HomeMy WebLinkAboutWell New 1041 Strong Road CONSUMER PROTECTION ��7� 5,i�2G�'
WELL DRILLING BOARD STATE OF CONNECTICUT PERMIT NUMBER
CPR-8 REV.11-82 ti DEPARTMENT OF CONSUMER PROTECTION. Q 5 6 2 2
WELL DRILLING PERMIT
165 CAPITOL AVE.;HARTFORD,CONNECTICUT 06106
LOCATIOpt,OF WELL(Town)• (Street) (Lot Number) DATE /
OWNER OF WELL
INDIVIDUAL ❑ BUILDER ❑ OTHER(Specify)
OWNEERRS ADDRESS
�:J
zd
BUSINESS
PROPOSED TEST Est.No.of
DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ -yVC{L People being
USE OF _ .
WELL PUBLIC AIR OTHER served.
❑ SUPPLV ❑ INDUSTRIAL CONDITIONING (Specify) 3
SKETCH OF WELL LOCATION .
Locate well with respect to at least two roods,showing distance from intersection and front of lot
Location of lot to at least two roods Well location on lot and to house(if present) _
Indicate North
5%MtTjG 91d
C
Approximate number of feet from well to r /
nearest source of possible contamination: J
The undersigned is aware that upon completion of the well, a "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. is per it is not volid4til q11 i ormot��is filled in and it has been counter-signed by the Director of Health or his agent.
APPLICA T(r stare) _ C APPLICANT'S ADDRESS
V G � a 7?L' REGISTRATION NO.
By,(Town Health Officer or Agent) DATE
PPROVED ❑ REJECTED
REMARKS
/
lie
ie c>
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
WELL COMPLETION REPORT STATE OF CONNECTICUT
CPR-9 REV.n-82 - -- DEPARTMENT OF CONSUMER PROTECTION `Do NOT fill in
WELL DRILLING BOARD STATE WELL NO.
165 CAPITOL AVE.
HARTFORD, CONNECTICUT 06106 OTHER NO.
NAME 'p ADDRESS
OWNER B1CkL`G+ Snow 1019 Stong Road, So. WindsOr, CT 06074
(No.& Street) (Town)) (Lot Number)
OF WELL Strang Roach. SO Windsor 6
BUSINESS
PROPOSED
DOMESTIC ESTABLISHMENT FARM TEST WELL
USE OF
WELL PUBLIC AIR❑ SUPPLY' INDUSTRIAL CONDITIONING (Specif y)
COMPRESSEDDRILLING EQUIPMENT ROTARY � A R ERCUSSION PERCUSSION ((SSpecf
Y)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 131 e 8 17-45 n.THREADED WELDED I YES NO [y�YES NO
YIELD HOURS YIELD(G.P.M.)
TEST ❑ BAILED PUMPED F.]COMPRESSED AIR 4 25
WATER MEASURE FROM LAND SURFACE—STATIC(Specify feet) DURING YIELD TEST,(feet) Depth of Completed Well
LEVEL 10 299 in feet below Land surface: 00
MAKE LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE(inches) FROM(feet) TO(feet
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.
T
Granitp
1
t
i
If yield was tested at different depths during drilling, list below Y
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT WELL RILLER(Signature) Eastern Drill
9-18-85 105622 � _2p_8
DEPT. OF ENVIRONMENTAL PROTECT ION-WATER RESOURCES
1zd
(OWN 8f4
0
' c
s �
O . �` 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
�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 hoer 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: RECEN��
Circle the appropriate service:
WELL MDC CT WATERSO
WELL USE: DOMESTIC LAWN & GARDEN AGRICULTURAL ENG NEER�NG pEP�
Well Location : ?10 :�:A (Zd, Ct)((f ous SWLL)
BACK DRAWING:
40 FT
A FRONT B --- - _ ---------
--�
30 14 FT
WELL
STREET