HomeMy WebLinkAbout1981-12-28 - 240 Deming Street - Well Drilling PermitCONSUMER PROTECTION ,,_ ~.. 'ti l y y
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VNELL DRILLING BOARD STATE N OF CON� ICUT PERMIT NUMBER
CPR4 REV. Ban . . . DEPARTMENT OF CONSUMER PROTECTION 68123
WELL DRILLING PERMIT
20 GRAND STREET, HARTFORD, CONNECTICUT 06106
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LOCATION Of WELL (lbw") (Sneer) (Lon Number) DATE
SOUTH i-r INDSOR DII IIPTG 1ST. 12/28/91
OWNER OF WELL
INDIVIDUAL BUILDER ® OTHER (Specify) IREW CALVARY CIUIRCH _dHA. EL
OWNER'S ADDRESS
DEI-1T -,G ST. , S. WIMSOR, CT.
PROPOSED BUSINESS TEST Est. No. of
11 DOMESTIC ❑ ESTABUSHMENT FARM WELL People being
USE OF served.
PUBLIC AIR
WELL . SUPPLY INDUSTRIAL ❑ CONDITIONING ❑ ((Specify)
SKETCH OF WELL LOCATION
^ Locale well with respect to at least two roads, showing distance from intersection and front of lot : 7fit
Location of lot to at least two roads
Well focalion•on lot and to house (if pr senlj
1. 161
D.
Indicate North /Q
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x faw d
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Approximate number of feet from well to f
75
nearest source of pomihle contamination:
The undersigned is aware that upon completion of the well, a "Well Completion. Report" containing construction details and information required under Section
25-13) 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.
S+guaru ) APPLICANT'S ADDRESS REGISTRATION INO.
P.O. BOX 1117 S. WILLINGTON, CT. 100
APPROVED REJECTED
BY (Town Health Of Her or Agent)
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DATE
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REMARKS
•SCA NNPD
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RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD