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WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
WD84 11-69
WELL DRI1 dNG PERMIT 5876
STATE OFFICE BUILDING,ItARTFQRD,CONNECTICUT 06115
LOCATION OF WELL(Town) (Sheet) (Lot Number) DATE
SOUTH WINDSOR BERLE ROAD 22 819J71
OWNER OF WELL
❑INDIVIDUAL ®BUILDER ❑OTHER(Specify) CARLO PRESTI iEO
OWNER'S ADDRESS
69 ASH ROAD, WAPPINGI CONN.
PROPOSED BUSINESS TEST Est.No.of
DOMESTIC
USE OF ❑ ESTABUSHMENT ❑ FARM ❑ WELL People being
served.
WELL PUBLIC❑ 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)
T.
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N /
Indicate North
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w ° A
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Y /''S e�4 D x T.
Approximate number of feet from well to 80
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 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 informo-
tion is filled in and it has been counter-signed by the Director of Health or his agent.-
APPU ( nah+ml APPLICAM'S ADDRESS
REGISTRATION NO..
Gc), T54ST. , VERNONt CONN. 100
�--y B (io fh Officer or Agent) '_ ` DATE
lJ APPROVED El REACTED W • ta 7/
REMARKS i ,
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE of CONNECTICUT
WDB-5 12-69 WELL DRILLING BOARD Do NOT fill in
STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME ADDRESS
.�
OWNER M0 P STILt I ON 6 ASH ROAD01 Wsa.G'P1041G C VIT.
LOCATION (No.-& Street) (Town) (Lot Number)
110
BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM I_J TEST WELL
USE OF
WELL PUBLIC AIR OTHER
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
DRILLING COMPRESSED CABLEER
EQUIPMENT ® ❑ AIR PERCUSSION ElP PERCUSSION (Spe if
ROTARY )
CASING LENGTH(feet) DIAMETER(fnches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS €: 6 10, THREADED ❑WELDED LtJYES '❑NO ❑YES X NO
YIELD HOURS G.P.M. YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR ..
1-1 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: 120
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of well including 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.
-5 Sand & Gravel
15 31 Clay
31 120 Bed-rook
I
y
If yield was tested at different depths during drilling,list below Ld6AL
'FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. 4DATE REPORT WELL D LLL R(Signature)