HomeMy WebLinkAboutWell Correspondence 765 Sullivan Avenue STATF OF CONNECTICUT
DEPAR TMENTOF CC)j?\fSUA4ER PR07-I-,rTI0N
REAL,ESTATL & PROCESSIONALA'RADES
' E"LL ABANDONMENI', VERIFICATION OF !VORK COMPLETED
Procedures follosyed: All procedures used to abandon a Nvell shfill follow regulations established under
Section 25-128-56 and 25-128-57 of the State of Connecticut Well Drilling Board Regulations (see itttach-
require that a registere'd well drilling contractor perform the work.
For %vittei,supply wells attach completed form to Well Permit. For non-water supply wells attach sketch
of well location to completed form. Distribution: Department cif Consumer Prot De aitment of
F fivil-on Mental Protection, Property Owner, Well Drilling Contractor
.FDatc work completed:
Name of Owner
SUAIh o6'Qn
Lociaion of well (if different from above):
Type of well (drilled, point, dirt,.etc.): Depth of well:
Dialliever of 4Y01:4 Len-th of casin-:
ae,U-E A-C-- 3- XA' C 0 C)� (4
Work details and other information: Witt 1 5, 0� Pv C,
Name of registered well drilling contractor perfortniiig work: U0( (4 PUC EC(Qt
Registered well drilling contractor's license type ScH: W I.-H
—W3-#—
Materitils Used: Itillount of Sand
amount and type(s) ot'grout
Description of work completed:p---('X—�
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tbe-n
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G;�Lts-� CAAi-t -�Euu
signed: -illim, contractor
....... Pcan sand
'Ib5 Copitol Avenue, Hartford, Connecticut 06106-11)30
I`cix: (860) 560-7630 o TDD: (860) 566-1547
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Or)pot-tunihl Eiiiployor
l.)L. " I j 1 N P 4 11(, N I N,I"IL 141
6: 111:I(I U HN 0 _"3 At L: vL')I L'Iu.i1 IS ill I I)I w, I:, nut UV ASO=0 OF M A"1, 14 cull Lon in a rion ur'Tull no U" a r gmund wAwr NsomTes.
'
ill I,,"i it I'— b I ': pv 11,0 FoICII 1)1 11 i I VU[e Ll r ll ill) 13)' ;1 egis turedV% V I l (I ViJ IC j,he I-eg 1'. istered well (I HIling
jwNwass the "urk orAbo"dia"ment shall U,- ,vspunwible rur cumpliance ON rho procedure of nbandon-
OrWdrd in An pArc And Will "Wily W local hirnbli "othowy ur ove ohalldonmeM Of be well.
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Ill ur (nhvr ,)'pc uf wc!Flhc proper procedure And rnatt!rials sluill be used
111.1(1 ell(I'micu lit ti'Tilve Nva[v.r, cil-c111:,ri6n (it'\\Aicr Ue.twevil, or mriorig pru.
All\ tnili.Ar rvstllrill� ill (ho coil tA 116;1.4 tilill ov polltiliull of grutold Ili lkler I-escitirces.
AL);Ilidwallivill L)F diScumit""wee of the "se A Any %"Ih I hewdl shall be Sealed MEll ,"I
il'. odl -.11-M Ili: cljlurilla(cd prior Ili ;Ib;lndUIIIIIeII1 tvillg ;I chlorin!: Su wirli ;I millifiluill colleen wai u I) of one
Iik 1,.u1 . in-J, Illillwil (150 1)1)11):) Of L:IIIUFilIV. 'j'hi-% c, equivalum ru i.5 t1n;,ris of ble:ich .it 2.25% ay.,iihible
Ilk;: InIndf0d (51,10) g.owns or wnwr ur MmIr h"movd thirty-three (333) feu:( ot'sk (6) inch diameter Well.
"S ShAl A Mcked front hind stirl"Ict! 10 the vIllice depill.ul,(lie well before it is insure ;lphisr file
of :nj) ob-iii-ijc(ion iluil will interbi-c ivirh sualing uperaHons,
III: llul*e-iliAl be filled 'And seAed Nvich MlY of Ihv Mowing maceHals: hca,t Cement grout, sand"cement grout,
owAuj"n clay gran!,or amd chy or betifonilt, evil-lent gi-olli.
W fne grwn inrucAd MwH be PlIteed in such MWAY To j"went Wds in the grow or dilution offhe grow
_%Ily %YCH colls(ructed ill n vonsohdanid rM ATIA11", inay be filled idth One sm"I in the zone br zones of consoli-
I o%A%. 1,11VA(Ill of(lie smid fill shall be III least trill (101 feel below the humni of the casing, and the reninining'por-.
Ill illv -.)ell Sh;II1 be filled willi :111), of[lie 111:11e1'kils Slivi,010d ill SubscClioll (C).
Q Ally imt md! ur burc sMill A abandunud in such a iwm"cr !hot it dues ium become wi uhnnnel fur We verdpal
:4livill I'll,liftnA, to the puLable grullini %virer resunrues.
iq WUP AAMYd"flu"I Ur OH IYAS Nvidl vasings free UfAIF'. Lireaks, ;*iu(I e\tendlug 1.)vin""Me powWo ground waur
wifil .1 w-mvi. 611111 cop kil. N%'0dVd pilot".
it-, 1-yoo cuiaplctitja ot';iDatidolinjelit of the NN'01, 11110 Eup A the cosin,- ti ur -uc ljlat4l-i;-d 1*1-1;*Iy be wrilinaled at leAsr
I
l'oliv t--ij fixi bvIcav (lie gyotitid surfnve.
\N1-,.,LL LOCATION
lociltiull U1, Nvell with dishinces to fit( lost hvu pertnanent landmarks
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CPR-8 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT 244353
DEPARTMENT OF CONSUMER PROTECTION
RE4L ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING:PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
South Windsor 765 Sullivan Ave. 12/15/08
OWNER OF WELL
F INDIVIDUAL BUILDER El
OTHER(Specify) 6 4 4-2 4 31
OWNER'S ADDRESS
John Woodcock PO Box 684 South Windsor
i Est.No.of
PROPOSED DOMESTIC BUSINESS FARM 'a TEST People being
USE OF ESTABLISHMENT WELL served.
WELL El PUBLIC INDUSTRIAL a AIR ® OTHER WET L BANTDONMENT
SUPPLY CONDITIONING (Specify)
SKETCH OF WELL LOCATION
Locate well with respect to at least two rnarle 1howing distance from intersection and front of lot
locatinn of I,,.•- / Well location on to and to house(if present)
/ - Y-6 I,�„
Indicate fd�^ I
ll,J c
Hoki
-..................
- �.
--------------
a
Approximate number of feet from well to
nearest source of possible amin n:
The undersigned is aw at u completion of the well, a"Well Completion Report"containing construction details and information required under
Section 25-131 of th 69 neral Statutes must be sent to the owner, the Department of Consumer Protection and the Water
Resources Com a 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. h o
APPLICANTfw�e)�_ APPLICANT'S ADDRESS REGISTRATION NO.
oe aven�4�,z PO x 406 Will ' gton 42
BY ow a th Offi ror gent) DATE � �^
APPROVEDJ. ❑ REJECTED \1V(j
REMARKS f
; N
DIRECTOR OF HEALTH