HomeMy WebLinkAboutWell New 91 Berle Road q1 0
WELL DRILLING BOARD STATEYJF CONNECTICUT PERMIT NUMBER
wDB.a ,,69 WELL DMILING PERMIT 5875
STATE OFFICE BUILDING,HA�jTFORD,CONNECTICUT 06115
t
LOCATION OF WELL(Town) (Skeet)
(!of Number) DATE
SOUTH WINDSOR BERLE ROAD 16
OWNER OF WELL
INDIVIDUAL - 2 BUILDER ❑OTHER(Specify) CARLO PRESTILEO
OWNERVS ADDRESS
69 ASH ROAD WAPPING, CONN.
PROPOSED DOM�TIC BUSINESS TEST Est.No.of
USE OF ❑ ❑ ESTABLISHMENT ❑.FARM ❑ WELL People being
served.
WELL ❑ SUPPLY
UPP Y ❑ INDUSTRIAL ❑ CIONDITIONING ❑ Sp�ea ) 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
v
ILI, ". . ,
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 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.
(Signature) APPLICANT'S ADDRESS
/d LAKE ST. REGISTRATION No.
• , VERNON, CONN. 100
BY(Town"Officer or Agent) DATE
�APPROI/ED ❑ REJECTED O /
REMARKS �/I
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fillWDB-S 12-69 WELL DRILLING BOARD in
• State Ofte Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADpRESS '
OWNER CARLO PRESTILEO 69 ASH ROAD, 14APPING, CONN.
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL BERLE ROAD SOUTH W'INDSOR 16
BUSINESS
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC❑ SUPPLY ❑ INDUSTRIAL ❑ AIR ❑ OTHER
CONDITIONING (Specify)
DRILLING COMPRESSED CABLE R
EQUIPMENT ® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ ((Specify)
CASING LENGTH(lest) DIAMETER(lnches) WEIGHT PER FOOT DRIVE SHOE (W`A CASING GROUTED?
DETAILS 2], 6 �-9 e y 5 ® THREADED ❑WELDED YES ❑NO IJ YES In NO
YIELD HOURS G.P.M. YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED ❑ COMPRESSED AIR �. 15 15
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 20 100 in feet below Land surface: 145
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE p1AMETER(inches) (F GRAVEL Diameter of well including GRAVEL SIZE(Inches) FROM(feet) TO(feet)
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. Sand & Gravel
11 145 Bedrock � >�'
o$D
u�c.L
- �R►VC
w,q y
f�QoX
If yield was tested of different depths during drilling,list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. ' REGISTRATION NO. DATE OF REPORT WELL Lf (S!g tar
8/12/71 5875 ' 1'0 8/16/71d-e .
BOARD
MLL DRILLING BOARD STATE OFJCONNECTICUT PERRMIT.NUUMBER
wDB-a. I1-69 WELL DRILLING PERMIT - 5 875
STATE OFFICE BUILDING,HARTFORD,CONNECTIC�JUT 06115.
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
SOUTH WINDSOR BERLE ROAD 16 8/9/71
OWNER OF WELL
❑INDIVIDUAL Fil BUILDER ❑ OTHER(Specify) CARLO PRESTILEO
OWNER'S ADDRESS
69 ASH ROAD, WAPPING, CONN.
PROPOSED BUSINESS TEST Est.No.of
®DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
PUBLIC AIR
WELL ❑ OTHER
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) 6
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of lot
Location of lot to at least two roads Well location on lot and to house(if present)
Indicate North
t4
x7
k%.
Approximate number of feet from well to `-
nearest source of possible contamination: 80
The undersigned is aware that upon completion of the well,a"Well Completion Report" containing construction details and information required under Section 6 of
Public Act 65$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 inform6-
tion is filleJA and it has been counter-signed by the Director of,Health or his agent.
APPL NT Signature) APPLICANT'S ADDRESS REGISTRATION NO. .
LAKE ST. , VERNON, CONN. 100
❑'LIQ APPROVED REJECTED
BY(Town alt fficer or Agent) - - DATE
(JY 9 1 A.
REMARKS
77,2,41
DIRECTOR OF HEALTH