HomeMy WebLinkAboutWell New 00 Burnham Street (2) CPR4 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT 2 3 8-5 21
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (StlAwnst
(Lot Number) DATE
South Windsor 1 3/8/07
OWNER OF WELL �"" — '
EzINDIVIDUAL BUILDER OTHER(Specify) g 17-5 0 2-210 4
OWNER'S ADDRESS
Tiger Lily Ventures c/o Todd Kriney 530 Boston Post Rd w Haven
Est.No.of
PROPOSED El DOMESTIC BUSINESS FARM a TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
PUBLIC SUPPLY CONDITIONING
AIR OTHER
CONDITIONING S )
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,s owing distance from intersection and front of lot
location of lot to at least two roads Well location on to and to house(if present)
Tat "a
Indicate North Ulf _w
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Approximate number of feet from well to
nearest source of possible cunt ination:
The undersigned is aeLon
upon pletion of the well,a Well Completion Report"containing construction details and information required under
Section 25-131 of thSupp ent to the General Statutes must be sent to the owner, the Department of Consumer Protection and the Water
Resources Commih rm provided by the agency. This permit is not valid until all information is filled in and it has been counter-signed by
the Director of
APPLICANT7(Sre) APPLICANT'S ADDRESS REGISTRATION NO.
Joel Stavens PO -Box 406 Willington pe%�7 42
BY(Town Health OeerorAgent) DATE
ROVED ❑ REJECTED ^/L; �-7
*MARKS 7
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7/95
Do NOT fill in
STATE OF CONNECTICUT STATE WELL NO.
YR DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING COMPLETION REPORT OTHER No.
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER NAME ADDRESS
Tiger Lily Ventures .�_ - 2 Boston Post Rd 57 Haven.
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL Burnham St South Win-'sor 1 test well
DOMESTIC BUSINESS FARM TEST
PROPOSED I� ESTABLISHMENT X WELL
USE OF WELL SUPPLY INDUSTRIAL 4J AIR ❑ OTHER
4,l CONDITIONING (Specify)
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT F AIR PERCUSSION PERCUSSION ® (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS '+ r THREADED WELDED
❑ YES ® N0 ❑'YES ❑ NO
YIELD TEST ❑BAILED [-7 PUMPED COMPRESSED AIR HOURS - YIELD(GPM)
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL 20 325 325
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(in'ches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feel) TO(feet)
PACKED: including gravel pack
._]
(inches)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
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If yield was tested at different depths during drilling,list below vim !
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Sign e
3/15/07 233521 2 3/20/07 §V.W-?A
DEPT CAP FMS/IR0KISiA1=RITA1
CPR-9 Rev.7/95
Do NOT fill in
STATE OFCONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE do PROFESSIONAL TRADES DIVISION OTHER No.
WELL DRILLING COMPLETION REPORT
165 Capitol Avenue,Hartford,Connecticut 06106
OWNER ADDRESS
T1 er Lily Ventures 2 Boston' Post Rd W Haven
LOCATION (No..a Street) (Town) (Lot Number)
OF WELL Burnham St South Windsor 1 test well
DOMESTIC BUSINESS FARM Q TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL PUBLIC INDUSTRIAL EJ AIR OTHER
SUPPLY CONDITIONING (S
DRILLING ® ROTARY COMPRESSED
❑ AIR PERCUSSION CABLE OTHEROTHER
EQUIPMENT
(Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE 1�W�yAS CASING GROUTED?
80 6 17
DETAILS 112 THREADED a WELDED YES ❑ NO. EX YES ❑ NO
YIELD TEST a BAILED PUMPED COMPRESSED AIR HOURS YIELD(GPM)
x 2 6
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL 20 325 325
SCREEN MAKE LENGTH OPEN TO AQUIFER-(feet)
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: incudng gravel pack
(inches)
dEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances.to at least two
FEET TO FEET permanent landmarks
0 9 Topsoil/gravel we,%\
9 68 Hardpan
a� by � e�
30'
68 325 Bedrock
F
1.oir 1
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A ubAk�
M
p�
4
P
If yield was tested at different depths during drilling•list below �v r^�ti sr -
-FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Siq
AGENCY