HomeMy WebLinkAboutWell New 106 Berle Road 1UDeu--dU Rd
WELL DRILLING BOARD STATk OF Co ECnCUT - PERMIT NUMBER
wD" 11-69 WELL DRILLING PERMIT' ' 6� 3 3
STATE OFFICE BUILDING, ARTFORD,SLONNECTICLIT 06115
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
SOUTH WINDSOR BERLE ROAD 24 5/17/73
OWNER OF WELL
❑INDIVIDUAL K BUILDER ❑ oTHER(specify) CAR ERESTILEO
OWNER'S ADDRESS
69 ASH ROAD, WAPPING,. CONNI,
PROPOSED BUSINESS TEST Est.No.of
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served
WELL ❑ PUBLIC AIR U OTHER
PPLY ❑ 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
' MiL
��RLE Ro
Approximate number of feet from well to 75
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 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.
ign re) APPIK:ANT'S ADDRESS REGISTRATION NO.
RW ST.. . VERNONS CONN. 100
B Officer or A nt) DATE
PPROVED ❑ REJECTED
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV.9-71 / WELL DRILLING'BOARD Do NOT fill in '
/ lY State Office Building STATE WELL NO.
6 HARTFORD, CO'NNECTICUT 06175 _ t
OTHER NO.
NAME ADDRESS
OWNER kt�a f0 PRESLILE0 I 09 r c Rn t tt Nn
LOCATION (Nn; R Street) (Town) (Lot Number)
OF WELL B. mz IgC)A ;30UT . )set s(
PROPOSED NO ElESTABLISHMENT ❑ 24
BUSINESS FARM
❑ TEST WELL
USE OF
WELL PUBLIC AIR❑ THER
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ ((Specify)
DRILLING COMPRESSED CABLE ❑ OTHER
EQUIPMENT ® ROTARY LJ AIR PERCUSSION ❑ PERCUSSION
(Specify)
CASING LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS I I .45 I THREADED ❑ WELDED I YES ❑NO ❑YES NO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED IN COMPRESSED AIR
p
WATER MEASURE FROM LAND:.SURFACE—STATIC (Specify feet) DURING YIELD TEST(feet) I Depth of Completed Well
LEVEL 240 100 in feet below Land surface: 9
MAKE 1
25
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE I DIAMETER (inches) I IF GRAVEL Diameter of well including
I GRAVEL SIZE(inches)FROM(feet) TO(feet)
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFACE
FEET to FORMATION DESCRIPTION
Sketch exact location of well with distances,to at least
FEET
two permanent landmarks.
- Rem...J: €3
F'
f.�a
I t 0 0Ir 6
If yield was tested at different depths during drilling, list below f Z
FEET GALLONS PER MINUTE �r
1;aJc`G.L .
DATE WELL COMPLETED I PERMIT NO. I REGISTRATION NO. I DATE OF REPORT r �yF.LI LLE '(Signatur
KEPT. OF ENV€RONhAENTAL PROTECTION