HomeMy WebLinkAbout1972-3-17 - 119 Ident Road - Well Drilling ApplicationWill DRllllNG BOARDwon-4 11—69 STATE OF CONNECTICUT
WEll DRllllNG PERMIT
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 061 15JI.
PERMIT NUMBER‘9314
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The undersigned is owote Ihal upon complelion of the well a ‘Well Completion Report containing co nstructlon detalls and Informahon required under Sechon 6 of
Public Act 659 must be sent to the owner,the Board and the Water Resources CommIsSIon on the form prowded by the Board This permit Is not volld until all Informa-
hon Is filled In and It has been counter signed by the Dlrector of Health or his agent
APPucmr (simm)-
cONNECTlCUT VALLEY ARTESIAII WELL m [H
Baum
I32.Schema R ieQ 'éM&/?90v L§
{WDAPPROVE
REMARKS
3/97 2/74
RETURN THIS COPY TO CONNECTICUT WELL DRILL ING BOARD
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ou T H I N 0 5 o R JIEN T-'Ro A n H
IOCATION OF WEI (Town)m t‘R l i k SOWNEROF‘INDIVIDUAL E/wlwaa D
OWNER'S ADDRESS
§5 IuRItI’Pm'a 'Ro,
(Sheet)(lof Number)‘E,‘4ial
DATE
3 '-‘l 9 -)2.
omsmspecify)
bulriwso a L—o¢»($o H r‘/'
PROPOSED
USE OF
WELL
gDOMESTIC
BUSINESS
ESTABLISHMENT D mm TEST
WELL
PUBLIC
SUPPLY D INDUSTRIAL D CONDITIONING
AIR D (SPeC'fY)
OTHER
Est.No.of
People being
served.
”
é
SKETCH OF WELL LOCATION
Locate well with resped Io at least fwo roads,showing distance from inlersedion and from of Iol
Location of Io!to of Ieust two toads Well Iocalicn on Iol and Io house (if preseni}
Indicate NorHI
S‘TR oN (e RD
OU
UK
I oE/I T RO
0i4 D
Approximate numbel of feet from well Io
neaiest source of possible contamination:75-