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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
SOR-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: /1�3
Circle the appropriate service: l� C-r
WELL MDC GT WATER
WELL USE: DOMESTIC LAWN &GARDEN AGRICULTURAL
Well Location :
BACK DRAWING:
40 FT
A FRONT B RECEIVED
30F 14FT
WELL FEB 16[uuy
STREET SOUTH WINDSOR
ENGINEERING DEPT.
CPR-6 Rek•71b5 PERMIT NUMBER
`- � 174706
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
•165 Capitol�,,Apvenue,Hartford,Co ecticut 06106
Sou7f/ W INffo 3 f3�ELZ9:Qu
LOCATION OF WELL (Town) (SbeeU (Lot Numbef) DATE
V iet () N to V., 11--1 O M 1 3 jlrj9,6
OWNER OF WELL
02 INDIVIDUAL BUILDER OTHER(Specify)..6,q Mp C.
OWNER'S ADDRESS
1M -r
Est No.of
PROPOSED DOMESTIC BUSINESS El FARM TEST People being
USE OF ESTABLISHMENT WELL rw�lL WELL served.
,�/
aPUBLIC a INDUSTRIAL a AIR 1 ,X OTHER
SUPPLY CONDITIONING III ���111 (Speafy)
SKETCH OF WELL LOCATION
Locate 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 to and to house(if present)
Indicate North
I
i \ r
t
Z Sd
Approximate number of feet from well to
nearest source of possible contamination:
The undersigned is aware that u on completion of the well, a'Well Completion Report"containing construction details and information required under
Section 25-131 of the 119 Su ement to the General Statutes must be sent to the owner,the Department of Consumer Protection and the Water
Resources Commission on the ed by the agency. This permit is not valid until all information is filled in and it has been counter-signed by
the Director of Health or his age
APPLICANT(Signature) APPLICANTS ADDRESS REGISTRATION NO.
CONNECTICUT VALIEY ART AN WELL CO. INC. . s' aLAMm0ltv A40ARI)
BY(Town Health Officer orA t) , DATE
nLVPROVED ❑ REJECTEDUT k
REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
CPR-9 Rev.7)SS I y _moo.,:==, --- -
___. NOT Jn
STATE OF CONNECTICUT STATE WELL NO.
DEPARTMENT OFCONSUMER PROTECTION NS
REAL ESTATE&PROFESSIONAL TRAt&S DIVI5I� �,V ' OTHER NO.
WELL DRILLING COMPLETION-REPOR7.99 i
16S Capital Avenue,Harttord.Coaaecticut 08108 ♦ `�
OWNER NAMA ADDRESS e;f?�rw U
u� 2' L C I ��W 1.Z so t,v1 MOJ� 1;7
LOCATION (No.3 Street) (Town) (Lot Number)
OF WELL S L
IT TIC ❑ BUSINESS ; FARM TEST
PROPOSED ESTABLISHMENT WELL
USE OF WELL. ❑ PUBLIC ❑ INDUSTRIAL ❑ AIR �ER
SUPPLY CONDITIONING LC ONN7LIy
DRILLING ROTARY COMPRESSED CABLE OTHER
EQUIPMENT ❑ ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (specify)
CASING • LENGTH(feet) DIAMETER(kdm) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS ❑ THREADED❑"WELDED El YES ONO O YES ❑ NO
YIELD TEST ❑BAILED ❑co THREADED
(— COMPRESSEDfUR HOURS YIELD(GPM)
U �
WATER MEASURE FROM LAND SURFACE-STATIC(Specify feet) DURING YIELD TEST(feet) Depth of Completed Well Vest
LEVEL !0 1�
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) IF GRAVEL Diameter of wea GRAVEL SIZE(ir>tme FRW(feet) TO(feet)
PACKED: !dxkm gravel Peck
( )
DEPTH FROM LAND TO SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least two
pennaitent landmarks .
FEET TO FEET
• 1
a
R
L
Vr
GEM
H yield was tested at different depths during drilling,list below
FEET GALLONS PER MINUTE
DA!ErJELL COPPLETED PERMIT NO. / I REQkTRATION NO. _____DA F PORT _ _ __ WELL DRILLER(Signature)
1CUT VALLEY ARTESIAN WELL CO. 1".
AGENCY