HomeMy WebLinkAboutWell Abandond 1 Kasheta lane STATE OF CONNECTICUT ftc
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DEPARTMENT OF CONSUMER PROTECTION s ��1V��
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REAL ESTATE & PROFESSIONAL TRADES HST w�ti
WELL ABANDONN ENT,VERIFICATION OF WORK COMPLETED FAT R
Procedures followed: All procedures used to abandon a well shall follow regulations established under
Section 25-128-56 and 25-128-51 of the State of'Connecticut Well Drilling Board Regulations (see
attachment). These regulations require that a registered well drilling contractor perform the work.
For water supply wells attach completed forrii to Well Permit. For non-water supply wells attach sketch of
well location to completed form. Distribution: Department of Consumer Protection,Department of
Environmental Protection,Property Owner,Well Drilling Contractor,Local Director"of Health.
Well information:
Town: a y-�-�1 t ruc�sU�— Date work completed: .2 3
Name of Owner: �� yr Jj�Se
Address: /-1 J- Z-A —1 0 UJ <<-1,t1 c)s c,
Location of well (if different from above): 1141(, �1 i4i�J � /� .�.yr�lu�
Type of well(drilled,point, dug, etc): I-)r tN}•- Depth of wellp d
Diameter of well: / `Z Length of casing: /v ' , /2 � p '
Work details and other information:
Name of registered well drilling contractor performing work: J-
J�
Registered well drilling contractor's license type&#: W1-# 4 W3-# 65
Materials Used: amount of sand
amount and types) of grout Iv cA1
Description of work completed: Cti���, � Dotes-kr ,ph,jr enJir�ti,,• _
Signed:
(well drilling contractor
165 Capitol Avenue,Hartford, Connecticut 06106-1630 -
Voice: (860)713-6135 -Fax: (860)7134239 -TDD: (860)713-7240
An.4jfzrmative Action/Equal Opportunity Employer
Form provided by Forms On-A-Disk,Inc.•Dallas,Texas•(214)340-9429``
CPR-8 Rev.7/95 PERMIT NUMBER
+ STATE OF CONNECTICUT 256198
DEPARTMENT OF CONSUMER PROTECTION
t REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
���-�• ,� r:� ILA af
OWNER OF WELL
.INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS `
Est.No.of
PROPOSED DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL Q M
SUPPLY PUBLIC INDUSTRIAL AR
CONDITIONING OTHER
p� �
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 to and to house(if present)
'y Oiot�s ✓:fit
Indicate North �t
O �� 1 PL�-k
Approximate number of feet from well to
nearest source of possible contamination:
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 Department of Consumer Protection and the Water
Resources Commission on the form provided by the agency. 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. j t I S o203 J- 2 oLq 9(0
APPLI l (Signature) APPLICANT'S ADDRESS REGISTRATION NO.
BY(Town Health Officer orAgent) DATE
APPROVED ❑ REJECTED
u
REMARKS
CPR-8 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT 256198
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL� (Town) (Street) (Lot Number) DATE
OWNER OF WELL
INDIVIDUAL BUILDER OTHER(Specify)
OWNER'S ADDRESS
-Est.No.of
PROPOSED DOMESTIC LiBUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
SUPPLY OTHER
PUBLIC INDUSTRIAL CONDITIONING Specify)
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 to and to house(if present)
P &AT -T
0-i
Indicate North aSCAq
z ..
Approximate number of feet from well to
nearest source of possible contamination:
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 Department of Consumer Protection and the Water
Resources Commission on the form provided by the agency. 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. -T (Jc A S ;ja-7 J- 0, 0-L1 Q(o
APPLI T(Signature) APPLICANT'S ADDRESS REGISTRATION NO.
BY(Town Health Officer or Agent) DATE
APPROVED. ❑ REJECTED U ' Y'
u
REMARKS
DIRECTOR OF HEALTH
PRIVATE DRINKING WATER
IN CONNECTICUT
Publication Date:May 2009
Publication No. 26: Private Drinking Water Wells
Types of Construction
When you turn on the faucet to get a drink or to take a shower, do you know where your
water comes from? It is estimated that approximately 400,000 Connecticut citizens
drink groundwater supplied by a private well on their property. Groundwater is water
beneath the earth's surface that fills and saturates the spaces between sediment particles
as well as the cracks and crevices within bedrock. When rain falls or snow melts some
of the water percolates into the ground and becomes part of the groundwater.
The U.S.Environmental Protection Agency (EPA)does not regulate private wells. As an individual well
owner,you are responsible for the quality of your own water. Individual well owners do not benefit from
the public health safeguards provided by a regulated and regularly tested public water supply system.
Responsibility for wellhead protection, adequate well maintenance, and water testing falls on the
homeowner.Although your first call should be to your Local Health Department with water quality
concerns,the Connecticut Department of Public Health's Environmental Health Section can also assist
private well owners.
So,what exactly is a well, where is it located and what can you do to maintain it? Simply put, your well is
a circular hole that extends into the earth until it reaches an underground water-bearing formation known as
an aquifer. Three basic types of wells are common in Connecticut; dug wells, driven wells and drilled
wells.
Well Construction
The Connecticut Department of Consumer Protection regulates the construction of private
wells through their well drilling regulations. Additionally there are regulations in the
Connecticut Public Health Code dealing with wells. A Connecticut registered well driller
should install a new well or improve or repair an existing well. These professionals are
knowledgeable of the well construction specifications. For more information on these
specifications, see the Department of Public Healthfind Consumer Protection's websites.
Additionally, all new wells, at a minimum, have to be tested in accordance with Section
19-13-13 101 of the Connecticut Public Health Code.
Dui Wells
Dug wells are holes in the ground dug by shovel or backhoe. Historically,a dug well was excavated below
the groundwater table until incoming water exceeded the digger's bailing rate. The well was then lined
(cased)with stones, brick,tile, or other material to prevent collapse. It was covered with a cap of wood,
stone, or concrete. Since it is so difficult to dig beneath the groundwater table, dug wells are not very deep,
011114%
Produced byThe State of ConnecticADepartment of Public Health
Q Environmental Health Section, Private Well Program
450 Capitol Avenue,MS#51REC,PO Box 340308,Hartford,CT 06134
Phone:860-509-7296 Fax:860-509-7295
Page 1 of Publication No.26:Private Drinking Water Wells,Types of Construction
typically only 10 to 30 feet deep. Dug wells have the highest risk of becoming contaminated because they
are so shallow. To minimize the likelihood of contamination,your dug well should have certain features to
help prevent contaminants from traveling along the outside of the casing or through the casing and into the
well.
Dug Well Construction
• The well should be cased with a watertight material (for
example,tongue-and-groove pre-cast concrete drainage tiles)
and a cement grout or bentonite clay sealant poured along the �'* '"90 °t"a""
outside of the casing to the top of the well.
y a concre e cur an cap a
stands about a foot above the ground. " y
• The land surface around the well should be mounded so that
surface water runs away from the well and is not allowed to
pond around the outside of the wellhead.
• Ideally,the pump for your well should be inside your home
or in a separate pump house,rather than in a pit next to the
well.
Land activities around a dug well can contaminate it. Examples include disposal of household chemicals or
oil on the ground or down the drain, car or other vehicle maintenance, failing septic systems, lawn
fertilization and pesticide application,roadway runoff, and pet or livestock waste. Protecting the water
quality of your dug well means that you must monitor activities around it and reduce or eliminate potential
contamination sources.
While dug wells have been used as a household water supply source for many years, most are "relics"of
older homes, dug before drilling equipment was readily available or when drilling was considered
expensive. If you are using a dug well on your property there is a greater likelihood it may go dry during a
drought or if the water table drops. Construction requirements for dug wells are covered in Section
19-13-1351 of the Connecticut Public Health Code (PHC).
Driven (sand-point) Wells
Like dug wells, driven wells pull water from the water-saturated zone
above the bedrock. Driven wells can be deeper than dug wells,typically 30
to 50 feet deep.Driven wells are usually located in areas with thick sand
and gravel deposits where the groundwater table is within 15 feet of the
surface. In the proper geologic setting, driven wells can be easy and
relatively inexpensive to install, although there may be limited locations
where these wells could be located in Connecticut. The soil conditions
must be such that little if any large rocks, boulders or large outcroppings
exist, otherwise this type of well would not be feasible.
Driven Well Construction
• Assembled lengths of 2"to 3" diameter metal pipes are driven into the ground. A screened
"well point" located at the end of the pipe helps drive the pipe through the sand and gravel.
The screen allows water to enter the well and filter out sediment.
• The pump for the well is in one of two places: on top of the well or in the house.
• An access pit is usually dug around the well down to the frost line and a water discharge pipe to
the house is joined to the well pipe with a fitting.
Page 2 of Publication No.26:Private Drinking Water Wells,Types of Construction
• The well and pit are capped with the same kind of large-diameter concrete tile used for a dug
well. The access pit may be cased with pre-cast concrete tiles. The pit should be gravity drained
and not subject to flooding.
DRWEN WELL Although deeper than dug wells, driven wells are still relatively shallow and
Ramos MOW aH�U" have a moderate-to-high risk of contamination from nearby land activities.
To minimize this risk,the well cover should be a tight-fitting concrete curb
and cap with no cracks and should sit about one foot above the ground.
Slope the ground away from the well so that surface water will not pond
around the well. If there is a pit above the well, either to hold the pump or to
access-Ll
the well pipe.
Protecting the water quality requires that you maintain proper well construction and monitor your activities
around the well. It is also important to follow the same land use precautions around the driven well as
described under dug wells.
Drilled Wells
Most drilled wells in Connecticut penetrate 100-400 feet into the bedrock. Bedrock found at or near the
surface is commonly called ledge. A drilled well must intersect bedrock fractures containing groundwater
to serve as a water supply.
Drilled Well Construction
• Most wells drilled today incorporate a number of construction [RILLEDWELL a
features to help protect water quality.
d
• The casing is usually metal pipe, six inches in diameter that °
extends into the bedrock to prevent shallow groundwater from
entering the well. By law,the casing has to extend at least 20 feet °
into the ground. The casing should also extend at least six inches
above final grade of the ground's surface. A sealant, such as
cement grout or bentonite clay, should be used to grout the well to
the top of the well's casing. The well is capped to prevent surface
water from entering the well.
• Submersible pumps located near the bottom of the well, are most commonly used in drilled
wells. Wells with a shallow water table may feature a jet pump located inside the home. Pumps
require special wiring and electrical service. Well pumps should be installed and serviced by a
qualified professional licensed by the Department of Consumer Protection.
• Most modern drilled wells incorporate a pitless adapter designed to provide a sanitary seal at the
point where the discharge water line leaves the well to enter your home. The device attaches
directly to the casing below the frost line and provides a watertight subsurface connection,
protecting the well from the frost and contamination.
• Older drilled wells may lack some of these sanitary features. The well pipe used was often 8,
10, or 12 inches in diameter and covered with a concrete well cap either at or below the ground's
surface. This outmoded type of construction does not provide the same degree of protection
from surface contamination. Also, older wells may not have a pitless adapter to provide a seal at
the point of discharge from the well.
Page 3 of Publication No.26:Private Drinking Water Wells,Types of Construction
Hydrofracting a Drilled Well
Hydrofracting is a process that applies water or air under pressure into your well to open up existing
fractures near your well and can even create new ones. Often this can increase the yield of your well.
This process can be applied to new wells with insufficient yield and to improve the quantity of older wells.
Locating Your Well
Locating your well is the first step to protection. Start by walking around your yard. If
you discover a metal pipe, six or eight inches wide, sticking up above the ground's
` surface and topped with a metal cap,then you have a drilled well. If you find a large
cement well cap about three to five feet in diameter at the ground's surface, it could be
Iq_du Ariven_or_o-lder-drilled-welt To-determine-what's-below-the-cement-ca -remove
it. If you see an open hole with water standing in it,you have a dug well; if you see a
pit with a pipe and/or pump at the bottom of the pit, you have either a driven or older
drilled well.
If you've looked and can't find your well or still aren't sure what kind you have, consider enlisting the help
of a registered well driller or someone with a metal detector. Even dug wells contain metal fittings and pipe
that can be picked up by a metal detector. The original cover of an older well may be covered by topsoil,
grass or other vegetation. If this is the case, it is recommended that the well is located and repaired with
some additional casing, extending 1 to 2 feet above the ground surface, and properly capped. In some
cases, old wells may be located in the basement of your home.
A well driller registered with the Department of Consumer Protection(DCP)should complete new well
construction, repairs to existing wells,and hydrofracting. DCP regulates the construction of private wells
through the well drilling code. These regulations along with the Connecticut Public Health Code (PHC)
detail procedures for the siting and construction of new wells,the improvement or abandonment of old
wells, and provide for registration of well drillers and pump installers. Since 1969 all registered well
drillers are required to file well drilling reports with the Connecticut Department of Environmental
Protection(DEP). An agent of your local health department signs the well permit.New well owners should
maintain a copy of the well driller's report for their own files.
Six Important Ways to Protect Your Drinking Water Well
1. Proper Location
Locate a new well as far away from potential contamination sources as possible. CT DPH regulates the
distance a private well should be from some potential contamination sources. Sources are identified in PHC
Section 19-13-1351.
2. Proper Construction
Construction of a new well or maintenance of an existing well should be performed by a
well driller or pump installer registered with the CT DCP. Periodically inspect exposed
parts of the well. Look for:
• Cracks, corrosion, or damaged well casing
• Cracked or missing well cap
• Settling or cracking of surface seals. When placing your hands on the well,you
should not be able to move it.
Page 4 of Publication No.26:Private Drinking Water Wells,Types of Construction
* Keep accurate records of well maintenance, such as disinfection or sediment removal
* Inspect your well at least annually; consider an inspection by a professional every 3 to 5 years
(well driller, local health authorities, state health department, etc.)
* Slope the area around the well to drain surface runoff away from the well. Do not allow surface water
to pond around the well.
3. Keep Contaminants Away
Keep potential contaminants as far away as possible from your well.
• Avoid mixing or using pesticides, fertilizers,herbicides, degreasers, fuels, and other
pollutants near the well.
• Inspect your septic system every 1-3 years and pump as needed.
• Never dispose of hazardous materials in the septic system
• Do not allow runoff from the road, driveway or rooftop to pond around the well.
Keep the area around the well clear and free of debris.
• Keep pet waste, dog runs and other livestock away from the well.
4. Prevent Backflow
Use backflow prevention devices on all outside faucets with hose connections. This is especially important
if you fill pesticide sprayers, other chemical container or swimming pools. Backflow devices prevent these
chemicals from being drawn into the household water supply in the event of a drop in water pressure. You
can purchase backflow prevention devices at a hardware store.
5. Seal Abandoned Wells
Abandoned and unused wells are a potential source of ground water contamination as they provide a direct
access or conduit from the ground surface to the groundwater source. They can also be a safety hazard on
your property. These wells should be properly sealed when no longer in use. The well drilling code
regulations state that a Connecticut registered well driller should properly abandon wells.
6. Test Well Water
Test your well semi-annually (spring/fall) for nitrates, bacteria,physical
parameters (color, odor,turbidity,pH) and other constituents of concern. Test
whenever you notice a change in taste, color, or odor of your drinking water. For
more information see Publication#24 Residential Well Water Testing.
For more information please click on the following links:
EPA Office of Groundwater and Drinking Water
http://www.e]Ra.gov/oaw
EPA New England
http://www.el2a. og_v/re iog n0l/
Adapted from Healthy Drinking Waters for Rhode Islanders, University of Rhode Island Cooperative Extension,April 2003.
Page 5 of Publication No.26:Private Drinking Water Wells,Types of Construction
§25-128-55a.Period of responsibility.
The well drilling contractor shall be responsible for a period of one(1)year from the date
of completion of work performed on the well to insure.that the physical construction of
the well meets the.requirements of this code.The contractor shall not.be responsible if
work has been performed on the well by others, or if activities by others in the vicinity of
the well.have adversely affected the-well. .
(Effective May-21, 1993.)
§25=128 56 Abandonment of wells,responsibihty
Any well that is abandoned shall not be a source or cause of contamination or pollution.of
groundwater-resources. Abandonment procedures shall be performed_or directed only by
a registered well driller:'The registered well drilling contractor who performs the work of
abandonment shall be responsible for compliance with the pro6edure.of abandonment of
the well, as provided in this part and`shall notify the local health authority:of the
abandonment of the well.
(Effective September.27, 1978;Amended May 21, 1993
25-128-57.Procedure of abandonment
In the event of abandonment of any'`water well or other type of well the proper procedure
and materials shall be used as follows:
(a) The well shall be plugged to prevent the entrance of surface water, circulation of
water between or among producing zones, or any other process resulting in the
contamination or pollution of ground`water resources:
(b)In the event of temporary abandonment or discontinuance of the use-of any well, the
well shall be sealed with a watertight cap:or seal, as provided by Section 25-128=4 (c).
(c)The well shall be chlorinated prior.to abandonment using a chlorim solution with a
minimum concentration of one hundred fifty parts per million.-(150 ppm)) of chlorine.
This is equivalent to 5.5 quarts of bleach at 2.25%o.available chlorine to five hundred -
(500) gallons of water or three hundred thirty-three (333) feet of six.(6)inch diameter
well.
(d)The well shall be checked from land surface to the entire depth of the well before it is
sealed,to insure against the presence of anyobstr fiction thatmill'interfere with sealing
operations: -
(e).The well bore shall be filled and sealed'with any of the following materials:.heat
cement grout, sand cement grout,bentonite clay grout, or sand clay.or bentonite cement
grout.-
(f) The grout material shall be placed in such a way to prevent voids in the grout or
t
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1 .
Well Abandonment
■ Permanent Abandonment
ping equipment an -check to ensure that there are no
obstructions within the well,which could interfere with filling it.
Chlorinate the well to 150 ppm.' (Each gallon of 5%bleach will
treat approximately 200 feet of a six-inch diameter well.)
♦ Fill the well,from the bottom up,with an impervious material.
Approved materials include neat cement(no sand),sand cement,
bentonite clay,sand clay and bentonite cement.
Bedrock wells may be filled with fine sand,to a point ten feet
below the casing,then filled with impervious material to the top.
♦ The abandoned well may be cut off at four feet below surface.
j
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26
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Drive"or sa"b poi"t wells shoulb be abanboitieb oiAl bq A licenseb well briller.removeb if their biameter is incbes or less if possible,the casi"g sboulb be rernoveb
A"b their beptli is 25 feet or less.The bole Arlb the borehole fillet with A cement- u r
shoulb be fillet with A be"to ite-ceme"t be"to"ite slurN.if the crsi"g ca""ot be
grout. if greater tbA"25 i"b th,larger removeb,the a"tire well shoulb be fillet (D`
thA"2 i11Ches i"biameter,or all"ot be with A ceme"t-be"to"ite slurN usi11g the groundwaler IK
r¢"loveb,the well shoulb be lleb with A pump-town methob with A tremie pipe.i"
be"to"ite-ceme"t grout from ottom to top areas subject to subsibence a"b/or farmi"g,
usi"S the pump-bows metbo usi"g A the top of the casi"S shall be cut off A
tremie pipe. mi"imum of three(3)feet below tha surface ®®®
Driller, Well s—Dia"icterf of 2 to 20 of the grow"t before pluggi"S operatio"s
i"cbes are t4pical for these w Ile,which are begi"s.After filli"S the well with the
i"stalleb with the use of A bri i"g rig A"b came"t-be"to"ite slurrH,theexcavatio"
ma,4 be several te"s to severer thousa"b above the top of the ceme"t plug shall be UY
feet beep. I"Alabama,trille bomestic fillet with compactcb soil to mi"i"size
wells are a"erall less tba" fo feet be future hazarbs to farms" a ui I+
S �,I ap• g q pme"t etc.
Drilleb bo"Iestic wells 4re ofM4 uHique i"other areas,the top of the casi"g stall
hi besis"A"b berth amb shotollb be be cut off At or below the Srou"b surface.
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Clean Trea 3d Sand&Gravel k<°
k.� • for more information o"well aba"l)m"ment ,
Grout/Be onite Seal ant otberwater qualit4 issues,please contact:
{ tl-�3'Minim
Water Table p
--- AlabamaDepartmcw
of£"vkonmental Ma"Agement
� • GrountwrtcrBra»ch
1751 Cong.W.L.Dicki"so"Dlvb
' f Ian Treated Sand&Gravel MontgomeN,AL 3Gio9-260S • +
• 4im delines for
� (334)271-7862
Well Abandnnmeni
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_ zer Screen
AUbamADenrrtmcmtoff-"m »mmUlMariagemervtDrokb ,
wen P.O.Box 3o1463 I+
MowgomeN,AL 3wo-1463
334-271-7$62 I+
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Closure of Unused Wells Prevent!»g grounbwater contamination wells,briven or salib point wells or brilleb
is the maln issue associates with well or augureb wells.As with other tHpes of
Wells that are u ssio b have "cb aba»bo»ment but there are seco»5ar4 wells,tke tHpe a»b bepth of well shoulb be
i pose
aperlH ue risk to labs ( Ua»boneb) co»cerfis as well.A»imrroperlil fillet or betermi»et,prior to plugging.A»,4
rose a serious risk to Alabama's cappeb well CA"be a ph-4sical hazarb; obstructions in the well shoulb be removeb
grounbwater et,we.s provi la recall the i»famous babti Jessica incibent prior to pluggi»g.V»ber»o circumstances
b "buit f r oneb wells cb surface
a birat from the late i9so,s.A»imrroperl�1 shoulb a»'4 part of the casing be alloweb to
conbuit for b water.This su Ce waters to abanboneb well CA"also have negative remain above the surface of the grount,
enter grownt,water.This can c »tam!»ate effects o»a small aquifer's Hie15, after plugging.
not just an l supplies
of waters all of but h�brostatic pressure a»b other factors that Shallow Dus Wells are ha»b bug wells
the water rs,I"t e of some or all of the will affect future well performance. that extelib bows to the aquifer a»5 are
well owners in the area.The rent of sometimes blasteb or chippeb into bebrock
contaminatio»is heighteneb i»Ce the Proper Well to reach the aquifer.Stone or concrete
surface water can move biro M into Decommissioning Procedures walls calleb curbiwg is sometimes
grounbwater,bypassing the I ItCH"S actin» »ecessarH to keep the well from collapsing.
of the soil.Extremelti high le cis of Havi»g a licewseb well briller These wells are rarelti beeper than A few
biological glib chemical co»ta inatio»Ca" becommissio»a well while he is o»the tens of feet ar b have biameters that are
be reacheb verH quickl-4. propertti to brill a new well is often the usuall,4 several feet across.
Well owners are sometimes tempteb to quickest,easiest arb safest watt of Pumps,pipi»g or bebris shoulb be
use aba»boneb wells to bispo a of sewage aba»bo»ing a well.While it is removeb anb the top 3 to S feet of curbing
anb other wastes.This is N VER recon"r»eoibeb that a well briller bo the job, shoulb broke"up prior to filllwg.A»H
acceptable;it is literallH like pouring waste it is not requimb unber current guibelines. portion of the well that extewbs iwto
birectlti into,4our briwking water,a»b the if Hou becibe to bo the work tiourself, bebrock shoulb be fillet,with a co»crete-
health risks cannotbe overstateb. viou will rrobablH neeb to seek the abvice be»tonite grout.The remainber of the well
of an outsibc authoritH at some poiwt.The shoulb be fillet,with clew"wative materials
state agewcies listeb iw the back of this that approximate the rermeabilitH of the
=� �`' brochure will be able to help-qou,natural
Compaotad=.1d soil
or el.y tmo�nd�„ aquifer aNb over tiiNg soils"car thewe .
-:'- .3 Grout/Bentonite Seal resource bistricts,certifiet,well brillers T-he soil shoulb be compaCteb t0 prevent
'.$ :' Treated Sand&Gravel cr anb local Officials malt be of ASSiSta»CC. settliwg alit,ponbi"S of water in the
Native rth Material The followi»g are a broab set of guibeli»eS
'p location of the former well.
A = for becommissio»i»g wells;the exact
Driven or_Sa»b_1'olit Welts,is a well
rrocebures will biffer bepenbing on e
th
Grout/ ntonite seal tHpe of well alit local geologic Cont,itlons. that is briven to the besireb bepth, either
_ -- 3'Mini 1»bivibual water Supp1�H wells are bH halib or machine glib mall evnplo4 a
—Water Table — — `;.; — — — — — — wellroi»t,or alternative equipment.These
. 1 Clean sated Sand&Gravel relativelH shallow iN bepth anb serve one wells tHpicallti have a small biameter(2
— _ _ _ to several householbs with a»ough water
Water —P_ro Gn9 Zona for bomestic purposes."ese wells are i»dies or less)with a short scree»»ear the
y" tHpicall�one of three tHpes:shallow bug poi»teb elib glib can o»1H be useb in soft
DWS Wen sanbH sebiments or soils.
TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
c Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. 07/4Y 9-1
TO THE BUILDING DEPARTMENT: Date. /4 Juts/ 19 &JQ
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: �?
1. Owner of Property 6W 1441 RAI AAAJJ#V Address of Ownerll4VG► MA/N J�&2�'P-
2. Location of Property AMA Lot. No.
3. Type of Structure "Zw>< Ll No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ '
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. .Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests Time for 1" drop in soil test Z M r it 4&T1 S Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching ,System: Number of trenches #b
LengthvWO t� Widthls�T 3- Total -54 Or
Other 44416ala/ /4-0 A+ s&a _
Signature CX K/ 1,Diin�o.
(Licen Installer)
(Sketch showing all minimum distances and at er stalls req it ow
I I
1 '
! I
9
40 c
rJ
SrRZ27-
Permit Issued 19 &50 B
Installation Completed, Inspected and Approved