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<. WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
WD54 'T-69 WELL DRILI" PERMIT 7875
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL(Town) (Street)
_ SOUTH WINDSOR BERLE RD. (Lot5Number)
DA 12/1/71
OWNER OF WELL
❑INDIVIDUAL ® BUILDER ❑ OTHER(Specify) CARIIO PRESTILEO
OWNER'S ADDRESS
69 ASH ROAD, WAPPING, CONN.
PROPOSED ® DOMESTIC ❑ BUSINESS TEST Est.No.of
USE OF ESTABLISHMENT ❑ FARM ❑ WELL Papple being
WELL ElPUBLIC AIR
OTHER -served.
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) 6
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
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ABQ 6/1 D ,fix% �ER �E /�o 4 D
Approximate number of feet-from well to
nearest source of possible contamination: 7 5
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 Act 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:
(Si9 1 APPLICANT'S ADDRESS REGISTRATION IJO.
" LAKF ST. VERNON CONK. 100
BY(Town Officer or Agent) DATE
❑ REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF COVNECTICUT Do HOT fill in
WDB-5 12-69 WELL DRILLING BOARD
State Office Building STATE WELL NO.
HARTFORD,CONNECTI;UT 06115
OTHER NO.
NAME ADDRESS
OWNER 69 ASH ROAD, WAPPING, CONN•
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL BERDE ROAD• - SOUTH WINDSOR 5
BUSINESS
PROPOSED il DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR 11SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER Y)
DRILLING COMPRESSED TR
EQUIPMENT [N ROTARY ElAIR PERCUSSION ❑ P RBLE CUSSION ❑ Spe Efy)
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 21 6 19.45 ® THREADED ❑WELDED ®YES ❑NO ❑YES ®NO
YIELD TEST ❑BAILED ❑ PUMPED � COMPRESSED AIR HOURS 1 G.P.M. 15 YIELD((3.P.M.)
15
WATER MEASURE FROM LAND SURFACE—STATIC(Specify to DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 7 68 in feet below Land surface: ?5
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 11 Sandy Topsoil
11 75 Reddish Rock
/7/Uv.1��
If yield was tested at different depths during drilling,list below 3f1�\ Z�FT
FEET GALLONS PER MINUTE
GJEt.L..
c li 4 E o,
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL LE (Signs re
12/8/71 7875 100 12/13/71 '
BOARD