HomeMy WebLinkAbout1971-5-25 - 21 Berle Road - Well Drilling ApplicationWELL DRILLING BOARD STATfRJF CONNECTICUT PERMIT NUMBER
WDBA 11�9 WELL DRILLING PERMIT 4533
STATE OFFICE BUILDING, HARPORD, CONNECrICUT 06115
LOCATION OF WELL (Tuw) (Srr"I) (Lot Number
SOUTH WINDSOR BERLE RD. 7
OWNER OF WELL
❑ INDIVIDUAL ® BUILDER ❑ OTHER (Specify) CARLO PRESTILEO
OWNER'S ADDRESS
69 ASH ROAD, 19APPINGt CORN.
PROPOSED BUSINESS TEST Est. No. of
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ WELL People being
USE OF served.
WELL ❑ BILIC AIR OTHER
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING El (specify)
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
4im y Ra,g/- ExT.
Well location on lot and to house (if present)
/ E 11,70 09- D
Approximate number of feet From well to A "
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 Ad 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.
APP y-d—) APPLICANT'S ADDRESS REGISTRATION NO.
- Wt LAKE ST..
BY rra Ilh Officer or Agent) _ DATE
® APPROVED ❑ • REJECTED �. `.
REMARKS
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
WDB-4 11-69 WELL DRILLING PERMIT 4533
STATE OFFICE BUILDING, HARTFORD, CONNECTICUT 06115
LOCATION OF WELL (Town)
(Street)
(Lot Number) DATE
SOUTH
WINDSOR
BhRLE
RD. 7 5/25/71
OWNER OF WELL
❑ INDIVIDUAL
lie BUILDER
❑ OTHER (Specify)
CiARLO PRESTILEO
OWNER'S ADDRESS
69
ASH ROAD,
WAPPING, CONN.
PROPOSED
g ❑ DOMESTIC
BUSINESS
ESTABLISHMENT
TEST Est. No. of
❑ FARM ❑ WELL People being
USE OF
served.
WELL
PUBLIC
❑ SUPPLY
❑ INDUSTRIAL
AIR OTHER
❑ CONDITIONING ❑ (Specify)
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 lir pcos� w)
Approximate number of feet from well to
nearest source of possible contamination: 80 i i -
The undersigned is aware that upon completion of the well, a "Well Completion Report" containing construction details and informotioir 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.
APrN! fpnatu j 0.APPLICANT'S ADDRESS
❑ APPROVED
REMARKS
❑ REJECTED
Offirer or
dlelz [a]
DIRECTOR OF HEALTH