HomeMy WebLinkAboutWell New 333 Griffin Road WELL DR.JUNG BOARD STATE OF CONNECTICUT __ 'PERMIT NUMBER
1-69 WELL DRILLING PERMIT 1.4921
STATE OFFICE BUILDING,HARTFORD;CONNECTICUT 06115
LOCATION Of WELL(Town) (S�tj - (Lot Number) DATE
e
OWNER Of U[ ,
❑INDIVIDUAL ❑-Btl1lDER ❑ OTHER(Specify)
OWN EIS
t , r
PROPOSED BUSINESS TEST Est.No.of
USE OF ❑ DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
served.
WELL PLIBLIC AIR
❑.SUPPLY El INDUSTRIAL ❑ CONDITIONING El ((Spec fy)
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 lot and to house(if present)
Indicate North
• Ir� .
' H
Approximate number of feet from.well to
nearest source of possible contamination:
The undersigned is aware that-upon completion of the well,a"Well Completion-Report"containing construction details and information requiied under Section 25-131..
of the 1969 Supplement to the General Statutes must,be sent to the owner,the Board and the Water Resources Commission on the form provided by the Board.This
permit.is not.valid until all information is filled in and it has been countersigned by the Director of Health or his agent.
APPUCA ign ) S ADDRESS r REGISTRATI
qtj.NO.
00
747; V
B own flea r or gent) DATE OF
vEo
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT- STATE OF CONNECTICUT: DO NOT fill in "
WDB-5 1249 REV.9•71 WELL-DRILLING BOARD STATE WELL No.'
State Office Building '
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ��' ' `r. ADDDRE 9 P
OWNER. v 'S V A
of
LOCATION (Noy t) (To`n)� P� (Lot Number)
" OF WELL ' - ct .
' PROPOSED'
�NIESTIC ❑ ESTABESHMENT ; ❑ FARM ❑ TEST WELL.
USE OF '
AIR
WELL ❑ PUBLIC SUPPLY ❑ INDUSTRIAL E.CONDITIONING ❑ (Spec fy) '
DRILLING ❑ ROTARY' ❑.A RMPERCUSSION OkESSED 13��RCUSSION ❑`
CABLE OTHER
EQUIPMENT 1speeify) -
CASING LENGTH(feet)` DIAMETER(inches) WEIGHT PER FO�O+T, DRIVE-•SHOE WAS CASING GROUTED?
DETAILSIEADED �L .WbLDED( ❑ �El NO 'S1 ES ❑NO
YIELD �-��77 � HOURS YIELD(G.P.M.)-
TEST L'�'$AILED ❑ PUMPED . ❑ COMPRESSED,AIR
y
WATER MEASURE FROM LAND SURFACE—STATIC•(Specify feet) .DURING YIELD TEST(feeet Depth of
t)) Completed Wel!
LEVEL f , aJ'C� in feet below Land-surface:
MAKE : (LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAYEL GRAVEL SIZE(Inches)FROM(feet) TO(feet)
t Diameter of weil.including I
I'PACKED: • I gravel-pack(inches): I '
DEPTH FROM LAND SURFACEFORMATION.DESCRIPTION Sketeh"exact location of well with distances;to at least
FEET' -to FEET two permanent landmarks.
�/f'le
If yield was tested at different depths during dhiling,list below
FEET GALLONS PER MINUTE M
YT 1: ,►.i
DATE WELL COMPIETEP I P IT•NO e:? i.;y REGISTRATION O. I DATE OF REPORT WELL D ignaWi
BOARD--