HomeMy WebLinkAboutWell New 106106 Berle Road WELL DRILLING BOARD 1(XD &� RdSTATE OF COhNECTICUT PERMIT NUMBER
wo81I 11-69 WELL DRILLING SSP,ERMIT' 16 4 3 3
STATE OFFICE BUILDING,*ARTFORD,LONNECTICUT 06115
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
SOUTH WINDSOR BERLE ROAD 24 5/17/73
OWNER OF WELL
❑INDIVIDUAL ®BUILDER ❑ OTHER(Specify)
OWNER'S ADDRESS 1':AR1't7FSTIItEO
69 ASH ROAD, WAPPING,. CONNI,
PROPOSED BUSINESS TEST Est.No.of
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
WELL ❑ PUBLIC AIR UY OTHER
PP ❑ INDUSTRIAL ❑ CONDITIONING ❑ (specify) 5
SKETCH OF WELL LOCATION
Locate welt 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
X use-
/
MIL
�cRLE Ro
a t
wt�
FxT.
41,
Approximate number of feet from well to
nearest source of possible contamination: 75
The undersigned is aware that upon completion of the well,a"Well Completion Report"containing construction details and information required under Section 25-131
of the 1969 Supplement to the General Statutes 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 information is filled in and it has been counter-signed by the•Director of Health or his agent.
APPLICANT'S ADDRESS REGISTRATION NO.
ST.. . VERNON, CONN. 100
� � B Officer w A nf) DATE
J T PPROVED El MEOW
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING'BOARD-
WELL COMPLETION REPORT STATE OF.CONNECTICUT
WDB-5 12-69 REV.9-71 �4-16
WELL DRILLING" BOARD Do NOT fill in
State Office Building STATE WELL NO:
HARTFORD,CONNECTICUT 06115 r/-
s W
OTHER NO.
NAME ADDRESS
OWNER _ 0 PPWISTIU0 I. 69 ASH ROAD �JWPPIINT 0 1-N.
LOCATION (Nn, P. Street) (Town) (Lot Number)
OF WELL . UI- F, s:.i.2.: SOUTH WLNDSOR 2
BUSINESS
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL ❑ THER
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)AIR (
DRILLING ❑ COMPRESSED CABLE ❑ OTHER
EQUIPMENT ROTARY AIR PERCUSSION ❑ PERCUSSION (Specify)
CAS LENGTH(feet) ( DIAMETER (inches)I WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
ING
DETAILS s.4 I THREADED ❑ WELDEDI YES ❑NO DYES ANO
YIELD
HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR 4
MEASURE FROM LAND SURFACE—STATIC(Specify feet) !/
WATER I DURING YIELD TEST(feet) I Depth of Completed Well
LEVEL 2.0 100 in feet below Land surface: ��
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) I
IF GRAVEL Diameter of wellI including I 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.
i5 Gravel
15 - Reddish Nock _ fz
Y -
6"s
3
r
;y. to
a
17�0 L)'r 6
If yield was tested at different depths during drilling, list below f
FEET GALLONS PER MINUTE
DATE WELL COMPLETED I PERMIT NO. I REGISTRATION NO. I DATE OF REPORT j�_ZL-L-,-M LL '(Signafur
DEPT. OF ENVIRONAAENT L PROTECTION