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HomeMy WebLinkAboutWell New 29 Community Drive CPR-8 Rev.7/95 PERMIT NUMBER STATE OF CONNECTICUT 243142 DEPARTMENT OF CONSUMER PROTECTION gr�Je REAL ESTATE&PROFESSIONAL TRADES DIVISION 9a WELL DRILLING PERMIT 165 Capitol Avenue,Hartford,Connecticut 06106 LOCATION OF WELL (Town) (Street) (Lot Number) DATE South Windsor 29 Community Dr 5/15/08 OWNER OF WELL INDIVIDUAL a BUILDER © OTHER(Specify) OWNER'S ADDRESS Environmental Services 90 Rrookfield 5t South Windsor Est.No.of PROPOSED DOMESTIC BUSINESS a FARM TEST People being USE OF ESTABLISHMENT WELL Served. WELL i; PUBLIC -- INDUSTRIAL a AIR OTHER ( PLL , SUPPLY CONDITIONING (Specify) Abandor ment 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) " 0" Indicate North` ` o-- Approximate number of feet fr_ m well to nearest source of possible ntami tion: The undersignZisawthat on c ell, a "Well Completion Report"containing construction details and information required under Section 25-139 ment to the General Statutes must be sent to the owner, the Department of Consumer Protection and the Water Resources Co e form the agency. This permit is not valid until all information is filled in and it has been counter-signed by the Director of t- APPLICANT( ture) APPLICANT'S ADDRESS REGISTRATION NO. Joel gtavens PO Box 406 Willington 42 Al BY w e Offic o gent) DATE APPROVED ❑ REJECTED REMARKS L DIRECTOR OF HEALTH STATF OF CON .NECTICUT DEPARTMENT OP CONSUMER PROTECTION REAL ESTATE & PRO FESSIONA LTRA DES WELL ABANDONMENT, VERIFICATION OF "VORI%'. COIN-IPLETED 1)jLocedures followed: All procedures used to abandon a Nvell sh'2111 f0110Wl-CaL11;ld0l1S established under Sacion 25-128-56 and 25-128-57 of the State of Connecticut Well Drilfin,,, Board Regulations (see ableh- 111CMI). These regulations require that a registered well drilling contractor perform the work. p'L)l- writer supply wells attach completed form to Well Permit. For non-water supply wells attach sketch of Iveli location to completed form. Distribution: Department of Consumer Protection, Department of L fivivoilmul till Protection, Property Owner, Well Drilling Contractor 40MMMA44. 'UNI, Well information: TONVII: 'A for Date work completed: Name of Owner: aot,4 soprvl'ces -AM-41- 1 < Addi S: L L"I'le 54 LOCILliMl of well (if different from above): COKIA of well (drilled, point, clu-%.etc.): Depth ofvvell: Diatyiever of well: Length of casing: J* Work details and other information: Nanle of'registered well drilling contractor performing 0-'e' work: Registered well drilling contractor's license type & N: =W141 7, W3-ft Materials Used: amount of sand amount and type(s) of grout C.0^.-,e-4 I)escriplion of work completed: u CG U. Signed: ------- zz— (Nvell drilling contractor) 0 165 C:opitol Avenue, Connecticut 06106-1630 Fox; (860) 566-7/630 4.P TDD; (860)566-1547 .-bt Affirmative Action/Eomil Opportuii--ily E)nploycr kRQUOUVIS Uf sjj:'tjj jj(j[ Ut: a sourcc or cy"Nu uFcantarninsdon ur pullurion or ground water res0tirces. _SJl'.'dI I)'! j4VFI*QVt'ljUL1 1)1' dimuted owy by n registered %yeR driUar. The registered-well drilling ...... !wl-wrilis the xNock Ora W,ild on Ill cut -shall b,• vspunsWle fur cumpHance AM rho Immeedure of abandon- ormWA in A, Pri" and shall nuAQ the IUCJ WiLh authority or rho ahn"donmentof the well. ..,, 1 ul ALA"don"W"i -fanY MINI` IvAl ur other vpo ufivol the pruper procedure and motedalsshal.1 be used 'to prvvcur C110, ciltra"Ce Ufs"chee wamr, Arcukicion orwnrer beviveen oramorig pro- orhcr Isrucass rimuWng in thu conmalioadun or polindun orgrollild »icier resources. afru"quvary a0mdomitwir or discunliummee of the use of a"), well, the %yell shall be sealed MEh "I pmvided by Sue6on 25-12SA2 -mall be chiurinated pdur to abandonment using a chludne sol"rion with ;-I minimum concentrahun of one C I I 10"i I I c- Ill k is dtl I I iv;I leer To -5.5 q no its of h I each a r 2.25% ay.-ii I-ab I e JINU llull,lre'.tj (SUO) 11'11101" Uf wamr ur thim humowd thirty-Wely (333) Vim UK (6) inch diameter NYW 'j I lic 1%cll sh.111 Lie checked fruill hull surface' 10 the, V-11tirt, depth of the ivell bef'ore it is sealed,-to insure Against the P a cxcucc of All) ubstrue Non that will in tedirc With Haling upern No ns. ,�.1 1 lic ,%Cll hurt:shill be filled mid su tled With any of this Ibilowing morn-jals: hell cernunt grout,sand.,eernenT grout, 'J.11te Cta)- 9mun ur and My or bentonitv currient , ruin Inaterial shall bt: placed in such PwaY TO Pivvent voids in the grout or dilution of the grout. ,g) -a)' "TH constructed in a cunsolidarod ruck lbrmatiun, May Lke filled with line smul in the zone 6r zones of consoh- I 1,11c fill) of[fie and fill shall be III least tali ('10) leer bt!ION1, the botton-I of the cinsing, and (lie remaining' por- W shAU be filled wuh any or Hie rualtWiAlS Sf3i.-C11-10d in subsiaciion (q. &L well or burn WH bembandunud in such a manner that it clues not become a channel for thp. vertical %Nmcr or uthur Substancu to the potable grucind ivater mucIrces. 1JCCj) I%Uslk: di�J)Us;jl Of oil s 10ER cmsWgs tfee of miy breaks, rind es riding below the potable ground water JQ ou Suaku w4h a WaWV tigm cap Ur welded pratc- Ij j Upoit culliplutiull jfjjb;IfId oil Inen t ul,[11t: ill, Cup of the Casing, or grum material may be Terminated at least Our(41 ICL lJOUs Inc ground surbee. 141-.1y 21, 0931) OF \,vt'LL LOCATION skefdl vxilct location of well with dishinces to tit least two pertminent landmarks 701 Ave 4 -3()