HomeMy WebLinkAboutWell Repair 89 Windshire Drive CONSUMER PROTECTION ,
WELL DRILLING BOARD STATE OF CONNECTfCUT PERMIT NUMBER
CPR-B REV.11-82 DEPARTMENT OF CONSUMER PROTECTION 81119
WELL DRILLING PERMIT
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
LOCATION OF WELL(Town) (Sheet) (Lot mumher) DATE
S. WINDSOR 89 WINDSHIRE DR.
OWNER OF WELL[ia a i�7 �t e
tili
INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) BRI�I,i� RSH
OWNER'S ADDRESS
59 ASH ROAD, S. WINDSOR, CT.
PROPOSED ® DOMESTIC El ES ABUSIBLISHMENT ❑ FARM ❑ WELL People being
ESS TEST Est.No.of
USE Of g
-
PUBLIC AIR
WELL ❑ SUPPLYCONDITIONING❑ INDUSTRIAL OTHER served.
❑ eorIDlnoNlNc • ❑ (specify) 4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot
Location of lot to at least two roads Well location an lot use(if present)
J�%/
1� try ha�
Indicate North 6�`� 4
///
lata F 4w
11
?0,
Approximate number of feet from well to ��t
nearest source of possible contamination:
The undersigned is aware that upon completion of the well, a 'Well Completion Repon"..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.
t rgnat re) APPLICANT'S ADDRESS REGISTRATION NO.
P.O. SOX 111, S. WIILLINGTON, CT. 100
BY(Town Heath Officer or Agent DATE
APPROVED ❑REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE-OF CONNECTICUT -
CPR-9 REV. 9-79 DEPARTMENT OF CONSUMER"PROTECTION Do NOT fill iri
WELL DRILLING BOARD STATE WELL NO.
20 GRAND STREET
HARTFORD, CONNECTICUT 06106 OTHER NO:
NAME ADDRESS
OWNER y� �Y
LOCATION (No. & Street) (Town) (Lot Number]
OF WELL 89 WINDS HIRE .IRE D. . Y MDSOR
PROPOSED � DOMESTIC "ESTABLISHMENT FARM
TEST WELL
USE OF
WELL PUBLIC SUPPLY INDUSTRIAL
a AIR OTHER
CONDITIONING �(Specify)
DRILLING F 7;t COMPRESSED CABLE i�ROTARY AIR PERCUSSION PERCUSSION OTHER .
EQUIPMENT
ASH ROAD.
(Specify)
LENGTH (feet) DIAMETER.inches W�11G;:PER f00T CASING ( ) DRIVE H E W S CASING GROUTE6?
DETAILS THREADED WELDED YES NO DYES NO
TIELD EST BAILED PUMPED COMPRESSED AIR HOURS YIELD ;.P.M.)
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet)
LEVEL ` 0 ��� Depth of Completed Well "
in feet below Land surface: 175
MAKE LENGTH OPEN TO AQUIFER(feet)
.SCREEN
DETAILS SLOT SIZE DIAMETER (inches) GRAVEL SIZE
.(inches) FROM(feet) TO(feet
IF GRAVEL Diameter of well including
PACKED: grovel pack (inches):
DEPTH FROM LAND SURFACE.
FORMATION DESCRIPTION Sketch exact location of well with distonces, to at least
FEET TO FEET two permanent landmarks.
Ylay
7 175 Refs Rack
v
i
x If yield was tested at different depths during drilling, list below 00�" -
FEET GALLONS PER MINUTE 1
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT. WEL LER(Signature)
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