIC ESTABLISHMENT FARM USE OF TEST WELL WELL PUBLIC SUPPLY INDUSTRIAL AIR OTHER CONDITIONING Q(Specify) DRILLING COMPRESSED CABLE OTHER EQUIPMENT ROTARY AIR.-PERCUSSION PERCUSSION EI(Specify) feet CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER F007 DETAILS IV O WAS CASING GR TED? PO 6 THREADED WELDED YES NO YES NO YIELD HOURS TEST BAILED El PUMPED YIELD (G.P.M.) COMPRESSED AIR � 10 WATER MEASURE FROM LAND SURFACE—STATiC(Specify feet) DURING YIELD TEST(feet) LEVEL Til epth of Completed Well 95 feet below Land surface: rt MAKE G00 LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) ' GRAVEL SIZE(inches) FROM(feet) TO(feet IF GRAVEL Diameter of well includin g PACKED: gravel pack(inches):,`- DEPTH FROM LAND SURFACE FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. 0 COY Gra el , Qlay If yield was tested at different depths during drilling, list below #' FEET GALLONS PER MINUTE kr DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE'OF REPORT WEL ILLER(Signature) 1 DEPT. OFFAIVIDONAACKITAI 00^7r,-Ti„®,