Loading...
HomeMy WebLinkAboutWell New 00 Deming Street (2) J CONSUMER PROTECTION WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER CPR-e REV.11-82 DEPARTMENT OF TONSISMER PROTECTION 146255 WELL DRILLING PERMIT 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 LOCATION OF WELL(TOWN) (Smeq (Lot Number)- DATE OWNER OF WELL a �-INDIVIDUAL . _ 0 WILDER El- 6 • OTHER(Specify) hn t'- tVt GVern OWNER'S ADDRESS t 0Z_- lane1nrt� eaA Ut ro in6 Z3 Sl PROPOSED mess TEST Est.No.of DOMESTIC ESTANLISHMENT a FARM WELL People being USE OF PWL1C AIR OTHER served ' WELL SUPPLY INDUSTRIAL CONDITIONING El (Specify) SKETCH OF WELL LOCATION Locate well with respect to at least two roods,showing distance from intersection and front of lot Location of lot to of least two roods Well location on lot and to house (if present) Irtdioate , ek._--z • 1AN : I H�:,sf -- -- I t4 0��e Approximate number of febi from welt to nearew source of possible contamination: The..undersigned is,aware.that.upon completion of•the well—a-"Well,Complei,on•Report': containing const.uction details bnd iriftirmotian required *under'Section 25-131::of-the•1.969-Supplement to..the General Statutes must.be-sent to the.-owner, the:Board and fhe.Water.Resources-Commission'on the forin provided by +hi Board.-This-permit is not valid until all information'is filled in,and'•if has been countersigned by the Director of-Health-or his ogeriv; "• 010 (Tretrrlrrrl• _ -w APPLICANT'S•ADDRESS '- : .a-:: GISTRATK)P1 N0. ... - o • Cl/BY(Totve Hedtb O .� �APFROVEp ❑ /fr"'-°'-Ad .1 , .. .. D'°'Tf :... Of o ' Z,Q rc•d Ai�H���itiz�r tC/ 1 -�c�� �%,�a:•/����. RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD a WELL COMPLETION REPORT STATE OF CONNECTICUT CM-9 REV.11-82 DEPARTMENT OF OONSUOAER PROTECTION Do NOT fill in STATE WELL NO. WELL DRILLING BOARD 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 OTHER NO. NAME ADDRESS OWNER John fin uerr GOCATTON (No.&Street) (Town) (Lot Number) OF WELL - Demming Street South Windsol Lot BUSINESS FROPOm © DOMESTIC ❑ ESTABLISHMENT ❑ FARM ® TEST WELL USE OFVAIL PUBLIC ` ❑ SUPPLY ElINDUSTRIAL D CIONDITIONING El((Spec h) COMP THER IQUIEfI FMT ❑ ROTARY AIR PER CABLESSED CUSSION ❑ PERCUSSION ❑(specify) CA$= LENGTH(feet) DIAMETER(inches) CA51j 6 WEIGHT PER FOOT WASa THREADED ❑ WELDED YFS NO (J YES� ❑D7 DETAILS 40 s 0 aNO yam HOURS YIELD(G.P.M.) TEST ❑ BAILED ❑PUMPED COMPRESSED AIR 17 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feeQ DURING YIELD TEST(feet) Depth of Completed Well ur4a in feet below Land surface. 250 MARE LENGTH OPEN TO AQUIFER(feet) scR DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet PAO(ED: grovel pack(inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least FEET TO MT two permanent landmarks. 0 3 Hardpan . 3 250 Sandstone Ali ego ke 101 73 8,•cqk7ree War wt;Fil fed ROA 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 noture) 1110191 146255 6 1-'15-9 1 I 0� Sima DrillingCo BOARD