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HomeMy WebLinkAboutWell New 79 Buckland Road CONSUMER PROTECTION WELL DRILLING BOARD STATE OF CONN'E0OiJT PERMIT NUMBER CPR'BREV.111'>9 - DEPARTMENT OF CONSUMER PROTECTION 68050 WELL DRILLING PERMIT 20 GRAND STREET,HARTFORD,CONNECTICUT 06106 ` LOCATION OF Wat(Town) (Stmet) (Lot Narmber) DATE SOUTH VFLITDSOR 79 BUCKW4A D RD. 11/6/81 OWNER OF WELL r5aINDIVIDUAL BUILDER El OTHER(Specify) KIRBY HOLCOMBE (644-1189 or 2447) OWNER'S ADDRESS 45 Vl1r,LEYVIL11 DR. , S. `v INDSOR, CT. PROPOSED BUSINESS ❑ ❑ TEST Est.No.of USE Ky 1 DOMESTIC El ESTABLISHMENT FAQ WELL People being _ OF WELL PUBLIC AIR OTHER served. SUPPLY INDUSTRIAL CONDITIONING (Specify) 4 SKETCH OF WELL LOCATION locate well with respect to ot.leasr two roads,showing distance from intersection and front of lot Location of tot to at least two roads Well location on lot and to house(if present) Indicate North �r, /V uJ .3� 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•Generol 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. T(Sigrrature)• APPLICANT'S ADDRESS REGISTRATION NO. C'm, LAKE ST. , V NON, CT. 100 BY(Iowan Health Officer or Agent) DATE APPROVED ECTED REMARKS � - nCTI16AI TLAC /Y10V Tn e^KIAIC1MTIY-I IT %AICII rNnIJIIKI� nnAn- WELL COMPLETION REPORT STATE OF CONNECTICUT — r CPR-9 REV.9-79 DEPARTMENT OF CONSUMER PROTECTION Do NOT fill in ' WELL DRILLING BOARD STATE WELL No. 20 GRAND STREET HARTFORD,CONNECTICUT 06106 OTHER NO. NAME ADDRESS OWNER KIRBY.-HOLCOMBE 45 VA.LLEYVIEW .DR. S. WIND80R -CT. LOCATION - (No.✓i Street) (Town) (Lot Number) OF tniEu ?9 BUCI�L�al�TD RD:' S,. •GIII�TDSOR BUSINESS PROPOSED ® DOMESTIC ESTABLISHMENT -E] FARM a TEST WELL " USE-OF ; INBLIC: AIR OTHER WELL SUPPLY ❑-INDUSTRIAL CONDITIONING' (Specify) DRILLING COMPRESSED CABLE, OTHER e EQUIPMENT ® ROTARY AIR PERCUSSION PERCUSSION (Specify) CASING LENGTH(feet)' DIAMETER(inches) WEIGHT PER FOOT- J�CASINGGROUTED? -DETAILS tIT- 21 6 Z e4 •©THREADED WELDED YES NO (1l YES NO LIT. YIELD. HOURS" - YIELD(G.P.M.) - TEST BAILED PUMPED, • FRICOMPRESSED'AIR 4 20- •WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet)• DURING YIELD TEST(feet) Depth of Completed Well. LEVEL ?5 1.25 in feet below Land surface: 1 Q MAKE LENGTH OPEN TO AQUIFER(feet) SCREEN-`. :DETAILS SLOT SIZE- � DIAMETER(inches). T IF GRAVEL Diameter of well including GRAVEL SIZE(inches), FROM(feei)' 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. 0 7 Sand & Clay 7 150 Bedrock . r . Al If yield was tested at different depths during drilling, list below" ' FEET GALLONS PER MINUTE DATE WELL COMPLETED - •_ PERMIT,NO. REGISTRATION NO.. DATE OF REPORT. . WELL RI R gnature 11/11/8i 6so5o 100 11 1' s1