HomeMy WebLinkAbout1984-11-9 - 235 Buckland Road - Well Drilling PermitCONSUMER PROTECTION ], Irlrd klc1
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-8 REV. 11-82 DEPARTMENT OF CONSUMER PROTECTION 91034
WELL DRILLING PERMIT .
165 CAPITOL AVE.; HARTFORD, CONNECTICUT 06106
LOCATION OF WELL (Town)
(Speer)
(Lot N.Mber)
DATE
S. WINDSOR
BUCSLAXID RD.
��/7/Qrr
84
OWNER OF WELL
❑ INDIVIDUAL �^ ® BUILDER
El
OTHER (Specify)" QUATTROPAIII
& CONEY
569-2410
OWNER'S ADDRESS
57 RIDGEWOOD RD., E. HARTFORD 9 CT. 06118
CWof
re I�cxx>:r
PROPOSED
® DOMESTIC
BUSINESS
ESTABLISHMENT FARM
TEST
WELL
Est. No. of
People be ng
USE OF
served.
WELL
PUBLIC
AIR
INDUSTRIAL
OTHER
SUPPLY
CONDITIONING
(Specify)
4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads, showing distance from intersection and front of lot
Qr1 L�� lq /ate
nearest source of possible contamination: _ 901
The -undersigned -is aware that upon completion of the well, a "Well -Completion Report" containin@ 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 provided 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.
A;rT r APPLICANT'S ADDRESS REGISTRATION —No.
P BO 111 • S. WILLIkiGMi CT. 100
y o ffl cd it Officeyar Agenr) DATE
APPROVED REJECTED
rREMARKS IL
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD