HomeMy WebLinkAboutDrain Layers Permit 80 Berle Road w_ TOWN OF SOUTH WI N DSOR .
DEPARTMENT OF POLLUTION CONTROL A
B/P No.:
South Windsor, Connecticut
List:No.. S-6o949
DRAIN LAYE.R'S PERMIT
0 1028
20 January , 19 76
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to-perform
the work indicated below at Berle Road (Lo 6) on the
north side, between Abby Road and Christinp T gn
at premises owned by
whose address is
and to X Lay House Drain, Repair House Drain, Lay Main, Other
for residential
occupancy or use,
with one ('1) Family Units, with acres:
Type of Sewage to be connected under this permit: '
SANITARY SEWAGE (X), INDUSTRIAL WASTESOR ( )
Connection will be made with six-inch (611) T11 anti i!
Permit to be issued to Names D. Aceto
the holder of Drain Layer's License No._ W!2.2657 7 Permit will expire on 19
The undersigned Drain Layer hereby agrees to all the terms and,conditions, set forth,on the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C HD Permit No:'`
for street excavation.
SPECIAL CONDITIONS
Signed /
Connection Charge Paid 01-20-76 Licensed Dta1n Layer
Rec. # 927 Issued by Melvin Edwards, Jr.
Tax Collector
Permit Fee:. Paid $
INSPECTION: Check Number: 1962
INITIAL (gig)
FINAL (Sig)
APPROVED 'lob a ua,vV i9 7!a (Date)
(Sig)
IR"ECTOR
VVCLL%..vMrLtIIVN KtPUKT STATE OF CON14ECTICUT
wDe-s 1269 REV.9-71 WELL DRILLING BOARD Do NOT fill in.
State Office Building STATE WELL NO.
HARTFORD,CONNECTICUT 06115
OTHER NO.
OWNER NAME I ADDRESS
LOCATION (No.&Street) (Town)
OF WELL e c (Lot Number)
BUSINESS
PROPOSED u DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF
WELL PUBLIC AIR❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING OTHER
( pacify)
DRILLING ❑ ROTARY {- ; COMPRESSED ❑ CABLE ❑ OTHER
EQUIPMENT L I AIR PERCUSSION PERCUSSION (Specify)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS ;`.� s I ❑THREADED ❑ WELDED I EJYES ❑NO ❑VES ❑NO
YIELD HOURS YIELD(G P.M.)
TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR
WATER
MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet)�� y Depth of Completed Well
LEVEL t y I in feet below Land surface:
MAKE
LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL i GRAVEL SIZE(inches)FROM(feet) TO(feet)
Diameter of well including
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.
t
s 5
t
t
c
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED 'PERMIT NO. I REGISTRATION NO. I DATE OF REPORT I WELL DRILLER(Signature)
LOCAL DIRECTOR OF HEALTH
WELL DRILLING BOARD.,, STATE OF-CONNECTICUT PEPM17'WUMBERr
w684 11-69 WELL DRILLING PERMIT;-
STATE OFFICE.BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) (Street) (Lot umber) DATE
' OWNER OF WELL
a INDIVIDUAL Q BUILDER a OTHER(Specify)
OWNER'S ADDRESS
PROPOSED DOMES IC BUSINESS ❑ TEST Est No of
ESTABLISHMENT FARM WELL People being
USE OF
PUBLIC served.
WELL AIR UPP Y INDUSTRIAL a CONDITIONING _ ❑ OTHER
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)
' Indicate North
i
714"100 tom"
t
Approximate number of feet from well to
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 prpvided-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{gnatu )'• APPLICANT`S-ADDRESS
.�� I I *•• REGISTRATION NIX
BY( n S h O er or gent) - - DATE
APPROVED REIECTED
EMARK$
DI RECTOR OF HEALTH
. y
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