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HomeMy WebLinkAboutWell New 00 Griffin Road CONSUMER PROTECTION WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER CPR4 REV.1I-8 DOXICYMENT OF CONSUMER PROTECTION 1 3 8-5 8 0 " WELL DRILLING PERMIT 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 L ION Ou F WELL(Town) (Stre,e�t,r (Lot Ntrmber) DAT1� E d 1� r IL t'�"i 914- 60 7 jet"R OF WELL 4 WDMDUAL BUILDER OTHER{Specify) ICX-u Lc� �h L •T-�i CIWNER'&A&PRESS x 1 dsolr —r O GoZ PROPOSEDEl BUSINESS ❑ TEST Est.No.of DOI UTIC ESTABLISHMENT FARM WELL People being USE Of WELL PUBLIC AIR OTHER served. SUPPLY INDUSTRIAL CONDITIONING (Specify) 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 for and to house (if present) ktdicole Nash Nq J � • ,y V cg h� GR�� �' 40) s� `46 F , 3 III b N 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 infounotior-t 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 slie form provided by the 94:10411-This mil is i/ i until all ' ormatro is filled in and it has been counter-signed by the Director of Health or his agent. f\t APPLICANT(Sigtwttrre) ((ZANT' DRESS REGISTRATION ND. � C) 1 T-31 1.1-L'rnorN al-co a" BY.(Tome Health Ojjrrer or Agent) DATE APPROVED �REJECTED REMARKS r7 S RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD to WELL COMPLETION REPORT STATE OF'CONNECTICUT: . Do NOT fill in CPR-vREV.It-es - DEtA,RTAOENT OF CONSUMER PROTECTION WELL DRILLING BOARD STATE weu NO. 165 CAPITOL AVE. -t HARTFORD,CONNECTICUT'06106 OTHER NO. NAME ADDRESS ° E 'David White P.• O. Box 731, South Windsor,- CT 06074 , LOCATION (No.8-Street) (Town) (Lot Number) OF VML Griffin Road South-Windsor_ 60 . BUSINESS PROPOSM C�DOMESTIC .a ESTABLISHMENT FARM a TEST WELL USE Of WOl AR 0 PUBLICOWILLING ` SUPPLY INDUSTRIAL. ❑- CIONDITIONING ❑'105PeciRfy) OTHER EQUIPAAENT L J ROTi4RY X� AICRESSED El RCU PERCUSSION: CABLE (specify)PERCUSSION CASINGLENGTH(feet) DIAMETER(inches) WEIGHT-PER FOOT " WAS CASING GROUTED' TATAILS. 2O t 6° 17 t �'. THREADED �VJELOEO YES IVO ®YES a Nq - HOURS - YIELD(G:P.M.) ' YIELD TST ❑ BAILED PUMPED a COMPRESSED AIR 4 20 Depth of Completerd Well INAT7� MEASURE FROM LAND SURFACE—STATIC'(Specify feet)' DURING YIELD TEST(feet) lEVE1 t in feet:below Land-surface:- MAKE LENGTH.OPEN TO AQUIFER(feet) _ scam - - I EM"". SLOT SIZE DIAMETER(inches) GRAVEL SIZE(incht—as) FROM(feet) TO(feet IF GRAVEL Diameter of well including PACKED: gravel pack(inthes): DEPTH FROM LAID SURFACE -FORMATION DESCRIPTION Sketch exact location of well with distances,to at least FEET TO FEET two permanent londrnorks. CIO If yield was tested at different depths during drilling,list below FEET GALLONS PER MINUTECIO I>VUE WELL COMPLETED PERMIT NO. - REGISTRATION NO.. GATE OF REPORT' WELL DRILLER,($ignaW 3/17/89 138580 - 324 3/2 8/89 ��Qc� � BOARD 1' WELL CGMPLET(ON REPORT srnrE of coNNEcncur CPR-9 REV.11-82 DEPARTMENT OF CONSUMER PROTECTION WELL DRILLING BOARD 165 CAPITOL AVE. HARTFORD, CONNECTICUT 06106 OTHER NO. OWNER NAME ADDRESS David White P. O. Box 731 , South Windsor, CT 05074 LOCATION (No. & Street) (Town) OF WELL Griffin Road (Lot Number) BUSINESS South Windsor 60 PROPOSED ]._f DOMESTIC D ESTABLISHMENT FARM USE OF 11 TEST WELL PUBLIC AIR WELL SUPPLY INDUSTRIAL CONDITIONING (Specify) DRILLING ' TRY © AIR MPERCUSSSION PERCUSSION (Specify) PRESSED CABLE OTHER E QUIPMENT .F4 CASING LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT T_[111�SH wA5 U+,IWG GROUtED7 DETAILS 2E)s 6is17 s THREADED WELDED NO ®' YES NO YIELD HOURS YIELD(G.P.M.) TEST ❑ BAILED PUMPED ®COMPRESSED AIR 4 20 WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) LEVEL Depth of Completed Well in feet below Land surface: MAKE in R SCREEN LENGTH OPEN'TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM(feet) TO(feet PACKED: grovel pack (inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least FEET TO FEET two permanent landmarks. RedC—lay rl r , -� ,t ux C C If yield was tested at different depths during drilling, list below [��� e6 FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILLER(Signature) R13R590 32a 3 28 9 DEPT. OF ENVIORNMENTAL PROTECTION-WATER RESOURCES