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HomeMy WebLinkAboutWell New 432 Buckland Road Y CP$-e Rev.7/95 PERMIT NUMBER STATE OF CONNECTICUT 196073 DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION i WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION OF WELL-, (Town) (Sfrceq (Lot Number) DATE S- WINDSOR 432 BUCKLAND ROAD 9/9/99 OWNER OF WELL a :INDIVIDUAL Q BUILDER ® OTHER(Specify) 401-232-5667 ! OWNER'S ADDRESS 2 9 17 PETER SANGERMANO CONSTRUCTION INC. 1201 DOUGLAS PIKE; SMITHFI LD, R.I. Est.No.of PROPOSED DOMESTIC BUSINESS FARM F] TEST people being USE OF ESTABLISHMENT served. WELL VVELL a PUBLIC a INDUSTRIAL AIR AIR © OTHER ABANDON WELL _ SUPPLY CONDITIONING (S ) 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 on to and to house(if present) Indicate North 0ANS ?� Approximate number of feet from well to nearest source of possible contamination: 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 Department of Consumer Protection.and the Water R,psdNces Commission pp the rm provided by the agency. This permit is not valid until all information is filled in and it has been counter-signed by Ae Dirictor oAHeafth oilds a nt. APPL NT( 'nature) APPLICANTS ADDRESS REGISTRATION NO. P.O. BOX 406r:,'-,WILLINGTON, CT. 42 BY(Town Health Officer orAgent)" DATE rn ROVED ❑ REJECTED REMARKS ABANDON EXISTING WELL ACCORDING TO STATE SPECS. RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION CPR-9 Rev.7/95 Do NOT fill in STATE OF CONNECTICUT STATE WELL NO. <' r DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION- OTHER NO. WELL DRILLING:COMPLETION REPORT 165 Capitol Avenue,Hartford,Connecticut 06106 OWNER NAME ADDRESS - PETER SANGERMANO CONST. INC 1201 DOUGLAS 'PIKE, SMITHFIELD, - R.I. LOCATION (No.d SfiftO' (Town) (tot Number) OF WELL 432 BUCKLAND RD. #S.WINDSOR DOMESTIC BUSINESS a FARM TEST PROPOSED ESTABLISHMENT, Ej WELL USE OF WELL PUBLIC ❑ INDUSTRIAL AIR ' ' OTHER�, X ABANDONED WELL SUPPLY CONDITIONING S DRILLING EQUIPMENT ROTARY a AIR PERCUSED CA13LESION OTHER SION PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(W&m) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS, ❑ THREADED Q WELDED ❑ YES ❑ NO• ❑ YES• ❑ NO YIELD TEST a BAILED [] PUMPED- a COMPRESS EDAIR HOURS YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Corn*led WeA in feet LEVEL MAKE LENGTH OPEN TO AQUIFER(feel) SCREEN DETAILS SLOT SIZE DIAMETER(indres) IF GRAVEL Oiameter of well GRAVEL SIZE(kxhaa) FROM(feet) TO(feet) PACKED: indud'stg gravel pads (indms) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET permanent landmarks ABANDONED- EXISTING WELL 'ACCORDING TO TATE SPECS. b- 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 L DRI R( lure) 9/17/99 196073 42 9/24/99 AGENCY