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Home My WebLink AboutWell Abandond 9999 davewell hollis ravin SCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) TO(feet) PACKED: including gravel pads (inches) DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two FEET TO FEET permanent landmarks If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE fit} 1 DATE WELL COMPLETED PERMIT NO REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature)" CPR-8 Rev.7/95 PERMITNQUMBEER STATE OF CONNECTICUT 2 4,IT v"65 y� DEPARTMENT OF CONSUMER PROTECTION s8/x REAL ESTATE&PROFESSIONAL TRADES DIVISION �3a WELL DRILLINGVERMIT 1,r10. o t 165 Cap'tg1 Aven e, rt o d,Connecticut 06106 �UVdL !-ib LOC� ION OF WELL (Town) (Street) (Lot Number) DATE !�V rlHAr CAis LJ A T 12-a 1AOW- OWNER OF WELL INDIVIDUAL BUILDER OTHER(Specify) I Tior�j OWNER'S ADDRES a DAYC Lo,-LL PO4-0 50UTif 1-01vq"02 C Est.No.of PROPOSED USE OF DOMESTIC BUSINESS ESTABLISHMENT FARM El TEST WELL V'' F L People being WELL — AIK vim SUPPLY L—J tNDtlSTR CONDITIONING (Specify) 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) t3 f?>4v►N►e 2 Indicate North w I LL 4 ' /FLL • � 1ri j'(Z w� f bAvFU c.(` ROAD L L l LvzfUHT VALLEY �OAO -D Approximate number of feet from well to nearest source of possible contamination: The undersigned is aware that up completion of the well, a'Well Completion Report"containing construction details and information required under Section 25-131 of the 1969 Sup a ent to th eneral Statutes must be sent to the owner, the Department of Consumer Protection and the Water Resources Commission on the f prov' egt-by;t c . This permit is not valid until ali information is filled in and it has been counter-signed by the Director of Health or his agfnj.ft&4PA V APPLICANT(Signature) AP_PLICAS ADDRESS U REGISTRATION�10�� i1 T'H o Yet 1,�U lar!r 11 AO! A �✓(V BY(Town Health Officer of Agent) DATE ❑ APPROVED ❑ REJECTED REMARKS DIRECTOR OF HEALTH Do NOT fill in STATE OF CONNECTICUT STATE WELL NO. y� DEPARTMENT OF CONSUMER PROTECTION REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO. WELL DRILLING COMPLETION REPORT I GS Capitol Avenue,Hartford,Connecticut 06106 OWNER NAME ADDRESS LOCATION (No.&Street) (Town) (Lot Number) ' OF WELL �4VG W E. // PC4 Sou>- GJ "✓dJ v DOMESTIC BUSINESS FARM TEST PROPOSED 11 ESTABLISHMENT WELL USE OF WELL �r9 ' PUBLIC INDUSTRIAL a AIR a OTHER We(/ SUPPLY CONDITIONING (Sped ) A-A e)PJ.(a,t ,,e,,,k,(— DRILLING ROTARY COMPRESSED CABLE OTHER EQUIPMENT AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? MInr YES LJ NO, 0 YES ❑ NO YIELD TEST a BAILED 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 MAKE SCREEN LENGTH OPEN TO AQUIFER(feet) DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well GRAVEL SIZE(inches) FROM(feet) 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 63 If yield was tested at different depths during drilling,list below R V r,t✓eA- FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT N0. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) LOCAL DIRECTOR OF HEALTH CPR-8 Rev.7/95 PERMIT NUMBER STATE OF CONNECTICUT 246864 DEPARTMENT OF CONSUMER PROTECTION 0�.s REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT 165 a itol Avenue, artford,Connecticut 06106 SOU rM W 1 rld�� 3TA\I Al I L rr u AD LOCATION OF WELL Town) (Street) (Lot Number) DATE OWNER OF WELL INDIVIDUAL BUILDER 9 OTHER(Specify) ("6`�j�p OWNERS ADDRESS /7 PROPOSED D DOMESTIC ESTABLISHMENT TEST WELL s WBL SHMENT 'rFARM ~~ a (�( L People ervedon9 USE WELL ,y. ,/ ;UPP Y Li BUSfiRFA� L� CONDITIONING (Specify) '//'1r/ 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 11-9 Pi7 1��.:t-►� � Pit- P� � o�fl J�J�Y�wR'tL D Y L Approximate number of feet from well to nearest source of possible contamination: The undersigned is aware that uLment�,to letion of the well, a"Well Completion Report"containing construction details and information required under Section 25-131 of the 1969 Sup the General Statutes must be sent to the owner, the Department of Consumer Protection and the Water Resources Commission on the fdcr( t cy. This permit is not valid until all information is filled in and it has been counter-signed by the Director of Health or his ag APPLICANT(Signature) VAPPLIc�NT'S A DRESS t REGISTRATION NO. S t��r1d�V )- `�vPIG-w)t"AD,mi olv�k 30 BY(Town Health Officer or Agent) DATE ❑ APPROVED ❑ REJECTED REMARKS DIRECTOR OF HEALTH