HomeMy WebLinkAboutWell Correspondence 1177 Sullivan Avenue 09 .
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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 OF R
'SOR-CO TELEPHONE(860) 644-2511 T
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 U I-
�' FRONT B 1( Co S c JUL V21 ,-,_�,
30 14 FT
WELL
STREET
WELL DRIWNG BOARD STATE-tf,jCONNECiiCIIT PERMIT NUMBER.
1ND" 11-0 WELL &ILLIND, PERMIT 60410
STATE OFFICE BUILDING,HARTFORD,CONNECTICUT 06115
LOCATION OF WELL (Town) ($treat) (Lot Number) DATE
SOUTH WINDSOR 1177 SULLIVAN AVE. 6/15/79
OWNER OF WELL
® INDIVIDUAL ❑ BUILDER ❑ OTHER ft-ify) JOHN MITCHELL, - JR.
OWNER'S ADDRES
11?7 SULLIVAN AVE. t S. WINDSOR, CONN.
PROPOSED BUSINESS TEST Es.No.of
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM IDWELL tPeople being
USE OF - served.
WELL ❑ PUBLIC SUPPLY EliNDUSiRIAL ❑ C'R OTHER ONDITIONING ❑ (Specify) 4
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads,showing distance from intersection and front of I
location of lot to at least two roads Well location on lot and to h use(f esent)
indicate North 'U PC
Cc
L1
1351
0
/'2 O
Approximate number of feet from well to OS
nearest source of possible contamination: 9
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. This permit is not valid until all information is filled in and it-has been counter-signed by the Director of Health or his agent.
AP �`gum'
I APPLICANT'S ADDRESS I REGISTRATION NO.
LAKE ST. , VERNON, CONK. 100
BY(Town Health Officer Agent) DATE
U APPROVED ❑ REJECTED I I 6_ r,,, .
REMARKS
0a 66U
as -
RETURN THIS COPY TO CONNECTICUT WELL DRILLING BOARD
tLL COMPLETION REPORT STATE OF CONNECTICUT
WDB-5 1269 REV.9-7I WELL DRILLING BOARD Do NOT fill in
State Office Building
STATE WELL NO.
HARTFORD,CONNECTICUT 06115
IOTHER NO.
OWNER
NAME
_j ADDRESS
Jt. 112 111I �.1�� . E j.LL LL e 'f` rh N Y r
LOCATION (No.&Street) (Town) (Lot Number)
OF WELL .T U IVAN ATf!,. S 0 U TUT sT 4DSO
BUSINESS
❑ ESTABLISHMENT ❑ FARM
PROPOSED :91 DOMESTIC ❑ TEST WELL
USE OF
WELL
PUBLIC ❑ OTHER.
❑ SUPPLY {{❑�� INDUSTRIAL ❑ CONDITIONING (Specify)
DRILLING ROTARY (_J AIR PERCUSSION ❑ PERCUSSION ❑COMPRESSED CABLE OTHER
EQUIPMENT y)
CASING LENGTH (feet) DIAMETER(inches) WEIGHT PER FOOT DRIVE SHOE WAS CASING GROUTED?
DETAILS 6 I I 19.4 I THREADED ❑ WELDED I YES ❑NO ❑YES l NO
YIELD I HOURS YIELD(G.P.M.)
TEST ElBAILED ❑ PUMPED El COMPRESSED AIR I 48
MEASURE FROM LAND SURFACE—STATIC(Specify feet)I DURING YIELD TEST(feet)
WATER I I Depth of Completed Well
LEVEL 3 100 in feet below Land surface: L ,
MAKE i (LENGTH OPEN TO AQUIFER(feet)
SCREEN
DETAILS SLOT SIZE ( DIAMETER (inches) I IF GRAVEL i Diameter of well including GRAVEL SIZE(inches) FROM(feet) ITO(feet)
PACKED: gravel pack (inches):
DEPTH FROM LAND SURFAC - Sketch exact location of well with distances, to at least
FEET to FEET FORMATION DESCRIPTION
two permanent landmarks.
0 13 mad 8r, Gravel
i3 5 ay
56 1
Bedro-ok
If yield was tested at different depths during drilling, list below
FEET GALLONS PER MINUTE
DATE WELL COMPLETED PERMIT NO. REGISTRATION NO. DATE OF REPORT I W L Q�LER(Signatur )
DEPT. OIL" ENVIRONMENTAL PROTECTION-WATER RESOURCES