HomeMy WebLinkAbout2016-8-16 - 124 Brookfield Street - Well Drilling PermitTHE
STEPHEN B. CHURCH
COMPANYFOUNDED 1886
WILLIAMS. DUNCAN, III
JAMES B. DUNCAN, P.E.
49 GREAT HILL ROAD • OXFORD, CT 06478 • PHONE (203) 888-2132 • FAX (203) 888-1863
August 27, 2016
To: Heather Otis
Town of South Windsor
South Windsor Health Department
1540 Sullivan Ave.
South Windsor, Conn 06074
From: Pete Duncan
Stephen B Church Company
Box 67
Seymour, Conn.
Tel: 203 888 2132
Fax 203 888 1863propose to replace this w
E-mail Sle ilienbch(u7aol.com
Reference: Well Permit
Dear Ms. Otis,
Attached is well permit No 259873 to replace an existing irrigation well at the
Willow Brook Golf Course. We received your permission to repair this well with permit
No 215430. Unfortunately the well has had significant failure and we need to replace this
irrigation well with a new irrigation well.
permit.
Attached is a check for $1.00 made out to the Town of South Windsor for this
Please sign the permit and return our copy to us. Thank you for your assistance.
Very truly,
(,�,� , RECEIVED
William Duncan AUG 3 12016
cc: David Fresk SOUTH WINDSOR
Willow Brook Golf Course HEALTH DEPT.
<6 SCM11NED
WELL AND PUMP SPECIALISTS
CPR-8 Rev 7/95 PERMIT NUMBER
STATE OF CONNECTICUT t-_' 7 3
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE & PROFESSIONAL TRADES DIVISION
Ilk WELL DRILLING PERMIT
165 Capitol Avenue, Hartford, Connecticut 06106
LOCATION OF WELL (Town) (Street) (Lot Number) DATE !
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OWNER OF WELL
INDIVIDUAL ❑ BUILDER ® OTHER (Specify)
OWNER'S ADDRESS
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PROPOSED
❑
DOMESTIC
BUSINESS
FARM TEST
Est. No. of
People being
USE OF
WELL
ESTABLISHMENT
WELL
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served.
❑
PUBLIC
❑ INDUSTRIAL
❑ AIR ' OTHER /r
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SUPPLY
CONDITION$NG (Specify)
SKETCH OF WELL LOCATION
Locate well with respect to at least two roads, showing distance from intersection and front of tot
location of lot to at least two roads
Well location on to and to house (if present)
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Indicate North
Approximate number of feet from well to -
nearest source of possible contamination:_Ir`
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 Ts not val;o until all information is filled in and it has been counter -signed by
the Director of Health or his agent
APPLICANT (Srgnature) t Ji OWNCANrSADDRESS `r it7+� `+ =/, w ,.=../. _ r : �• REGISTRATION NO.
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B f%wl+ H"t4oflFcaror U DATE
APPROVED REJECTED
49; SCANNED
DIRECTOR OF HEALTH