HomeMy WebLinkAboutWell New 118 Berle Road WELL DRILLING BOARD STATE OF CgNNECTICUT _ PERMIT NUMBER
wDs-a. 1-69 WELL DRILLA PERMIT 12601
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL(Town) (Sf i) (loot Number) DATE
SOUTH WINDSOR �3�!y Lo 1 c� 9/19/72
OWNER OF WELL
❑INDIVIDUAL Ga BUILDER• •❑ OTHER(specify) CARLO 'PRESTILEO
OWN6YS ADDRESS
69 ASH ROAD I WAPP.ING CONN.
PROPOSED BUSINESS TEST Est.No.of
USE OF ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ yyEil People being
served.
WELL PUBLIC❑ SUPPLY . ❑ INDUSTRIAL ❑ AIR
ICONDMONING ❑ (Specify)
SKETCH Of WELL LOCATION
Locate well with respect to at least two toads,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)
r l^
Indicate North
,� •e D
�4/l
Approximate number of feet from well to
nearest source of possible contamination:
The undersigned is aware that upon comp) 'on of the we11,a"Well Completion Report"containing construction details and information required under.Section 25-131
of the 1969 Supplement to the Generot f lutes 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 i led in and it has been counter-signed by the Director of Health or his agent.
. �nalu APPLICANT'S ADDRESS - REGISTRATION NO. -
BY.(Town Ne Officer or nt) DATE •
APPROVED REJECTS - •
REMARKS r
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in
WDB-5 12-69 REV. 9-71 WELL DRILLING BOARD
State Office Building
STATE WELL NO.
HARTFORD, CONNECTICUT 06115 S C f 7
OTHER NO,
NAME ADDRESS
OWNER CEO PI'S Et I6 A THE ROAD, W-APPING, 0014T .
LOCATION (No. &Street) (Town) (Lot Number)
OF WELL :4& PIOA 0 VI, WINDSOR
PROPOSED DOMESTIC ❑ BUSINESS
ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR ElSUPP Y_ ❑ INDUSTRIAL ❑ CONDITIONING ❑ (STHER
pecify)
DRILLING ❑ COMPRESSED CABLE OTHER
EQUIPMENT ROTARY AIR PERCUSSION ❑ PERCUSSION ❑
(Specify)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS I I THREADED ❑ WELDED I YES ❑NO ❑YES a NO
HOURS YIELD(G.P.M.)
YIELD BAILED ❑ PUMPED COMPRESSED AIR TEST ❑ I �, E�
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) d
WATER ( I Depth of Completed Well
LEVEL 0 110 in feet below Land surface: 125
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER(inches) I IF GRAVEL I Diameter of Well including I GRAVEL SIZE(inches)(FROM(feet) ITO(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.
20 Sand.& Graval
20 30 Hard
'c ZW .
O U'l
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED I PERMIT NO. I REGISTRATION NO. DATE OF REPORT WELL R L (Signs re) -
�. rl € 1 I912SZ22
DEPT. OF ENVIRONMENTAL PROTECTION