HomeMy WebLinkAboutWell New 953 Sullivan Avenue .,CONSWMER PROTECTION . .
WELL DRILLING BOARD STATE OF CONNECTICUT P RMIT NUMBER
CPR-$REV.f I.e2 DEPARTMENT OF CONSUMER PROTECTION. i .170694
WELL DRILLING PERMIT
165 CAPITOL AVE..HARTFORD,C0NIECTIC6T ob±oigr�qoa'$U�,i q,fi 0�� vnfi
LOCATION Of WELL(Tmoe) (Staeq (Lot Neerbeq DATE
W/
SOu4-h nf�sa/' 953 gccl�iVi4n/ xa
OWNER Of%Ut _
0 Tft10LY1DlIJ1l WADER .OTHER(Specify) s//tG t° k
OWNER'S ADDRESS
f Si1C UTAILISNAAENT MRM Y NL People being
PROPOSED FlUSE Of Kra.
WELL PUKIC Alit OTHER
W► Y D 1114M IIIAL 0 CONDITIONING ❑ (Specify)
SKETCH OF WELL LOCATION
Locate well with respect to at least two roods,showing distance from intersection and from of lot
Location of lot to at bast two toads Well location an got and to house(I present)
e
btdicose Natlh
1
�'sla.lnd
Approximate number of feet from well to
nearest source of possible contominotiom.
The undenigned is aware Ihot upon completion of the well. a ,well Completion Report" containing construction details and information required under Section
25131 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 countersigned by the Director of Health or his agent.
(s r APKICANTwS ADDRESS r T . .. . REGISTRATION NO.
e ■ '�1f J/'ff ���v /'� "i�� �=!...ram .= =/'/
v \ .. BY(Town Heetrb U/Jrcer or Agent) DATE
NROVEO p RE,EeTEo R Q .-- 7
,fEMARKS '` �`«sass= —_,
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
l -
WELE COMPLETION REPORT STATE OF CONNECTICUT
CPR-9 REV.1142 DEPARTMENT OF CONSUMER PROTECTION - _oo NOT rill in
STATE[ Wfu NO
WELL DRILLING BOARD f/
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO
�� Ts QF��id3 fA"�n
ADDRESS
"ICA"" / �(No- Street) �own) JOF f (Iat Numbed
or wlu 9573BUSINESS
PROI103ED ❑ DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
U$1 OF
` PUBLIC AIR❑ OTHER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING 34U(Spec fv)
!p{�MEBEE ROTARY ❑ AIR PPEERCUUSSSION ❑:PfSSED �RCUSSION ❑Rare ti)
CASH LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT ❑THREADED ❑ WELDED YES NO ❑ES 'G ifD1
OETAIIt NO
vKD HOURS YIELD(G P M i
Tm ❑ BAILED ❑PUMPED ❑COMPRESSED AIR i
MEASURE FROM LAND SURFACE—STATiC(Specify feet) WRING YIELD TEST(feet)
WATf� F=1
of Completed We11LIM AO � below Lend surface
MAKE LENGTH OPEN TO AOUIFER(feet►
fCREEFI
011TA" SLOT SIZE DIAMETER(inches) GRAVEL SIZE(tithes) FROM(feet) TO(feet
IF GRAVEL Dto peter of well includingJ
C V a 0 41 PACKED. grorel pock(inches): //
DEPTH FROM LAID SURFACE FORMATION DESCRIPTION Sketch ettocl location of well with distances. to at least
FEET TO FEET two permanent landrrtorks.
f� F/n a0 o t? MWS'
F' _low arhu
_
AAlc9
I q !' ,9C e
'TuCrG'�t WAl
• �LR.nn 3
If yield was t.ued at diffetenl depdts during drilling,list below T tR vN S
FEET GALLONS PER NUNUTE
i51t}N
_ SuIIi VAN ���--
DATE WELL O D FERMI NO.
�GISIRAIICIN NO DATE OF REPORT WEL DRILLER( tvre)
4 �+
BOARD
WEUL COMPLETION REPORT
CPR-9 REV. It STATE OF CONNECTICUT-
' DEPARTMENT OF CONSUMER PROTECTION 7STATN
T fill in
WELL DRILLING BOARD 165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106
OWNER ADDRESS ----
� � #,e;_�j�/�y��,f ,may/ � �/,,�' �f J
LOCATION_. (No. Street) ` ! 7 �� � jdj/,1,OF Y1iEll (Topw�n)
PROPOM DOMESTIC BUSINESSde-
-
USE OF ESTABLISHMENT FARM
WELL PUBLIC TEST WELL
SUPPLY INDUSTRIAL CIONDITIONING OTHER,
D
^J(Spedfy)
RILLING• ❑ COMPRESSED CABLE
EQLN%Wff ROTARY AIR PERCUSSION PERCUSSION OTHER
PERCUSSION ❑(Specify)
CASING LENGTH(feeQ DIAMETER (inches) WEIGHT PER FOOT
DETAILS - t WAS CASitvG GROULEDr
THREADED WELDED YES NO YES NO
YID HOURS TEST BAILED PUMPED O COMPRESSED AIR YIELD (G P M
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) -�-
- Depth of Completed Well
MAKE
in feet below land surface.
------._
sCRoN LENGTH OPEN To AQUIFER(feet)
DETAKS SLOT 512E DIAMETER (inches)
IF GRAVEL Diameter of well indudmg GRAVEL SIZE(inches) FROM(feet) TO(feet 6 h >t PACKED: grovel pock(inches):
DEPTH FROM LAND SURFACE
FEET TO FEET FORMATION DESCRIPTION Sketch eXocl location of well with distances, to of leosf
two perrnonent landrrtorks.
co
If Yield teft tested of different
depth:during d.inirq,.Ii:f below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. (� k(A N
RETRATION NO. DATE OF REPORT WELL DRILLER Si
o ( nfPlure)
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