Loading...
HomeMy WebLinkAboutWell 07009999 Bailey Circle irrigation •CPR-8 Rev.7/95 PERMIT NUMBER STATE OF CONNECTICUT 250789 DEPARTMENT OF CONSUMER PROTECTION yr REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT 16S Capitol Avenue,Hartford,Connecticut 06106 LO( ATION OF WELL (Town) (Street) �+ (Lot Number) DATE cJ iJ �✓ CLV �t —// OWNER OF WELL ^ INDIVIDUAL � BUILDER Q OTHER(Specify) [O/J(W�NER S ADDRESS v C i Y Est.No.of PROPOSED DOMESTIC BUSINESS FARM TEST People being USE OF ESTABLISHMENT WELL served. WELL PUBLIC [j—SUPPLY INDUSTRIAL AIR OTHERCONDITIONING ® Specify)G/'Y'!� 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 Mj Approximate number of feet from well to nearest source of possible contamination: f / y�y t r� L? 011Xo The undersigned is aware that upon completion of the well, a 'Well Obmpletion Report"containing coAtruction 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 th r of Heg#h or his agent. APP NT ig re) )i� APPLICANT' A DVRE REGISTRATION NO. APPROVED REJECTED BY(Town Health Officer orAgent) DATE ❑ REMARKS rwk use\\ %S kb Ice— oni,� o�-� C O r lASet.wti 1► \J01 cWrnWA 1 •' '' arc © r� ��� RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION CPR-9 Rev.7/95 Do NOT fill in STATE OF CONNECTICUT STATE WELL NO. DEPARTMENT OF CONSUMER PROTECTION �Je REAL ESTATE&PROFESSIONAL TRADES DIVISION OTHER NO. WELL DRILLING COMPLETION REPORT 165 Capitol Avenue,Hartford,Connecticut 06106 OWNER NAME ADDRESS }} \ i'r ur.' -`3i Ib r i' ',t '�l a io J` .J i� -rl1 1 �J i .'.:.I.:'J L. "S.i fr.�.. .f.i.. LOCATION (No.&Street) (Town) (Lot Number) OF WELL Ci PROPOSED DOMESTIC aBUSINESS ESTABLISHMENT a FARM TEST WELL USE OF WELL a PUBLIC a INDUSTRIAL AIR a OTHER - a i SUPPLY CONDITIONING (Specify) "' J x ""0,` DRILLING ROTARY COMPRESSED CABLE OTHER EQUIPMENT 1:1 ® AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH(feet) I DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS THREADED WELDED �t / � � I � ❑ YES ❑ NO, ❑ YES ❑ NO YIELD TEST a BAILED a PUMPED COMPRESSED AIR HOURS YIELD(GPM) WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) G YIELD TEST(feet) Depth of Completed Well in feet LEVEL t j 1 DURIN , 53 v MAKE LENGTH OPEN TO AQUIFER(feet) 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 7 tm- clay f i I l If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTE I DATE WELL COMPLETED PERMIT NO. REGISTTRATION NO. j_DATE OF REPORTWELL DRILLER(Signature) JJ .3VI ! iF.iiJ�',✓:l "ai��l /d 1 � 1 f >i9�-"4. t�'� .t�::l.z U U LOCAL DIRECTOR OF HEALTH CPR-8 Rev.7/95 PERMIT NUMBER STATE OF CONNECTICUT 250789 DEPARTMENT OF CONSUMER PROTECTION yr REAL ESTATE&PROFESSIONAL TRADES DIVISION WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION OF WELL (Town) (Street) (Lot Number) _ DATE �� "s -�i OWNER OF WELL INDIVIDUAL BUILDER OTHER(Specify)Q OWNER'S ADDRESS Est.No.of PROPOSED El DOMESTIC Q BUSINESS FARM TEST People being USE OF ESTABLISHMENT WELL served. WELL PUBLIC SUPPLY INDUSTRIAL AIR CONDITIONING FA (STe iN) 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 1 Approximate number of feet from well to ® -I—) nearest source of possible contamination: f j a//X /1 The undersigned is aware that upon completion of the well, a"Well Obmpletion 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 th r of Heggh or his agent. APP NT ig re) APPLICANT' A D REGISTRATION NO. BY(Town Health Officer or Agent) DATE C&fAPPROVED ❑ REJECTED Q REMARKS P�fi yy � � �t ®��1(;y c°X1�1v( o+..�, C��`Zf' �Ssza e�ai 1� v�z� r�� : '•`�'�' �° °�_ 9_1 , ��� RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION