HomeMy WebLinkAboutWell New 601 John Fitch Boulevard COI bd PERMIT NUMBER
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CPR-8 Rev.7/95 �n 'H+c
Kn -S .M OF CONNECTICUT 177802
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION ,
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06100
LOCATION OF WELL (Town) (Street) (Cot Number) DATE
South Windsor Route 5 August 2, 1996
OWNER OF WELL
INDIVIDUAL ® BUILDER OTHER(Specify) WaWa Market C/O Niro Const.
OWNER'S ADDRESS
1235 Dunbar Hill Road Hamden CT 06514
Est.No.of
PROPOSED DOMESTIC El BUSINESSFARM TEST People being
USE OF ESTABLISHMENT WELL • served.
WELL
❑ PUBLIC ❑ INDUSTRIAL. a AIR � OTHER Ab a n d nme n t N/A
SUPPLY 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)
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Indicate North
Please,..k
Approximate number of feet from well to
nearest source of possible contamination:
The undersigned is aware that upon completion of the well,a"Nell 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.
APPLICA ' atme) APPLICANTS ADDRESS REGISTRATION NO.
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150 School House Road Cheshire T W1-1
` BY(Town Health Officer or Agent) DATE
f�gYPROVED ❑ REJECTED
REMARKS �C O
G .2. y,7�
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTIONT
STATE. .VF CONI ECTICUT
DEPARTMENT OF HEALTH SERVICES
Well Abandonment, Verification of Work Completed
Procedures followed: All procedures used to abandon a well shall follow
regu ations established under Section 25-128-56 and 25-128-57 of the
State of Connecticut Well Drilling Board (see attachment). These regu-
lations require that a registered well drilling contractor perform the
work.
Well information r
Town: South Windsor
Name of Owner: Wawa Market C/O Niro Cons rurrinn
Address: 1235 Dunbar Hill RAad Hamden. CT_ 06514
Location of well (if different from above): Route 5
Type of well (drilled, point, dug, etc): Due
Depth of well: 12' lot ; ,h QA.- cc. i5TATtG
Diameter of well: 3011
Length of casing: CoNcre4 e.
Work details and other information
Name of registered well driller performing work: James M. sima, sima Drilling Co.
Registered well driller's license /: Wl-1
Materials used: amount of sand 2 50y�
amount and type of grout 756W,#gle Plus, rrWX.-e 1,
Description of work completed: Res'O." , -
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Date work completed: August 2, 1996
signed: (well driller)
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