HomeMy WebLinkAboutWell 60 Griffin Road ii!04SLIMER. PROTECTION
WELL DRILLING BOARD STATE OF CONE IECTICUT PERMITNUMBER
GPR-B REV.11-62 - DikFeAMENT OF CONSUMER PROTECTION 138,580
WELL DRILLING PERMIT
165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106
L iON OF WELL(Powit) (Stre,e�t ,t (Lot Number) DATE
u d 6 r i t--t'i '�
R OF WELL �( )C^ �/ � I! ,
NQIV{DUAL BUILDER OTHER(Specify) L6 L(4 0j W. k L 1,e,
OWNER'S ESS � y
�C Cr °'0
EUSINESSS TEST EsI.No.of
PROPOSED DOMESTIC ESTABLISHMENT FARM O WELL People being
USE OF served.
WELL PUBLIC AIR OTHER
SUPPLY INDUSTRIAL CONDITIONING (Specify}
SKETCH OF WELL LOCATION
Locale well with respect to of least two roads,showing distance 6om inlersection and front of lot
Location of lot to at least two roads Well location on lot and to houses (if present)
Incfkole North 4 '
10
,r lI eg
1 Q �fi: TAB f.
"1 � N
3
4 Aa'
Appro>image 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' contolning construction details and informotior•n required under Section
25-131 of the 1969 Supplement to the General Statutes must be sera to the owner, the Board and the Water Resources Commission on the form provided by Ike
This mit is n chid until all o,,,,,,, is filled in and it has been counter-signed by the Direuor of Health or his agent.
�APPLICANT ue) T REGISTRATION No. �—
8Y.(b-wn Health Officer or Agemr) DATE
�APP6TCYED ❑REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
CPR-9 REV. 11_82 DEPARTMENT. OF CONSUMER PROTECTION
WELL DRILLING BOARD
165 CAPITOL AVE.
HARTFORD,CONNECTICUT 06106 OTHER NO.
NAME OWNER ADDRESS
David White P. 0. Box 731 , South Windsor, CT 06074
LOCATION (No. & Street) (Town) (Lot Number) �^
OF WELL Griffin Road South Windsor 60
flPROPOSED DOMESTIC ESTABLISHMENT I FARM TEST WELL
USE OF
WELL PUBLIC AIR OTHER
SUPPLY INDUSTRIAL CONDITIONING (Specify)
DRILLING ` COMPRESSED CABLE OTHER
EQUIPMENT OXWRY ® AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTEDI
DETAILS Z 0 E 6 ti 117, THREADED Ei WELDED CANS Ej NO ®YES �NO
YIELD HOURS YIELD (G.P,M)
TEST C BAILED PUMPED COMPRESSED AIR 4 G 0
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feel) Depth of Completed Well
LEVEL 2.01 in feet below Land surface:
r
MAKE LENGTH OPENWTO AQUIFER (Feet)
SCREEN
DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including 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.
Qm-n
' ' 1
.' e. u
C �q
b
ti
If yield was tested at different depths during drilling, list below T Q/�� e6
FEET GALLONS PER MINUTE (�J
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL DRILL 11 ER(Signature)
DEPT. OF ENVIORNMENTAL PROTECTION-WATER RESOURCES