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HomeMy WebLinkAboutDrain Layers Permit 249 Oakland Road (4) ob, 4 TOWN OF SO&H VI N DSOR DEPARTMENT OF POLLUTION CONTROL gip No.: _ _—C South Windsor, Connecticut List No.: J.},�u 4/s"? DRAIN LAYER'S PERMIT N0 529 MA"k 25 , 19 74 Pursuant to written oa��pplicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below atd" Ookk.7&A-d a{: — Nr0 3txti©lt on the 8QUtw side, between_ liU6tkjAukd & F61t :u. at premises owned whose address is $lift bartferd and to Lay House Drain, Repair House Drain, Lay Main, Other LamerciaRl for occupancy or use, with Family Units, with acres. Type of Sewage to be connected under this permit: SANITARY SEWAGE (x), INDUSTRIAL WASTES ( ), OR ( ) Connection will be made with W1Y1ft1—_1QiAt. pfautl.t.? tillere Permit to be issued to J8*09 ralat,,,r the holder of Drain Layer's License No. W9-2UG451 Permit will expire on HP.Y 75 197. 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 H D Permit No. for street excavation. SPECIAL CONDITIONS r. Signea Connection Charge Paid 03,25..74 Llceesed Drain Layer P4r Ee Maxis Issued by RalPh doe Jr. Tax Collector Permit Fee: Paid $ _ •_"� ,r INSPECTION: Check Number: INITIAL (Sig) FINAL t (Sig) APPROVED r�- ' (Date) (Sig) INSPECTOR TOWN OF SOUTH WINDSOR South Windsor, Conn. 7. . ....... 55 . ....... Date ... .... ................ WELL DRILLER'S PER T I, ... . .. ..................................... of the firm of... ....... .. .....1—16.....Ir . . . .... ................. ..... ...7 . ............ ........................ ................................... (address) ........................................... ................................................................................... hereby:state that I (we) am (are) a well driller duly and currently registered with the State of Connecticut Water Resources Commission and do make application herewith for a Well Driller's Permit in accordance with the provisions of Public Act 187 of the 1963 Session of the Connectie; Legislature, for a well to be drilled on the property of: Name.of Property Owner: .. ............. ... .... .... 2_49 ....... ......... ................ ........................ ................. Address of Property Owner:........... . ............. .... ... ................ ....................................... Address of Premises on which well is located:. .. F . . ..... ...... ............................. ...................... .... �f ......... The approximate location of the well will be as shown on the reverse side of this permit. The undersigned is aware that upon completion of this well the above data,together with a-well log of information required under (c) and (d) of Public Act 187 of the 1963 Session must be sent to: Water Resources Commission, 223 State Office Building,:Hartford, Connecticut on the form entitled"Well Complet' p eengu plied Repo "which has D regisd drillers. iedto tA ..... . ...... .. ............ Applicant This permit is issued for a well located as shown to the above named well driller in accordance with the Provisions of Public Act 187 of the 1963 Session of the Connecticut Legislature this..............7............... y of.......... .......... ............... ------- ............ 196. WHITE— . — —ISSUING AGENT ..................... ....... ...... .. . ........ .. .......... ................... GREEN—APPLICANT in icial or Town Clerk PINK-LOCAL HEALTH OFFICER CT CANARY—WATER RESOURCES COMMISSION (Over) Location of Well: Town of::.....:, w SKETCH SHOWING LOCATION OF PREMISES IN TOWN (Show distance and direction from road intersection or other landmark) J ��S t > _ E Diagram Showing Location of Well on Premises: s ,}fi Drl S3�..:� Z� 6 E _ Route Directions for Reaching Well Site from Nearest City or.Village Center: t „ TOWN OF SOUTII'WINDSOR_' _ South Windsor, Conn. 57 Date 1.0111 .....!`1�C�.......l."..7......�.9�i`�=. WELL DRILLER'S PERMIT ...................... of the firm of ........0 w...................... '.>.......1..N...gr ......../OY7. /�q....n!... .S'Trc�T- ddress) Sd IiC5T....U ' ,eJ .......... .. . ....... .... .. .. .. ......................................... (a ...................... .......:............ hereby stake that I (we)Iam (are) a well driller duly and currently registered with the State of Conn icut Water Resources Commission and do make application herewith for a Well Driller's Permit in accordance with the provisions of Public Act 187 of the 1963 Session of the Connecticut Legislature, for a well to be drilled on the property of: Name of Property Owner:...R.T..A..S....... ...+. cd M ►OQ q, _ . ........................ ................ .. .......... ....................................... Address of Property Owner:....�.4.5T............fT _!' .'ta.�`!d............. d��, /I►► :Address of Premises on which well is located: k...�-4.N j I"`� So. �� A1�,S'a I- ...............................................................................................I.................. The approximate location of the well will be as shown qn the reverse side of this permit. The undersigned is aware that upon completion of this well the above data,together with a well log of information required under (c) and (d) of Public Act 187 of the 1963 Session must be sent to: Water Resources ComWission. 223 State Office Building, Hartford, Connecticut on the form entitled"Well Completio Report”whit as b sup 'ed to registered drillers. ....... ................................ ......... . . .... ................................................................. plicant This permit is issued for a well located as shown to the above named well driller accordance with the Provisions of Ar _ Public Act 187 of the 1963 Session of the Connecticut Legislature,this ........j/.�...............day of.................1. .... ............................. .., 96.4.... WHITE—ISSUING AGENT ••...........:.!:.� ... GREEN—APPLICANT ilding O ialnk PINK—LOCAL HEALTH OFFICER CANARY—WATER RESOURCES COMMISSION (Over) Location of Well: Town of::.Sb.,:,.........,. 7 N S O-. 1— ........... ...............................................................:....:...... SKETCWSHOWING LOCATION OF PREMISES IN TOWN (Show dista"n%and direction from road intersection or other.landmark) \ v 3 � tee �l N .Diagram Showing Location of Well on Premises: QJ. a me well k r J 1a. W- A LOC&T aN Nip o �- 1as O► Route Directions for Reaching Well Site from Nearest City or Village Center: a N �1 S iv s � 79, ']9 2z° NOTES SOUTH WINDSOR POLLUTION CONTROL LOCATION Iy A w s C/ OWNER '- TYPE OF WORK DATE c ` PERMIT c3".Z PIPE lac. INSTALLE INSPECTOR DRAWN BY ,�