HomeMy WebLinkAbout1999-11-1 - 1523 Main Street - Well Completion ReportCPR~9 Rev.7/95
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE &PROFESSIONAL TRADES DIVISION
WELL DRILLING COMPLETION REPORT
1 65 Capitol Avenue.Hartford.Connecticut 061 06
Do NOT fill in
STATE WELL NO.
OTHER N0‘
OWNER NAME.LSQUCY &SQRS ADDRESS50 LATHAM ROAD,WILLENGTGN,CT.
LOCATION
OF WELL
PROPOSED
USE OF WELL
DRILLING
EQUIPMENT
(No.8.Streei)(Town)(Lot Number)1523 NAIR ST.3.WENBSOR
X DOMESTIC BUSINESS FARM I I TEST
ESTABLISHMENT WELL
PUBLIC INDUSTRIAL AIR OTHER
SUPPLY CONDITIONING (Specify)
ROTARY COMPRESSED CABLE OTHER
AIR PERCUSSION PERCUSSION (Specify)
CASING
DETAILS
LENGTH (feet)DIAMETER (inches)
5
WEIGHT PER FOOTl7.GQ THREADED D WELDED
DRIVE SHOE
YES D N0.
WAS CASING GROUTED?
YES D NO
YIELD TEST BAILED D PUMPED COMPRESSED AIR HOURS
8
YIELD (GPM)20
WATER
LEVEL
MEASURE FROM LAND sURFACE -STATIC (Specify reel)49 DURING YIELD TEET (Taft)Z.
Depth of Compleied We”in feel
5
SCREEN
DETAILS
MAKE LENGTH OPEN To AQUIFER (feet)
SLOT SIZE DIAMETER (inches)IF GRAVEL
PACKED-
Diameter ol we”
Including gravel pack(inches)
GRAVEL sIzE (inches)FROM (Ieet)To (feet)
DEPTH FROM LAND TO SURFACE
FEET TO FEET
FORMATION DESCRIPTION Skelch exact Iocation of well with distances.to at least two
permanem landmarks
if}LIE Eag$31O E gsavai
gx
w“;I f if
12 13D Ola?
1L ’4f}i;-‘.3&5 ic§r3ak
§é ’Ié s
L u
if
{I .I/j I
I;i
3w.T
_l{LIV
gpg,
If yield was Tested al different depThs during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED10f30f99 PERMIT No.
lg536O
REGISTRATION NO
$2
DATE OF REPORT
11/1/9§
DEPTOF ENVIRONMENTAL PROTECTION -‘WATER RESOURCES
"PERMIT NUMBER'195360'CPR‘B Rev.7/95
STATE OF CONNECNCUT
DEPARTMENT or CONSUMER pn‘oTEcno'u
_nEAL EsTATE a:pnorEssmNAL TRADES mvxsxoxw
WELL DRILLING PERMIT
l 65 Capitol Avenue,Hartford.Connecticut 06 l 06
LOCAHON OF WELL ~(Town)‘(stree!).(Lowumber).'DATE‘8 /1 1 /9 9s.WINDSOR ‘15'23 MAIN ST.
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
OWNEROFWELL a INDIVIDUAL BUILDER D 'OTIIER
(specify)429.9 282
’OWNER'S ADDRESS 1 -‘I
SOUCY &SONS 50 LATHAM RD .p WILLINGTON I CT .7 _
PROPOSEDUSE 0F.WELL
DOMESTIC
-B BUSINESS .»_D‘
FARM .‘
.D TEST
7 _“’
I '
ESTABLISHMENT ‘I WELL v'.:_
-suPPLYPuaLIc B .INDUSTRIAL '"D AIRCONDIYIONING D (Speciiy)
OTHER '
Est.No.ofPeoplebeingserved
4 .-
_SKETCH OF WELL LOCATION V .
r ..‘T -Locate well with respect to at least two roads.showin distance from intersection and front of lot
r .A .-.Iocation of Iot to at least two roads ~.-Well Iocation on to and‘to house (if present).
Indicate North Wlw S £‘i
if
d’W
bs#a _g
I
r70’7‘-
U3
.
A &I f‘J 6‘t —t
Approximate
nearest source
number
of possible
of feet
contamination:
from well to ..7 5 '+(san 1.t arY Sewer ‘
s )..
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 fonn provided by the agencyt This permit is not valid until all information is tilled in and it has been counter-signed by
I
APPLICANTS ADDRESS ..
P.0.BOX 406,WIL‘LINGTON,CT.V
REGISTRATION NOD
42
BY (Town Health Officer orAgent)i ’
‘_QJ)£4né/L._-"'.
DATE
?u Ly??
REMARKS ‘i r
CPR~9 Rev.7/95 k
STATE OF CONNECTICUT
‘.
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE &PROFESSIONAL TRADES DIVISIONWELLDRILLINGCOMPLETIONREPORT
I 85 Capitol Annue.Harthrd.Connecticut 061 06
OTHER NO.
AGENCY
Do NOT till inswnEwHLNQ
OWNER WE
SOUCY &SONS,
ԴԴADDRESS
5 O LATHAM.ROAD ,WILLINGTON l CT .
LOCATION
OF WELL
(No.&Street)(Town)-“‘(Lo!Number)1523 MAIN ST.S .W I NDSOR
PROPOSED
USE OF WELL
_.._.__DRILLING
EQUIPMENT
DOMESTIC
_ESTABLISHMENTBusINEss D FARM
WEL‘LTEST
PUBLIC ‘INDU$TRIAL AIR I OTHERSUPPLYCONDITIONING(SpedfY)ROTARY COMPRESSED CABLE."-OnER
AIR PERCUSSION PERCUSSION (sbeéim ..
CASING
DETAILS
LENGTH (veer)140 oIAMETER (inches)__‘WEIGHT PER Foot17.00 THREADED D WELDED DRN’EW—a YEs_U N0-
WAs CASING GRoutED?‘
E yes U NOYIELDTEST.l D wLEo D Pun-FED
>
coupnEssEn AIR HOURS
8 Y'ELD (GM)20
wATERLEVEL
MEASURE FROM LAND SURFACE -STATIC (sway Isel).DURING YIELD Test (Ieel)00 DwmdAmwwmwwmmm
SCREEN
DETAILS
MNE LENGTH OPEN To ADUIFER (Ina)
SLOT snzE DIAMETER (inchas1 FGMWLmmmu Diamatsr oi wellindudinggravalpad(Mes)
amwuMEmmu FROMIRnn Tomw
DEPTH FROM LAND TO SURFACE
FEET TO FEET
FORMA‘HON DESCRIP‘HON’'f Skelch exact Iomtion of wen with distances,to at least Iwupermanentlandmatks
0 12*Topsoi1 &7Grével'
12 130 Clay
130 305 Bedrock
-11 yield was tested at difierent depths during drilling.list below
FEET GALLONS PER MINUTE
DATE1&730799Lco pLETED -PERMIT To.195360 REGISTRATION N0.
42 DATE OF REPORT11/1/99