HomeMy WebLinkAbout1977-6-29 - 119 Farmstead Drive - Well Drilling ApplicationPERMIT NUMBER
w>EI.L uwwNG Boaeu� STATE al:,{pNrI�TICLIT 51015 -
WDe.a 1149 WELL DRILLING PERMIT
STATE OFFICE BUILDING, HARTFORD, CONNECTICUT 06115
DEEPEN MISTING WELL
SOUTH WINDSOR
I1_9_ Fatmstead Dr. I
(5/29177
OWNER OF WELL '
_
® INDIVIDUAL ❑ BUILDER
❑ OTHER (Specify)
WILLIAM STOUT
OWNER'S ADDRESS
3 U DIANE DR.,
S. WINDSOR,
CONN.
_
PROPOSED
® DOMESTIC
❑ BUSINIESS ESTABLLSHIMENf
❑ FARM ❑ VAU
People being
USE OF
served.
WELL
❑ SUPPLY
❑ INDUSTRIAL
AIR OTHER
❑. CONDITIONING ❑ (Specify)
4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads, showing distance from intersection and front of for
Wmi ion of lot to at least two roads I Well location on lot and to house Of present)
6-AAdAAA
'-Rp
r7RI ,` Y
N J S fFE
V,U/_�i (1.9,41
"&' .rTE A D ,DP.
Approximate number of feet from well to
nearest. source of possible contamination: Sanitary Sewers -
The undersigned is aware that upon completion of the well, a "Well Completion Report" containing. construction details and Information required under Section
?5131 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.
19 APPROVED ❑ REJECTED
VERNON CONN. 100
or 1F.wi) DATE
RETURN THIS COPY TO- CONNECTICUT WELL DRILLING BOARD