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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
�OSox-co TELEPHONE (860) 644-2511
Dear Homeowner:
The Town of South Windsor Health Department's goal is to keep you informed about the
status of water quality throughout the town whether you are served by and individual well
or by a public water source.
In an attempt to better serve you, we have reviewed our files to ensure we have the
most recent and accurate information possible. Our review has revealed that we do not
have any information regarding how your residence receives its water.
We are hopeful that you will take a moment to help us keep our records current. Please
indicate the type of water service by circling the appropriate entry below and return this
letter no later than in February 27, 2009, in the self addressed stamped envelope
provided.
If you receive your water from a private well, please let us know the location as it relates
to your home by providing two measurements from the foundation to the well in the
space provided and let us know if the well is used for domestic, lawn and garden, or
agricultural use. See example below.
Thank you in advance for your cooperation.
Any questions can be addressed to the South Windsor Environmental Health Officer,
Robert De Vito at 860-644-2511, extension 248.
Water service:
Circle the appropriate service:
WELL MDC T WATER
WELL USE: DOMESTIC LAWN & GARDEN AGRICULTURAL
Well Location :
BACK DRAWING: td 'L V,
SOUTH
ENGINEERING DES'
40 FT
A FRONT B
30F 14FT
WELL
1/
STREET
CONSUME
WELL DRIL D STATE OF CONNECTICUT PERMIT NUMBER --
CPR-BREV.11-e2 DEPARTMENT-'OF CONSUMER PROTECTION- .
j; gg4� WELL DRILLING PERMIT 160888
OCCUPAT10NAl
LICENSINC7 DI�qSlOrI 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106
Dept.of Consumer Protedorl
LOCATION OF WELL (Tomes) (Street) (Lot Number) DATE
Smith- Windsnr 89 Beelzebub Road 12/1/93
OWNER OF WELL
INDIVIOUAt WILDER Q OTHER(Specify) ' F i r s t F e d e r a l-Sibley Tower
OWNER'S ADDRESS
PROPOSED IUSINESS TEST Est. No.of
DOMESTIC ESTABLISHMENT FARM WELL People being
USE OF
served.
WELL ►UBLIC AIR OTHER "
SUPPLY INDUSTRIAL CONDITIONING FRI (Specify) Abandonment
SKETCH OF WELL LOCATION
'Locale well with respect to at least two roads,showing distance from intersection and front of lot
• location of lot to at least two roads Well location on lot and to house (if present)
- Indioote North ,. '. .
0.
Weil
Approximate number-of feet from well to
nearest source of possible contamination.
The undersigned is aware Ihat upon completion of the well, a "Well Completion Riport•' containing 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.
APPLIGWT(S1 ter J - APPLICANT REGISTRATION NO.
By(Towr Health Offtter or Agee DATE
E 4A
VED REJECTED
REN14KS
f 13 2 Y "
.RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
CONSUME,.
WELL DRIL D '" STATE OF CONNECTICUT PERMIT NUMBER
CPR-9 REV.TI-B2 04 DEPARPRENT F CONSUMER PROTECTION c O O p p
5 199 ` WELL DRILLING'PERMIT 6 . O v 8
- ' QCCUPAT10N1�-L10�'�iNG DIVISION' 165 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 '
Dept.ofi Consumer Protectiari
LOCATION OF WELL(Town) (Street) (Lot Number) DATE
Sadth- Wind r 89 Beelzebub Road 12/1/93
OWNER OF WELL
INDIVIDUAL BUILDER a OTHER(Specify) First Federal-Sibley Tower
OWNER'S ADDRESS
11 BUSINESS TEST Est. No.of
PROPOSED DOMESTIC 11 ESTABLISHMENT FARM WELL People being
USE OF served.
WELL PUBLIC AIR OTHER
11 SUPPLY INDUSTRIAL CONDITIONING (Specify) Abandonment
SKETCH OF WELL LOCATION
'Locate well with respect to of least two roads,showing distance from intersection and front of lot
Location of lot to at least two roods Well location an lot and to house (if present)
Indioole Nash
0.
Well
Approximate number.of feet from well to
nearest source of possible cantommation.
The uncle signed is aware that upon completion of the well, a "Well Completion Report"-containing construction details and information required under Section
25191 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.
APPIICYWi(Si to 1 APPLICANT REGISTRATION NO.
to
BY(Town Health Officer'or AStwo DATE
-VIED REJECTED -
z-6 43
RE S
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
L . G
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- - SO A - N� 1 T
TATE OF CO, ECT CU
o,G DEPARTMENT OF HEALTH SERVICES
Nw.
v
ppePt 4�06� well -Abandonment, Verification of work Completed
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Procedures followed:' All procedures used to abandon a well shall follow
regu atlons established under Section 25-128-56 and 25-128-57 of the
State of Connecticut Well Drilling Board (see attachment). These regu-
lations require that a registered well drilling contractor perform the
work.
well information
Town: South Windsor
Name of Owner: First Federal--ATTN: Pat Robinson
Address: 25 Franklin Street, Rochester. , NY 14604
Location of well (if different from above): .89 Beelzebub Road
Type of well (drilled, point, dug, etc): Drilled
Depth of well: 140'
Diameter of well: 611
Length of casing:� 201
Work details and other information
Name of registered well driller performing work: Sima Drilling Company Inc.
Registered well driller's license #: 126
Materials used: amount of sand 900 #'s # 1 Morie Sand
amount and type of grout 650 #I s of Holeplun
'Description of work completed: The well was layered with sand and
Bentonite to 20' from the surface and then oortland cement was
—put into the toe of the casinos
Date work completed: Nove er. 30 1993
:..-.. . signed: a, ! -- :.(.well driller) .
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