HomeMy WebLinkAboutWell New 63 Foster Street WELL DRILLING BOARD STATE oA:ONNECTICUT PEST NUMBER
1NDB4 11-6' WELL DRILLING,_PERMIT
� .
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 0611 S 1 � �17
LOCK (Street) (Lot Number) DATE'.
1�vI Aild 17 72-
OWNER OT WrLL
®INDIVIDUAL ❑BUILDER ❑ OTHER(Sp.'fy)
OWNER'S ADDRE
PROPOSED BUSINESS TEST Est.No.of
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑WELL People being
USE OF served
WELL El LIC UPPP Y ❑ INDUSTRIAL ❑ CONDITIONING SAllit
PU p HER
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 lot and to house(if present) '
Indicate North
Approximate number of feet from well to r-
nearest source of possible contamination:- � -
The undersigned is aware that upon co 1 "on of the well,a"Well Completion Report"containing construction details an information required under Section 25.131
of the 1969 Supplement to the Gener atutes must be sent to the owner,the.8oard and the W r Resources Com scion on the form provided by the Board.This
permit is not valid until oil information Pilled in ondjt has been counter•sig y t e Director f or his a t.
APPEICA Si ) APPUCA REGISTRAATIIO,NN NO.
BY(Town Health Officer or Agent) DATE
PAPPROVED ' REJECTED .i , --
REMARKS
RETURN THIS COPY TO CONNEMM WM DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 12-69 REV. 9-71 WELL DRILLING BOARD DO NOT fill in
State Office Building STATE WELL NO,
HARTFORD, CONNECTICUT 06115 �
OTHER NO.
NAME ADDRESS
OWNER ` -{-p_IAN ^� _ t
LOCATION (No, R Street) (Town)
OF WELL 63 O.E: T-B T a -BUSINESS
fLu# Number}
PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM
❑ TEST WELL
USE OF
WELL 3UBLIC AIR ElSUPP Y ElINDUSTRIAL ❑ CONDITIONING ❑- ((Specify)
DRILLING COMPRESSED CABLE El (Specify)
❑
EQUIPMENT ROTARY AIR PERCUSSION ❑ PERCUSSION
(Specify)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE I WAS CASING GROUTED?
DETAILS - - 1 04 I - ❑YES �NO
THREADED ❑ WELDED AYES ONO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED ❑ PUMPED 7 COMPRESSED AIR
WAFER MEASURE FROM LAND SURFACE—STATIC(Specify feet)- DURING YIELD TEST(feet) Depth of Completed Well
LEVEL 20 100 - in feet below Land surface: 150,
MAKE LENGTH OPEN TO AQUIFER(feet)
SCREEN -
DETAILS SLOT SIZE I
DIAMETER(inches) I
IF GRAVEL Diameter of- well including -GRAVEL SIZE(inches) FROM(feet) TO(feet)
PACKED: gravel pack(inches):
DEPTH FROM SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEETT to to FEET two permanent landmarks.
1 150 Red Rock
0)tt, 2—¢'
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
f
DATE WELL COMPLETED -I PERMIT NO. I REGISTRATION NO. DATE OF REPORT WE[4.DXV/
DEPT. OF ENVIRO M EENT L PROTECTION
,`OWN seq
OD T-0� ap siou�
C r U
1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
r�OSOR-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 CT WATER
WELL USE: DOMESTIC LAWN & GARDEN AGRICULTURAL
Well Location :
BACK DRAWING: RECEIVED
40 FT
FEb .l .I ?nr'D
A FRO B
SOUTH WINDSUR
30 F 14 FT ENGINEERING DEPT.
FRONT
WELL
STREET
N�n,epoolooPROPOSAL
P improvement or8542494
SPBCW m NEW ENGLAND BLACKTOP ftueNo OF page
200.20.2 .541 GRISWOLD ST-GLASTONBURY CT-06033- 860 j633.4554 FAX(860)657-9977
PROPOSALSUBM(iTEDTO PH DATE
BEVERLI%Y MANN 617-599-8290 9-4-2009
STREET
63 FOSTER ST; JOBNAW NEW CONSTRUCTION
C(M STATEATDZIP CODE !OB LOCATION
SOUTH WINDSOR. CT. 06074 SAME
"GARYJAKUSBACH RES 643-9307 E-MAIL GARRYJCCOX.NET CELL#209-1372
NEW CONSTRUCTION OTHER TAXABLE SQ. FT- CALCULATIONS: SQ. FT. TOTAL: 1 083SF
CHECK WITH A WELL COMPANY TO SEE IF THE WELL HEAD CAN BE 1-9X57=1083
REMOVED, IT WOULD BE EASIER,THANKS GARY.
Z L�
RESURFACE/SHIM 11/2"BT
FINE GRADE&PAVE W12"BT X}()(
WELL-HEAD . PARTIAL,EXC FG PAVE WIT BT.
COMPLETE EXCAVATION XXX
REMOVE GRASS SMALL PROCESS STONE 20
LARGE PROCESS STONE
BANKRUN GRAVEL--FILL
TOPSOIL-FILL CU.
WIDEN THIS BITUMINOUS CONCRETE TONS
AREA
CURBING IN LINEAL FT. (5)(6)M
MISCELLANEOUS WORK:
WIDEN; AND REMOVE GRASS
BURM FROM DRIVE. BURM AT STREET.
I
t
NOTE;DUE TO THE RAPIDLY RISING MATERIAL AND FUEL,COSTS,THIS
PRICE IS SUBJECT TO.AN INCREASE,IF NOT ACCEPTED WITHIN 10 DAYS. J
A FINANCE CHARGE OF I v2%V&L BE APPLIED TO THE PORTION OF THE PREVNDUS BALANCE OUTSTANDING FOR 6
RATE OF 18%.TO"DID ADDITIONAL FINANCE CHARGE BILL MUST BE PAIN WTHIN 30 DAYS FROM BILLING DATE CO:
WILL BE ADDED TO ACCOUNTS REFERRED FOR COLLECTION.
we pig hereby to famish material and bi"-complete in accomlam with a
ftymeIk`e'mdeffimaw IN FULL UPON COMPLETION OF SPECIFIED WORK liars
TO ACCEPT PLEASE SIGN AND RETURN WHITE COPY TO NEW OP
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BY us if not in
acceptance of proposal-The above prices,specifications and
ditk=are satisfactory and are hereby accepted.You are authorized to
do the work as specifled,payment will be made as outlined above.
Date of AcceptamB. Signahm