HomeMy WebLinkAboutWell New 1101 Sullivan Avenue - CPR-e Rev.7195 PERMIT NUMBER
STATE OF CONNECTICUT 212120
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106 L
LOCATION OF WELL (Town) (sheeU (Lot Number) ;
S.WINDSOR 1101 SULLIVAN AVE. `
3/2.8:�Q2:
OWNER OF WELL
INDIVIDUAL BUILDER OTHER(Specify) :ro 4
OWNER'S ADDRESS
SULLIVAN TOWN HOMES LLC 2600 BERLIN TPKE. , NEWINGTON 06111
PROP05ED EJ DOMESTIC BUSINESS FARM TEST ;:-ESt ng
WELL
USE OF ESTABLISHMENT WELL �rved
PUBLIC INDUSTRIAL Q AIR OTHER ABANDO MENT
SUPPLY CONDITIONING (Specify)
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot ,-.a
location of lot to at least two roads Well location on to and to house(if pMent)--r-r
A Pit n
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Indicate North ev' 14 �� �QV g
tw
rf�s-t IA . n yJ Gt
floor ac
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Su Lk_(ryAN
Svi ttvAri 'Agar.
Approximate number of feet from well to N/A ABANDONMENT
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
Resources Commission on the form 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 Health or his agent.
PLICAN Sig APPLICANTS ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON,- CT. 42
BY(Town Health OtticerorAgent) DATE
PROVED ❑ REJECTED
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
('PR-9 Rev.7/95
Do NOT fill In
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO.
WELL DRILLING COMPLETION REPORT
I"Capitol Avenue,HaMord,Connecticut 06106
OWNER FNAME ADDRESS
N TOWN -HOMES LLC 2600 BERLIN TPKE. , NEWINGTON
LOCATIONStreet) (Town) (Lot Number)
oFWELLLLIVAN AVE. S.WINDSOR
STIC BUSINESS FARM TEST "
PROPOSED 'ESTABLISHMENT EJ yyELL
USE OFWELLC INDUSTRIAL AIRY CONDITIONINGOTHER(Specify) ABANDONMENT
DRILLINGY . COMPRESSED CABLE OTHER
'EQUIPMENT AIR PERCUSSION a• PERCUSSION• (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE. WAS CASING GRO D?
DETAILS THREADED. WELDED ❑ YES ❑ NO• ❑ YES ❑ No -
" YIELD TEST BIULED a PUMPED Q COMPRESSED AIR HOURS YIELD(GPM) •
WATER' MEASURE FROM LAND SURFACE-STATIC(Specify feet)- DURING YIELD TEST(feet) Depth of Completed Well in feet
LEVEL
165
SCREE
fNAKE LENGTH OPEN TO AOUIFER((eel)
DETAILS SLOT SIZE DIAMETER(inUkea) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: imcchding gravel peck
(irdires)
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
FEET TO FEET permanent landmarks
j V U,I V A/V *05.
If yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION U. DATE OF REPORT LER(Signature)
4/1/02 212120 42 4/9/02
AGENCY �j