HomeMy WebLinkAboutWell Abandond 116 Sullivan Avenue J STATE OF CC) NNECTICUT
DEPARTMENT OFCONSLIMER PROTECTION
REAL Es'rATE&Pf"OFESSIONAL TRkDES
Wt LL ABANDOr4jNjE'NT, VERIFICATION OF WORK.'CONIPLETED
All procedures used to abandon a well shall folio,ecTion 25-128-56 and 25-128-5'7 of the State of Connecticut e V reaUlAtions established Luider
Drilling B
i registered well , wird I e-Ulations (see attacil-
lile4). These rea-tilatioiis require that ,, ti Ut'W 11 rilli
drillina
, contractor perforill the-work.
"'or Fv2-11er supply wellsattach completed form to Well Permit.of well loc pion For non-water sUPPly'vvells attach sketch
ro completed form, Distribution.: Department of Consumer Protection
Protection, Prope"TY Owner, Well Drillino, , Department of
Contractor, Local Director of Health.
Tolvil.- South Windsor
Date work completed: 4/6/05
of Owner: Scott Leonard Plaza Bank
Address: 116 Sullivan Ave South Windsor
1-0ea-floll of well (if different from above):
YP8 of well (drilled, point, dtig,.etc.):
D-1--r-lU Lled
of well: -103 '
DhauleTel- of well: 611
Length of Ctsin,. Aprox 60'
`Fork details and other infotn2Afikjj,,
Name of,reo-is tere'dwell d
rilling-contractor peffOrmjilg work: Stavens Bros
Registerecl vvell dfillilla contractor's
license
type
W1-# 4
W3-#
Milrerials Used: amount of sand
afflOtlilt and type(s) of grout1 yard of grout mix
J)eserip-tioll of l'York C0111PIetcd: —Cut. caELng, below grade, fill Well with grout
mix and topped off surface with soil
ell drilling contractor)0
165 COpitol Avenue, Hartforcl, Connecticut 06106-2630
Fax: (860)566-7630 e TDD: (860)566-1547
ArtAffIT'rriative ActioplErIlifl, Oppormnihj Eniployc7
ti
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES
WELL ABANDONNjriNT, VERIFICATION OF WORK COMPLETED
Lollo-�)Lecj- All procedures
--;eUion 25-128-56 11se(l to 'ban(IOU 11 well shall follow regulations established Under
and 25-128-57 Of the Stafe of Connecticut-Well
Weill). These reujjlatiojj_� Drilling Boarcl Regulations (see att,,ich-
1=1 C,
recit"l-e that 11 reolistereel well drilling contractor perform the work.
.b'ijr VaTer supply Ivells attach completed form to Well Permit. For non-water st'Pply wells attach sk
of"'ell location 10 completed form. Distribtition: Department of Consumer P etch
.Protection Department of
-Eliviroliflielital Protection, Property Owner, Well Drilling Contractor, Local Director Of Health.
),III inform i C1 oft:
1 wvll: South Windsor Date Work completed: 4/4/0 5
Mime of Owner: Scott Leornard
Address: Plaza Bank 116 Sullivan Ave. South Windsor
'�Oc"'011 Of well (if different from above):
'!'YPe Of Avell (drilled, point, ijtj-o
I.etc.): Depth of well: 41 '
D111111erer of well-
21
Length of casing: 41
vVoft detflih :And other h-fo
Name of registered well (billing Contractor performing work: Stavens Bros
lZe--21'steFec1 well drilling contractor's license type & #: -,Wl-# 42 W3-#
N-larerials used: amount of Sand Yard
am011n-t and type(s) of grout
of work COMPleted: Sand and gravel fill to 2' below grade
to surface
-- -yell drilling- contractor)
165 Capitol Avenue, Hartforct, Coanecticilt 06106-1630
Fax: (860)566-7630 as TDD: (860)566-1547
Ail Affirmative Action/EcItial Oyportimihj Employer