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HomeMy WebLinkAboutWell New 141 Miller Road UCrAKIMCIVI Vr bVNaWMCK rKVICb11%0" 1 J bZ WELL DRILLING PERMIT J.a! f. 165 CAPITOL AVE., HARTFORD,CONNECTICUT 06106 SOUTH WDWOR 141 Miller Road LOCATION OF WELL(TOWN) (Street) (Lot Number) GATE John Iaanmrice 1.5/10/88 OWNER OF WELL ® INDIVIDUAL D BUILDER OTHER(Specify) OWNER'S ADDRESS_ .486 Prospect Ave.,. Hartford, CT 06105 BUSINESS TEST Est. No.of PROPOSED DOMESTIC ESTABLISHMENT FARM WELL People being USE OF PUBLIC AIR ORserved. WELL SUPPLY INDUSTRIAL CONDITIONING (Spe if ) 4 SKETCH OF WELL LOCATION Locate well with respect to at least two roods, showing distance from intersection and front of lot Location of lot to at least two roads t Well location on lot tt and to house (if present) W1G (04 Irdioote NoMt PHI193: Road - - goo \ f Approximate number of feet from well to nearest source of possible contamination: 200 The undersigned is aware that upon completion of the well, a "Well Completion Report' containing construction details and information required under Section 25131 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 Boa .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. ( irotWrs) APPLICANT'S ADDRESS REGISTRATION NO. 81 IMU Hebron Ave.Glaston CT 060 10 -fee p BY(TOwe`HDh Ojjtcer A t) DATE p. J. APPROVED R REJECTED �j�p�^^ 8 r REMAR..P� KS !Id 60 ti0 .( r tjcAvtvr�& OL . so DIRECTOR OF HEALTH 'CONSUMER PROTECTION _ �•=1Nt DRILLING BOARD STATE OF CONNECTICUT t PERMIT NUMBER CPR-$REV.11-92 DEPARTMENT OF CONSUMER PROTECTION 133032 t WELL DRILLING PERMIT `. 165 CAPITOL AVE., HARTFORQ, CONNECTICUT 06106 L LOCATION OF WELL - (tram) (Lot Number) -aDATEj nav f.. OWNEF-41—W , IV rear R OF WEI .INDIVIDUAL BUILDER []-OTHER(Specify) -- 'OWNER'S ADDRESS CA ►� - .... BUSINESS TEST Est.No.of PROPOSED ❑ DOMESTIC ESTABLISHMENT FARM WELL People being USE served. rIJBUC r ...._ST - ». -....� AIR .a :.:.y OTHER ._�, .• - f SU PLY " INDUSTRIAL -'CONDITIONINGa (SPA.Y).-.-—. SKETCH OF WELL LOCATION " Locate well with r expect to of least two-roods, showing distance from intersection and from of lot Location of lot to of least two roods -- -Well location on lot and to house (if present) - s 7w dP a r� 7s r e1J+ , v t roo1e North _ - - z © .1 tfi � 41eY x,.. '.row-. •.- _ - _- a.'t ,Approximate number of feet from well to nearest source of possible contamination: ;The undersigned is aware -that upon completion gf the well, a "Well Completion Report'_,,,containing construction details and information required under Section ,25.131 of the 1969 Supplement:io the General Statutes fnust.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 oil information is'4illed in and it has been counter-signed by the Director ofHeoith or his agent. AFPIICANi(Si"hire) APPLICANT'S ADDRESS REGISTRATION NO. t - _ B (Tow,,HJW&j fi R`or Agen DATE ' MROVEO L REJECTED - ,?o8' ' REMARKS c..> t tr a�•oP „k .7� tor.: �aGLO ..eat ,L.a,. .•C, DIRECTOR OF HEALTH 1 CONCERN; E & M BERNAT South Wind,lior Sep.28.8� 141 MILLER RD. SOUTH WINDSOR, CONN. 06074 TOWN OF SOUTH WINDSOR 1540 Sullivan Ave. S.WINDSOR, CONN.06074 Att. Mr. DEPTULA I, the undersinghned EDWARD BERNAT, resident of 721 King St. S. Windsor, Conn. 06074,didn't ever give any permission to start well at 141 Miller Rd. S. Windsor, Ct. 06074. I would like to give permission,to drill the well, to DICKS ARTESIAN WELLS. DICK'S ARTESIAN WELL CO., INC. GARAGE&WAREHOUSE-LITCHFIELD ROAD,LITCHFIELD,CONNECTICUT SINCERELLY MAILING ADDRESS: P.O.BOX 895-LITCHFIELD,CONNECTICUT06759 TELEPHONE:(203)567-8090 EDWARD BERNAT ) ov all