HomeMy WebLinkAbout1977-8-4 - 160 Chapel Road - Well Drilling PermitWELL DRIWNG BOARD
WDB4 11-69
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WELL DRILLING PERMIT
STATE OFFICE BUILDING, HARTFORD, C.ONNECTICUT 06115
PERMIT NUMBER
51888-
LOCATION OF WEXt (Town)
(Sere et) J _
(Lot Number) DATE
SOUTH WINDSOR
ROAD
8/4/77
OWNER OF WELL
_CHAPEL
9 INDIVIDUAL 0 BUILDER
F] oTm (specify) - EUSEBIO
SILVA CORDEIRO
UWNEWS ADDRESS
111 HENRY
ST., HkRTFORD, CONK.
PROPOSED
® DOMESTIC
BUSINESS
❑ ESTABL€SHMENT ❑ FAIL
TEST
❑ WELL
Est. No. of
People being
USE OF
served,
WELL PUBLIC
El UPP Y
AUt
❑ INDUSTMIL ❑ CONDITIONING
El OTM
(Specify)
4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads, showing distance from intersection and front of tot
_
Location of lot to at
least two roads
I Well location on lot and to house (if present)
17_•V I
root
Indicate North
Approximate number of feet from well to
nearest source of possible contamination: 1001
The undersigned is aware that upon completion of the well, a 'Well _Co mplation Report" containing consttuction details and lnforrnaNan 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.
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD