Loading...
HomeMy WebLinkAboutWell Repair 66 Windshire Drive CONSUMER PROTECTION WELL DRILLING BOARD STATE-OF CONNECTICUT PERMIT NUMBER CPR-B REV.8•79 DEPARTMENT OF CONSUMER PROTECTION 70271 �O*1 7 7 WELL DRILLING PERMIT L 1 1 20 GRAND STREET,HARTFORD,CONNECTICUT 06106 LOCATION OF WELL(Y'owrr) _.. (Street) (Lot Number) DATE S. WINDSM WIRDSHIRE DR. 6 al/16/82 OWNER OF WELL N INDIVIDUAL El BUILDER El OTHER(Specify) ALLEN GOLDSTEIN (872-8001) OWNER'S ADDRESS 203 NEW ROADS TOLLAND, CT. PROPOSED BUSINESS TEST Est.No.of 12 DOMESTIC ElESTABLISHMENT FARM El WELL People being USE OF served. WELL PUBLIC AIR OTHER SUPPLY INDUSTRIAL CONDfT10NINO � (Specify) y- SKETCH OF WELL LOCATION Locate well with respect to of least two roods,showing distance from intersection and front of lot Location of lot to at least two roads Well ocafton n lot and to house(if present) O a ky Indicate North � �� r- t oa X 1 ,AfN� Approximate number of feet from well to nearest source of possible contamination: 75 t+ The undersigned is aware that upon completion of the well, a "Well 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 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 (rgnattrr J APPLICANTS ADDRESS REGISTRATION NO. P.O. Box 111, S. Willi.ngton, Ct. 100 8Y(Town Hed1h Offuererrl) DATE ©APPROVED REJECTED 9^/—�Z REMARKS G lv /?e RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL 'COMPLETION REPORT STATE of coNlveerlcur ; CPR-9 REV. 9-79' DEPARTMENT OF CONSUMER PROTECTION Do'NOT fiii.iri. WELL DRILLING BOARD STATE WELL NO. 20 GRAND STREET HARTFORD, CONNECTICUT 06106 OTHER NO. NAME ADDRESS OWNER LEN GO STEIN 20 VEW RD• 1� T0LLjUM's CT.. No. 8 Street (Town) (Lot Number) LOCATION ) own OF WELL WINDSHIPE DR. S. WIISID-SOR BUSINESS PROPOSED Gi DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL, PUBLIC AIR THER SUPPLY INDUSTRIAL CONDITIONING ❑O (Specify) DRILLING COMPRESSEROTARY AIR PERCUSSION - PERCUSSION (CABLE Specify) EQUIPMENT Y) CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE O WAS CASING GROUTED? DETAILS "t 17-00 THREADED WELDED YES -a NO YES NO YIELD HOURS YIELD (G.P.M.) TEST BAILED PUMPED r2- COMPRESSED AIR 15 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL 10 150 in feet below Land surface: 200 MAKE 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. 0 2 Topso 1 2 12 ,Sand & Gravel 12 30 Clay 30 200 Red. Rook qs t� If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE = ! fil /f , DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT - WELL ER(Signature DEPT. OF ENVIRONMENTAL PR0TFCTlnM \A/ATFD DCC(lt tDr-ec