Loading...
HomeMy WebLinkAboutWell New 00 Smith Street (2) WELL QRILLMIG BOARS STATE OF CONNECTICUT PERMIT NUMBER � •WD6-ir, _69, ,rZ WELL DRILLING PERMIT 8799 STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115 :S .LOCATION OF WELL wn) /. . et) (Lot Number) DA OWNER OF WELL +/ or d7K., 1-401 INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify) OWNER'S ADDRE S o - PROPOSED MESTI ❑ BUSINESS TEST Est.No.of DO USE OF ESTABLISHMENT ❑ FARM ❑ WELL People being WELL ❑ PUBLIC AIR OTHER served. SUPPLY ❑ INDUSTRIAL 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(if present) Indicate North IT W� 1-R- f3W R N FtNA Approximate number of feet from well to nearest source of possible contamination The undersigned is aware that upon completion of the well,.a"W I ompletio ep rt containing construction details and information required.under Section 6 c:Public Act 659 must be sent to the owner,the Board and the Water Resources am ssion on the form provided by the Board. his permit is not valid until all informa- tio is ille I as be ounter-si by the Director of r is ent. A i ature) APPLIC 'S ADDRESS REGISTRATION NO. a BY o n Hea,W Offiic Age ) DATE APPROVED ❑ REJECTED ©`//v j?' / REMARKS Y DIRECTOR OF HEALTH o re 2 '2P'rnard L -I kehart Dear Mr, 'Lc11�eh4rt On . 'are!, k. 6erf0rmed a ��=rcclation = - t Es t on your prop yrt'y I th StrP-I t in: Tne Town _ �f c uth Wlr{ Jcr+COn�2�.c#-lout, '£.hc° 3 r '.ion- of f:he ' yen. artea# t ? mciis sh P. = hysica.I1y th sci�3 is as follo., ?fir n_ Ia 1 -and The ,seepage, rate ess than ot7e te fact? 'and 19'i31 requi Ire-a.. i.: Um I each in IF area, -,f 375 Square feet "fora house Lontainlr:t threA ° ,fWc;_: roams or .lryss.A?:ot?:gr i tiG.lare Feet Ot 1e�;�'f^{M�. area. must be prov.. p- �` �_fl 'P SAA, Iy A �C�O 4 V � f - F