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HomeMy WebLinkAboutWell New 1395 John Fitch Boulevard CONSUMER PROTECTION WELL DRILLING BOARD STATE Of CONNECTICUT Gr I MBER CPA4 REV.IJ.0 DEPARTMENT OF CONSUMER PROTON , 06 WELL DRILLING PERMIT •QF �� ' 14 CAPITOL AVE.,HARTFORD,CONNECTICUT 06106 CO�SUr'' vT*0110460710 N LOCATION OF ll(Totem) (Smret) (Lot Nrmbrr) DATE OWNER OF WELL ❑ INDIVIDUAL ❑ WILDER ❑ OTHER{Specify) OWNER'S ADDRESS 39:!,=& PROPOSED ❑ aw"Ess TEST Est.No.of IDIOM= ESTAKISHMENT ❑ FARM ❑ WELL People being USE OF f served. WELL ❑ SUPPLYS INDUSTRIAL El CONDITIONIN AM G (OSpecd Y SKETCH OF WELL LOCATION Locate well with respect to at least two roods,showing distance from intersedron and front of lot Location of lot to at least two roods Well location on lot and to house(if present) --------------- r hdioolt North Approximate number of fee om well to „ nearest source of possible contamination: S - The undersigned is aware that upon completion of the well, o "Well Completion Report" 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 countersigned by the Director of Health or his agent. APPL (Sig re) APPLICANT'S ADDRESS REGISTRATION NO. ,)r2, y_(Tow-wNedth Officer or Ageer DATE �+^ VED ❑WIto �^Z f•! fin. ,p�,,•,` a 7—�- q Z �i.►rt? 5=�9 -Qr"� w. - &'. per,►.. 411-< RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD i — WELL COMPLETION REPORT STATE of CONNEcnCUT CPR_vREV.11-82 DEPARTMENT'OF CONSUMER PROTECTION Do NOT fill in WELL DRILLING BOARD STATE WELL NO 165 CAPITOL AVE. HARTFORD, CONNECTICUT 06106 OTHER NO OWNER NAME ADDRESS OWNER c.lnhn Rich Blvd. LOCATION (No. 3 Street) (Town) � CT- —� OF WELL (Lot Number) ri rout h tit f rug'sary CT DOMESTIC ESTABLISHMENT FARM BUSINESS USE UPROPO TEST WELL SE OFF OTHER�' WILLPUBLIC L SUPPLY �'1 INDUSTRIAL CONDITIONING (_J(specify) DRILLING COMPRESSED CABLE OTHER EQIIMMENT i19 ROTARY iv AIR PERCUSSION PERCUSSION (Specify) CASINO LENGTH(feet) DIAMETER (inches) WEIGHT PER FOOT I wAS ASinG GRQUTED, 17 DETAILS ® THREADED WELDED t YES NO a YES NO YIELD HOURS TEST .a BAILED PUMPED COMPRESSED AIR , yIEID (GPM; 1 4 35 MEASURE FROM LAND SURFACE—STATIC WATER (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well tEHg in below Land surface MAKE � h SCREEN LENGTH OPEN TO AQUIFER ;feet) DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of will including (feet)GRAVEL SIZE (inches) FROM TO(feet PACKED: grovel pock (inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least FEET TO FEET two permanent landmarks. Setnd & Gravel - aray c l ado -- r.) y; Pan 175 Pad le Fenn If Yield wall tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL ILLER(Signature) ! fi170006 61 495 f r-+ Jahn lei Dttff0rd k STATE OF CONNECTICUT DEPARTMENT OF PUBLIC IIEALTII AND ADDICTION SERVICES ti STATE OF C0NN2=.%Ci7T . AM " } HARRY GOLDSHER AND C'HARLE R_ CLUE t�R, sa3 3y , �r 1395 JOHN PITCH BOULEVARD Agy SOUTH WINDSOR, CT 06074 IN THE MATTER OF A CONSENT AGRBHML='A1T BETWEEN THE.STATE OF CONNSCTIC[7T, y: T]F.PARTMENT OF PUBLIC HEALTH AND ADDICTION SSR'VICES AND t!7E$$I¢T,TR3 60LDSHER AND P .+ {� CLARK TO ALLOW AN EXCSDTION TO SECTION 19^s3-B51m{b) OF TH3 PUBLIC HEALTH CODE. CONSENT AGREEMENT c t9f�ERR31B, the papartm"t of publ.iC Kealth and Addiction Services (Department) ;z .r �i has jurisdiction over all matters concerning the purity and adequacy of public {water supplies pursuant to Connecticut General Statute Section 25-32; and ., WHZ EAS, the Department has jurisdiction over the subject matter of this CPerit Agreement p+azr�uant to Becton 19a-5, 19a-36, 25-32, 25-32e, 25-32g, `' s 25-134, and 25-36 of the Connecticut General Statutes and Section 19-13-a51m(b) of"thcr ConnecticutPublic Feal.th.,Coda (pplC) and k� x, WHEREAS, Barry Goldsher and Charles ,R. ,Clark Jr, formally requested an , s " E ��£ aXc�ptj.gYl .£rpm $ectioti 19-13-Brim(b) pi,trauarit to $ectiOM 19-13-B57m(c) of the Public Health Code, and approval to install an irrigation well; and - _x WHEREAS, the Commissioner may grant an exception to Section 19-13-B51m(b) upan 3 $ a finding that such exception will not adversely affect the puritan and ;' > adequacy of the community wateT,, supply nor the service of the community water } € } .: supply system; and ; 1. rJ WHEREAS, tho Commissioner finds that an exception may be granted to the owner .y {y` to install an irrigation well providing that the following aonditions are metr µ + and ere enforceable by law; 't NOW, THBRUPORB, the owner hereby stipulates and agrece that: ' 1. The well site must aoaform to all other existing state and local regulations and be approved by the local health department. No well should be located less than 75 feet from a property line unless the �x adjacent property owner rants a sanity easement- for all land within - r - s 7 L p Y 9 sanitary k a 75-foot radius of the well. a, plans for the irrigation system must be provided to both the local health department and this Depastxnant. 3. The well and i==igation system, including all pipi g and any storage and pumping facilities, must noI be physically located within or connected to any building served by the public water supply. Phone. r 99468 Telephd'1A1015AW for Nte Deaf (203) 566-1279 r 150 Washington Street •— Hartford, f,T 0610C An Equal Opportuithy F-nytloyer � Y GVUUVVI 11VLaibb6 -41 IN ,7 s 4. Na physical connection skull ever be permitted between any portion of r` the domestic water system and the irrigation system. Periodic ¢< i incpeotiana will be conducted by repxesentativea of the public water FL supply purQuant to PHC Regulation 19-13-8102(f) to confirm that this condition has been satisfied. ;'•`„�,� a 5. A reduced pressure principle backflow preventer approved by this Department must be ixiatalled on the service line connection frpm the - �x r public water supply system and inspected annually by a properly a �� certified profa66ional. K_ The well must be monitored everygive vo (5) years for all water quality parameters included in PUC Regulation 19-13-BI02(4) and (4) (4) (A) . Results must be submitted to the local health department. r 7. During critical periods when the public water.aupply may impose water ? r : use restrictions on its cuatomcra, the property owner must comp],y with the same restrictions in order to conserve water. j 3{qT 0-;1 S. Approval for use of this well will be expressly for irrigation s � Yzr j purposes only and any other use will void approval. sR. ! ltr ,�Yiw"y 9. All approvals for the installation and use of this well are non-transferable through the sale or'other assign-ant,ant of this y� g gn— property, This Consent Agrseman.t has the force of an, agency•.order, and the nepartment { .h,►a the right to seek- Judicial enforcement of this Consent Agreement in the {� -event that the owner fails to comply with its item*. Who Department may, at s� r time, take any and all legal, admirsistxative or equitable actions to assure the purity and 2degUQ*y Of the public water supply. d h?r {3 f IN 77ITmss PPm.roF, the parties hereto have caused this Consent Agreement to Y be effective on the 1$E day ofMN r,l(o 1g95. By. z' pate Paul M. faY�►ar, pixeotcr 4.k a �S¢ s $ftivi.aronmen4al Health Services Division v , ere' Department of Public Health and i a�r Addiction Services 4 � J t•j T s Date Barry Galdah Property owner By[ Date Charles R. Clark r., Proper Owner r � W88 Order No. 9 5—1 3?.-o-I 1 t : p8P/jpt r� t 89468/1-2 zt 1£ 'M�.E,., !� I"A: i. T Ole s, s N t j STATE OF CONNECTICUT - �k DEPARTMENT OF PUBLIC HEALTH AND ADDICTION SERVICES r S, t May 1, 1995q Mesaieurc B. coldsher and C. Clark Jr. .x F 1395 Jahn Ditch Boulevard South Windsor, CT 06074 Rf3: Well Permit Exception zrxigation well for Engineering services and -� e4.. Products Company, Inc., 1395 John Fitch Blvd., South Windsor, CT Dear Messieurs Clark and Gloldsher: ? Pursuant to section 19-13-B51m(c) of the Public Health Code, this Department t has determined that the installation of a well to provide irrigation water for 1395 John Fitch Blvd. , South Windsor, h is allowable. Approval is granted to develop such a well providing the followings 3 contingencies ,are met: 6 a) The well site must lie approved by the South t9indsor Health Department y � z b) The Convent Agreement between Barry Galdslaer and Charles R. Clark Tr, x'R and this agency moot be fully complied with (Agreement enclosed) . �' � •.•Y� fPt 1. Sincerely, , Yn hP q'^y Qgul M. Schur, M.P.A. Director ro Bnvironmgntal Ftealth services DivisionYA- = �' �Y Y! ©/Pf3P/jpt YM ;j Enclosure co: Gerald Schwartz, MD, DOH, south Windsor Daniel reanxa$ki, CTWC Paul Riteick, WSS (Engineering) James ORZongly, Wss (Planning) Judith Sartucci, LHA Post-it"Fax Note 7571 sale , S pages r ti r i.t• Ca, Phone • + "1 Phase Pax Bggg t` Fax Ol 8946E/4 240-9262 Phone. ram: Telephone Device for the Deaf (203) ,166-079 150 lVaslttngron .Street — Hartford, CT 06106 do Egirul Opportunili Employer