HomeMy WebLinkAbout1994-9-6 - 1287 Main Street - Well Completion ReportA..'CONSUMER PROTECTION
WELI.DRILUNG BOARD
CPR-I REV.H-IZ
smE or comxcwrcm
DePAR‘IMENY OF CONSUMER PROTECTION
WELL DRIILING VERMI‘I'
lbs CAPIIOL AV£.,HARtroao.CONNECIICUI 0mm
(L0!Nu mbrr)DAVE{fhnt}
1287 MAIN ST.
mam os wm (rm)S .WINDSOR
locum wall with "spec!w o!has!Mo roads.thawing damn“horn inlevseuicn and hon!oi lo :
ll$m Nodi
mt}.J svlwoo‘L
Approzimoh number of fa!(ram well to
mar”!wurc.o!pouible conhmina‘ion:
The owned is aware "u!upon complelion a‘Ihe well,a “Well Comp1eucn Repon”comaining cansuutllan deloul;and mfounolion (eQuired undcr Secln'on
25-DJI d the 1969 Suppiemen‘Io ihe General Siames mun be senl Io Ihe owne'.the Board and IHe Water Rem-ace;Commission on Ihe {mm pvuvided by Iho
aoord.Thin povmix is noi vuud'unul all inioymanon i;lined in and a has been counver-signed by the Divec‘ot cl Heohh ov his oggnL
§£GlSIRAHm m‘44
85'
AMONY'S A90%SS
P.O.BOX 406,WILLINGTON I CT.
BY (Faun Hullb 0$ctr or A‘ut)
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DATE
Wlovm ‘D miCT‘D I “=M‘M gar {a 7?r J3 SEP 1 4 1994
OCCU?ATIONH.USEw-i‘e EMSIOs‘i-3.Cd..m o:‘hVanstmasr Ps‘ctecmn
RETURN THIS COPY TO CONNECTTCUT WELL DRILLING BOARD
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KHMIT NUMBéR159220
7/21/94
Well local-on on 1o!and I'a house (J pvesenl)
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WELL COMPLETION REPORT SIM:o:conmcncm
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WELL COMPIETION REPORT SYAYI OF CONNECTICUY
CPR-9 REV H42 DEPARTMENT OF CONSUMER PROTECTHON
WELL DRILLING BOA D
\65 CAPITOL AVE,
HARTFORD,CONNECTICUY Ob‘w
DO NOT (Hi In
SYAYE V/ELK NO
OTHER NO
Mil
NAME
ETIéVID KASHETZK
ADDRESS
1287 MIQKN ST.r S.WINDSOR;CT.
tOCAnONO!ml
(No 3 Stree‘)(town)1287 MAKE ST .S .WINDSOR
(lo'Number)
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BUSINESS
ESYABUSHMENT a FARM B YEST WELL
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QOTARY AIR PERCUSSION PEPCUSS‘ON
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WASURE FROM LAND SURFACE—STAYIC (Specify fem)DURIW WELD TESI New)
3 Ei E 3 ‘rd
Depth of Compleved Weli
m §eel below Land wrfoce 4 6 5
WIDam
MAKE LENGYH OPEN YO AQUIFER {‘eel)
SLOT SIZE D‘MAETER (inches)'F GQAVEL
PACKED:I Duome'er of well includmg
gmvel pack (mches)
GRAVEI SIZE (inches)FROM {feel}YO (5eel
um Fm LAPD SURFACE WHON DESCRIPTION Skevch exec!Rocahon of we”wilh dmencex,10 a'1eos!
KEY TO FEET Mo permanem ‘c'dmov’u
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KEY GNLWS PER MINUTE
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DAVE Will WETED
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REGISYRATION NO.
44
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