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WELL DRILLING BOARD STATE OF CONNECTICUT
PERMIT NUMBER
. .
" 11-6' WELL DRILLING PERMIT 4534
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL(Town) (Street) (Lot Numi6er) DATE
SOUTH WINDSOR' BERLE RD. 6 5/25/71
OWNER OF WELL
❑MMMAi. - ®Bumm ❑ OTHER(Specify) CARLO PRESTILEO
OWNER'S ADDRESS
q ASH ROAD, PING CONN
PROPOSED ® ❑ BUSINESS TEST Est.No.of
DOMESTIC USE OF ESTABLISHMENT ❑ FARM ❑ WELL People being
served.
WELL ❑ SUHER PPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ S PUBLIC AIR TPecify) 5
SKETCH OF WELL LOCATION
locate well with respect to at least two roads,showing distance from intersection and front of lot
Location 6f lot to at least two roads- Well location on lot and to-house(if present)
0 X `
Indicate North
a
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E�iQ% E N 0 r9 D
9y �0�.0 CxT, -
Approximate number of feet from well to
nearest source of possible contamination: 80
The undersigned is aware that upon completion of the well,a"Well Completion Report"containing construction details and information required under Section 6 of
Public Ad 659 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 informa-
tion is filled in and it has been counter-signed by the Director of Health or his agent.-
AFPU ( 'gnaturo APPLICANT'S ADDRESS REGISTRATION NO.
ST. , VERNON, CONN. 100
BY(To Officer or Agent) DATE
ED L�APPROV 0 REACTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF coNNECTH:uT
WDB-5 12-69 WELL DRILLING BOARD Do NOT All in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER CARLO a T=LEO 69 ASH ROAD WAPPING CONN.
LOCATION (No. a Street) (Town) (Lot Number)
OF WELL BERLE ROAD SOUTH' WINDSOR 6
BUSINESS
PROPOSED ® DOMESTIC ❑ E TABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR• ❑ UPPLY ❑ 1 NDUSTRIAL ❑ CONDITIONING ❑ (specify)
)
DRILLING ® ('� COMPRESSED CABLE OTHER
EQUIPMENT ROTARY LJ AIR PERCUSSION El ❑ (Specify)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WASCASING GGRyRRO�OU ED?
DETAILS 22 6 i9,4'5 ® THREADED El WELDED ®YES El NO ❑YES LINO •
YIELD
TEST El BAILED El PUMPED Ei COMPRESSED AIR HOURS 1 G.P.M. YIELD(G.P.M.)
91
WATER MEASURE FROM LAND SURFACE—STATIC(Specifyfeet) DURING YIELD TEST(test) Depth of Completed Well
LEVEL 15 100 in feet below Land surface: 120
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(Inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(lest)
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE Sketch exact location of well with distances,to at least
FEET to FEET FORMATION DESCRIPTION two permanent landmarks.
0 12 SA$DY TOPSOIL
12 120 REDDISH GRANITE
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 LL R(Sign fur
6 2 1 4 100 6 1
BOARD