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Home My WebLink AboutWell New 411 Griffin Road 4/ &j)99/�l WELL DRILLING BOARD STATE OF CONNECTICUT MMIT, NUMBER r &41 '1-69 WELL DRILLING PERMIT 1 5 3 8 8 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT.06115 r J / Its LOCATION OF WELL own) (Street) (Lot Number) DATE OWNER OF WELL ❑INDIVIDUAL ®BUILDER ❑ OTHER(Speafy) OWNER'S ADDRE$$ �+ /,, / e0f7cl S. PROPOSED ❑ BUSINESS TEST Est.No.•of USE OF DOMESTIC ESTABLISHMENT ❑ FARM ❑ WELL People being served. WELL PUBLIC❑ R OTHER SUPPLY ❑ INDUSTRIAL ❑ CIONDITIONING ❑ (Specify) SKETCH OF WELL LOCATION Locate well with respect to at least two roads,showing distance from intersection and from of lot Location of lot to at least two roads Well location on lot and to house(if present) Indicofe North �� - � 07 746: • - .��,�,cl� Vic! 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 required 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 counter-signed by the Director of Health or his agent. APPWk (Signal /ADPRESS REGISTRATION NO. BY(Town Officer gent) DATE APPROVED ❑ REJECTiE) REMARKS RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD WELL COMPLETION REPORT t ' STATE-OF COriNECTICUT. : WD8.5 1249 REV.9-71: WELL DRILLING•BOARD' Do NOT'till`in " State'Office Building STATE WELL NO. HARTFORD,CONNECTICUT 06115 OTHER NO. OWNER N. ADDRESS w LOCATION' (N treat) :.OF WELL (Town) (Lot Number) BUSINESS PROPOSED OMESTIC ❑ ESTABLISHMENT ❑ ^ FARM' ❑.TEST WELL USE,OF WELL ❑ SUPPLY PUBLIC ❑'INDUSTRIAL ' El AIR OTHER n t CONDITIONING ❑ (Specify)DRIU�ING •- EQUIPMENT ❑ ROTARY: 'SgIRMPERCUSSI ON ❑ CABS OTHER PERCUSSION ❑ (Specify) ' CASING LENGTH(feet) DIAMETER(inches) WEIGHT-PER FOOT DRIVE SHOE WAS CASING GROUTED?. DETAILS.-. ;I IIR tf�l:r•9+THREADED ❑ WELDEDI ❑'1ES ❑NO ®YEr`'. No .YIELD HOURS YIELD(G.P.M.) TEST 1LED ❑ PUMPED _ OMPRESSED AIR /JO WATER MEASURE,FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Q+ _ Depth of Completed Well LEVEL'. I in.feet below Land surface: MAKE I LENGTH OPEN TO AQUIFER(feet) SCREEN ' 1 DETAILS SLOT SIZE DIAMETER(inches) I )F GRAVEL I Diameter of well including I GRAVEL SIZE•(inches)•IIIIFROM(feet) TO(feet) IJ PACKED: gravel pack,(inches} I I DEPTH FROM LAND SURFAC FORMATION DESCRIPTION Sketch exact location of well with distances,to at'least FEET to FEET / two permanent landmarks, ' If yield was tested at different depths during drilling; list below• ' FEET GALLONS PER MINUTE DATE WELL COMPLETED` PERMIT NO.. REGISTRATION O. DATE OF REPORT WELL DRIL i 'ature se �BOARD SMELL COMPLETION REPORT STATE OF CONNECTICUT WDB-5 12-69 REV. 9-71 WELL DRILLING BOARD Do NOT fill:in State Office Buildin STATE WELL NO.g ' HARTFORD,CONNECTICUT 06115 S yj Z,5 33 OTHER NO. OWNER NAM ADDRESS LOCATION E _ (No.-S,$street) (Town) (Lot Numbor) s f 7 OF WELL �. I� t 31 ` f /_/ f v✓s it /p 319 PROPOSE® OMESTIC ❑ ESTABLISHMENT ❑BUSINESS ❑ TEST WELL FARM USE OF . WELL ❑ OTHERPUBLIC AIR SUPPLY ❑_INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING EQUIPMENT El ROTARY CABLE AIRM ERCUSSDION ❑ PERCUSSION ❑ ((Spec fy) LENGTH (feet) DIAMETER(inches) WEIGHT.PER FOOT CASING ( DRIVE SHOE WAS CASING GROUTED? DETAILS ,/ THREADED ❑ WELDED ❑-?ES ❑NO ES ❑NO YIELD HOURS- YIELD( .M.)" TEST. L oA1LED ❑ PUMPED OMPRESSED AIR a WATER MEASURE FROM LAND SURFACE—STATIC (Specify feet) DURING YIELD TEST(feet) Depth of Completed Well LEVEL I v{�' in feet below Land surface: MAKE I LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) ITO(feet) PACKED: gravel pack(inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least FEET to FEET ff two permanent landmarks. f f _rt L1'fl F �i t�ct`S lac�l�h 1 � 'V f , fcy , Cr"),Iq76 � tic if yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DPTE L OMPLETED PERMIT NO. REGISTR, O O. DATE OF REPORT WELL DRILL" ature DEPT. OF ENVIRONMENTAL PROTECTION - ... . - ^1 - - �� sc� � ^tz-.: ,•s-fir ._ - mod.._.,.,�..a,--P WELL COMPLETION REPORT STATE OF.CONNECTICUr Do NOT fill in WDB-s 12-69 REV.9-71 WELL DRILLING BOARD STATE WELL NO. State Office Building HARTFORD,CONNECTICUT 06115 OTHER NO. OWNER NAME ADDRESS LOCATION (No.& treet) (Town) (Lot Number) OF WELL BUSINESS PROPOSED 94�OMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL , USE OF WELL ❑ PUBLIC AIR THER SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) . DRILLING ❑ COMPRESSED ❑ CABLE ❑ OTHPIk-' EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED? DETAILS ` `'f /° `THREADED ❑ WELDED I `❑'YES ❑NO ❑"rff ❑NO YIELD �?''� HOURS YIELD(G.P.M.)` TEST D'BAILED ❑ PUMPED OMPRESSED AIR I i r MEASURE FROM LAND SURFACE—STATIC (Specify feet) DURING YIELD TEST(feet) WATER I ...,. Depth of Completed Well �- LEVEL *' * in feet below Land surface: MAKE I LENGTH OPEN TO AQUIFER(feet) SCREEN DETAILS SLOT SIZE I DIAMETER(inches) IF GRAVEL Diameter of well including I GRAVEL SIZE(inches) FROM(feet) TO (feet) PACKED: gravel pack(inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least FEET to FEET two permanent landmarks. f t r r'�X ell <.1 If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT NO_. y REGISTRATION NO. DATE OF REPORT WELL DRILLER`(Sighature _ DIRECTOR OF HEALTH WELL DRILLING BOARD STATE OF CONNEC'RdUT PERMIT NUMBER WD13-4 11-69 WELL DRILLING PERMIT 15388 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 r LOCATION OF WELL((town) (Street) (Lot Number) DATE OWNER OF WELL ❑ INDIVIDUAL BUILDER ❑ OTHER(Specify) OWNER'S ADDRESS PROPOSED BUSINESS TEST Est.No.of DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being USE OF served. WELL El SSUUBLIC AIRPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (SpHEIfy) 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 o r CA Approximate number of feet from well to 1 nearest source of possible contamination: 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 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 counter-signed by the Director of Health or his agent. APP Signatur y APPLICANT'S ADDRESS � / REGISTRATION NO. bass 1 t 4 / .v(z/ BYV(TownHth Officer gent) DATE APPROVED ElREJECTED REMARKS Cy gfcg 2 3 2 9 DIRECTOR OF HEALTH