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1540 SULLIVAN AVENUE• SOUTH WINDSOR, CT 06074
f�Osoe•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:
40 FT
A FRONT B
30F 14FT ® 5����
WELL SOUTN WIND DE'?
V—NGINEERjNG
STREET
WELL CPMPLET6ON REPORT STATE OF CONNECTICUT Do NOT fill in
AB-5 12$9 REV.9-7I WELL DRILLING BOARD STATE WELL NO.
State Office Building
HARTFORD,CONNECTICUT 06115
OTHER NO.
NAME, ADDRESS
OWNER =5.Y .* &RD 31 �}PMAN� ROAD g .t�.�`PIN g CON.
LOCATION �(No.&Street) (Town) (Lot Number)
OF WELL Os1 t n I A3 D SOUMT t ,�lv1D e�'3.
BUSINESS
PROPOSED DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
USE OF PUBLICAIR
WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify)
y)
DRILLING+ 6a ROTARY El A RMPERCUSSION El PERCUSSION ❑ (Specify)COPRESSED CABLE (S
THER
EQUIPMENT
LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
CASING THREADED ❑ WELDED RI YES ❑NO ❑YES NO
DETAILS I I 1 $45 1
HOURS YIELD-(G.P.M.)
YIEL TEST ❑ BAILED ❑ PUMPED COMPRESSED AIR , 4- 12
MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST(feet) I Depth of Completed Well ry
WATER in feet below Land surface: 75
LEVEL 0
MAKE I LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE DIAMETER(inches) I GRAVEL SIZE(inches) FROM(feet) I70(feet)
IF GRAVEL Diameter of well including
PACKED: , gravel pack(inches): .+
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION Sketch exact location of well with distances,to at least
FEET to FEET. two permanent landmarks.
Q 11 Sand & GraVel
Lr�
//0 co
1�2
�7/
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
4 04 D
DATE WELL C�O-gMPtL}ETTED PERMIT NO. REGISTRATION{NO. DATE OF RLPORT WE LLER Signat e)
a t;J -f C3 i ( 1 �� +: 8
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