HomeMy WebLinkAboutWell Repair 42 Windshire Drive ✓ CONSUMER PROTECTION
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-8 REV.eav DEPARTMENT OF CONSUMER PROTECTION 70553
WELL DRILLING PERMIT
20 GRAND STREET,HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(!'own) (Street) (Lot Nit-ber) DATE
Be WINDSOR WINDSHIRE DR. $ 8/30/82
OWNER OF WELL
® INDIVIDUAL ❑ BUILDER [� OTHER(Specify) NICHOLAS LESBINES
OWNER'S ADDRESS --
126 ROCKVILLE ROAD, BROAD BROOK, CT.
PROPOSED BUSINESS TEST Est.No.of
FXIDOMESTIC El ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
WELL PUBLIC AIR OTHER
ElSUPPLY ❑ INDUSTRIAL
❑ CONDITIONING ❑ (Specify) 4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of tot
Location of lot to at least two roads Well location on lot and to house(if present)
O �l
Indicate North t `�
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x�
- �Rr DR AO.
E
0
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Approximate number of feet from well to 0
nearest source of possible contamination: 8 8
The undersigned is aware that upon completion of the well, a "Well Completion.Report" containing construction detail 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.. -
1 + APPLICANT'S ADDRESS REGISTRATION NO.
P.O. BOX 111, S. WILLINGTON, CT. 100
BY(Town Hedtb Offreer o Ageat) GATE
P"APPROVED ❑ REJECTED P All
REMARKS
a
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
,t-eG '
WELL COMPLETION REPORT srnre of cONNEcncur
CPR-9 REV. 9-79 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
20 GRAND STREET
HARTFORD, CONNECTICUT 06106 OTHER NO.
NAME ADDRESS gg�� ;�t{:�•�}^�y^��y;se T3�} �s
OWNER NICHOL 1ESBIMS - 1 6 f'I'Oi�=L1Y:L,L.3J�iE C:,L . BROAD BROOKS- CT.
LOCATION (No. & Strgeyet)_ t (Town)�T �t +p,y (Lot Number)
OF WELL � WMJ3� E . R.— S* WINDi+SOR ts.
El TEST WELL
PROPOSED �' DOMESTIC [] BUSINESS
ESTABLISHMENT FARM "t'
USE OF
WELL PUBLIC ElAIR OTHER
SUPP Y INDUSTRIAL
CONDITIONING EI(Specify)
LLING
PRESSED CABLE
EQUIIPMENT ROTARY A RMPERCUSSION PERCUSSION OTHER
(Specify)
CASING LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT DRI ,E SH E WAS CASING GROUTED?
DETAILS 21 17 THREADED WELDED ®YES �.NO �YES 1:1NO .
TEST BAILED PUMPED' COMPRESSED AIR HOURS YIELD (G.P.M.)
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) -
LEVEL Depth of Completed Well
10 125 in feet below Land surface: 175 -
MAKE
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feel
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.
1 01 Gy s
11 1 'Red: Rock
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 WELL R jSignature) _
s 2 • 2
DEPT. OF ENVIRONMENTAL PROTECTION - WATER RFRni trarFs