HomeMy WebLinkAboutWell New 125 Ellington Road CPR-8 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT 191141
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
SOUTH WINDSOR 125 ELLINGTON RD. 12/29/98
OWNER OF WELL
INDIVIDUAL BUILDER OTHER(Specify) 8 7 5—3 8 9 2
OWNER'S ADDRESS
ART BARBER EXCAVATING, INC. P.O. BOX 439, ELLINGTON, CT.
Est.No.of
PROPOSED DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
PUBLIC INDUSTRIAL 1:1AIR I1�1I OTHER
SUPPLY CONDITIONING UU (Specify) ABANDO ED EXISTING
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front o lot
location of lot to at least two roads Well location on to and to house(if present)
d
Indicate North
� `L11Z
C d145
ILI/-
� 0.
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 Department of Consumer Protection and the Water
Resources Commissi on a form provided by the agency. This permit is not valid until all information is filled in and it has been counter-signed by
th i ctor Heaft r '
PLI ANT i natu APPLICANT'S ADDRESS REGISTRATION NO.
P.O. BOX 406, WILLINGTON, CT. 42
BY(Town Health Officer or Agent) DATE
Vo
APPROVED ❑ REJECTED
REMARKS
ABANDON EXISTING DUG WELL ACCORDING TO STATE SPECS.
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION