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y� • �� 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
Sox,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 Pleas - -- --_-
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:
WELD MDC CT WATER
WELL USE: J D M T CIT t LAWN & GARDEN AGRICULTURAL
Well Location :
BACK ' DRAWING:
A 40 FT ��� �\y J�
FRONT ��p ' ovC`6
30 F 14 FT 70
WELL
STREET
Fro C
State of Connecticut WELL COMPLETION REPORT DO NOT FILL IN
WATER RESOURCES COMMISSION This report must be completed and submitted
223 State Office Building to State Water Resources Commission no later State Well No.--SL"'.
Hartford, Connecticut than 30 days after completion of well.
Other No.
WELL `
OWNER _ �`E r t71 ttl le
t�
WELL str
ee
t Add res City and Town
DRILLER 4Ce "1"
(t;=
street Address pity and Town
PROPOSED USE OR USES _(Check):
Domestic ❑ Farm Business
❑ Irrigation ❑ Establishment ❑ Municipal p ❑ Industrial Test Well
CASING DETAILS YIELD TEST WATER LEVEL
SCREEN DETAILS
n Bailed (measure from and su ace)
Length: .20 Feet or �-S _Hours Static: -?(2)
❑ Pumped Feet Make:
Diameter: (2 Inches or 31 During Yield
Compressed Air' dpf G.P.M. Test: Feet Length Ft. Slot
Kind:
DRILLING E661PMENT
S��C',�
ize
Yield: 2/" G.P M ❑ Cable Tool ❑ Other (Specify) Diameter: In.
0 Rotary
TOTAL DEPTH OF WELL- Cj0_—FEeT
WELL LOG
Depth From Give description of formations penetrated, such as: peat, sift sand y, hardpan,
Ground Surface granite, etc. Include size of gravel (diameter) and sand (fine,medium, c arse), color of material st structure
(loose, packed,cemented,soft,hard). For example:0 ft.to 27 ft.fine
�granite. ,packed,yellow sand;27 ft.to 134 ft. gray
FT.to F l. tt c . (3,t�UL.1
FT.to'76CFT• v(4�t 11 c I e
FT.to FT.
FT.to FT.
FT.to FT.
FT. to FT.
FT.to FT.
FT.to FT. —t
YIELD TEST DATA IN G.P.M.
If Yield Was Tested At 6ifferent Depths During Drilling,List Belo W !
E Q E X\1.(:7
..FT. G.P.M.
FT. G.P.M.
FT. G.P.M. l ...........
FILE
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_ FT G.P.M.
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Date Wei Was Completed: � � �, t Date of Report
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Town Permit Number:.-
Well Driller
(Sig at
Certificate No.
LOCATION OF WELL: TOWN OF F' (�i1I nd! 01-
SKETCH SHOWING LOCATION OF PREMISES IN TOWN:
(Show distance and direction from road intersection or other landmark.)
0
' INDICATE NORTH
DIAGRAM SHOWING LOCATION OF�WELL ON PREMISES:
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ROUTE DIRECTIONS FOR REACHING WELL SITE FROM NEAREST CITY OR VILLAGE CENTER:
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