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Home My WebLink AboutWell New 367 Griffin Road CONSUMER PROTECTION &—� WELL DRILLING BOARD 'STATE OF CONNECTICUT PERMIT NUMBER CPR-8 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION (] Q WELL DRILLING PERMIT' 91038. 165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106 LOCATION OF WELL(TOWN). (Street) (Lot Number) DATE S. WINDSOR GRIFFIN RD. 11/14/84 OWNER OF WELL 0 INDIVIDUAL ® BUILDER ' El OTHER(Specify) CORBITT 0OiVSTRUCTI014 646-5355 OWNER'S ADDRESS 128 GRAIIDVIE49 K&IM ESTER, CT. PROPOSED BUSINESS a TEST Est.No.of USE Of DOMESTIC � ESTABLISHMENT FARM WELL People being- PUBLIC AIR OTHER served WELL SUPPLY INDUSTRIAL ' CONDITIONING � {Specify) _ j�,. SKETCH OF WELL LOCATION Locate well with respect to at-leosi two roods,showing distance from intersection and front of lot Location of lot to least two roads Well location on lot and to house(if present) Indicate North Cl/�i4fl�i9.�t • 2A. . 1`Ir aclv'� 60- ' I �r.ce rY X - rep. 461 ' W PIS Approximate number of feet from well to nearest source of possible contamination: 1201 The undersigned-is. aware that upon completion of the well, a "Well Completion Report" confoininq construction details and information required under Section 25-131,of the 1969 Supplement to the General Statutes must be-sent to'the-owner, the Booid-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.counter-signed by the Director of Health or'his agent. : . are) APPLICANT'S ADDRESS REGISTRATION NO. BOX 111 S. WILLIMGTOA CT. 100 BY(Town Health Officer o Agent) PATE APPROVED REJECTED 2- REMARKS RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD 4. WELL COMPLETION REPORT srnrE of coNNECTIcur — CPR-9 REV.11-82 DEPARTMENT OF CONSUMER.PROTECTION Do NOT fill in WELL DRILLING BOARD STATE WELL NO. 165 CAPITOL AVE. HARTFORD,CONNECTICUT 06106 OTHER NO. NAMEADDRE;S --- OWNER COY0 7 T�fyTY © G^ T ;8T t IftwiC27 clip. LOF W OLD �+tqyq��^ } q� (No. &Street)j� ROAD ��tt (Town) --��°°�� (Lot Number) PROPOSED DOMESTIC ET BUSINESS ESTABLISHMENT FARM § USE OF � TEST WELL PUBLIC AIR WELL SUPPLY El INDUSTRIAL CONDITIONING ❑OTHER pecDRILLING COMPRESSED CABLE OTHER EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION El(Specify) CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT RIVE SH WAS CASING GROl/TED7 DETAILS F' 1 ..� _ WELDED YES NO YES NO C3 THREADED YIELD HOURS YIELD(G.P.M.) TEST � BAILED � PUMPED �COMPRESSED AIR �� WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) � LEVEL 1 Depth of Completed Well •L in feet below Land surface: 10 MAKE SCREEN LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER(inches) GRAVEL SIZE(inches) FROM(feet) TO(feet IF GRAVEL Diameter of well including PACKED: gravel pack (inches): DEPTH FROM LAND SURFACE FEET TO FEET FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. 43 : 4-5 —105 —Red Rook i If yield was tested at different depths g the during drilling, list below �� L FEET GALLONS PER MINUTE f DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WEL" ILLER(Signature) r .. e- s MDT nr-1:AI%/I1LDnkIAAGk1TA 1 nn/Vr�os...