HomeMy WebLinkAboutWell New 71 Berle Road ' ...1 I... ..&-1-h Rd
WELL DRKUNG BOARD STATE OCCONNECTICUT. PERMIT NUMBER
WD" T T-69 WELL DRILLING PERMIT
STATE OFFICE BUILDING,HARTF.OBD,CONNECTICUT 06115 8414
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LOCATION OF WELL(Town) (Street) (lot Number) DATE
SOUTH WINDSOR BERLE ROAD 15 I 1/28/72
OWNER OF WELL
®INDIVIDUAL ❑BUILDER ❑ OTHER(Specify) GEORGE MELLEN
OWNER'S ADDRESS
107 BURNSIDE AVE. E. HARTFORD CONN.
PROPOSED ® DOM�TIC BUSINESS TEST Est.No.of
USE OF ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
served.
WELL PUBLIC AIR
❑ SUOTHER
PPLY ❑ 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 lot and to house(if present)
Indicate North
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tiff.
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/9 8 A9 P 'Wo.9 D 4x77- C a 09 6Approximate number of feet from well to ?5
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 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.
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APPUCANT'S ADDRESS REGISTRATION NO.
LAKE ST.., VERNON, CONN. 100
�/'� BY(Tow Nh Officer or Agent) DATE
APPROViD ❑ REJECTED
i
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
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WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12.69 WELL DRILLING.. BOARD Do NOT fill in
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
OWNER -E RGGEE A 11 1 URNSI }E k 'E. $ E. H RTFOORDj CCUIT.
LOCATION (No. &Street) (Town) (Lot Numhcr)
OF WELL sF E SOUTTH WIN-DOSO
BUSINESS
PROPOSED
LN DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR❑ SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING OTHER
I
DLLING COMPRESSED CABLEEQUIPMENT ® ROTARY ElA R PERCUSSION ❑ PERCUSSION (S(Specify)
e if I
CASING LENGTH(feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 0 19,451 THREADED ❑WELDED [;YES ❑NO [:]YES �NO
YIELD HOURS G.P.M. YIELD(G.P.M.)
TEST ❑BAILED ❑ PUMPED ® COMPRESSED AIR 101
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 2 1 in feet below Land surface: i6o
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER:(1nch:es:) j:GRAVEL
Diameter of well including GRAV SIZE(inches) FROM(feet) TO(feet)
CKED: 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 1 Sand,7 Topsoil
15 166 Reddish Rock
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d
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If yield was tested at different depths during drilling,list below 7�s
FEET GALLONS PER MINUTE
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DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL QR1�ER igna re) t