HomeMy WebLinkAboutWell Abandond 122 Beelzebub Road CPR-8 Rev.7/95 PERMIT NUMBER
STATE OF CONNECTICUT 249693
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATE&PROFESSIONAL TRADES DIVISION
WELL DRILLING PERMIT
165 Capitol Avenue,Hartford,Connecticut 06106
LOCATION OF WELL (Town) (Street) (Lot Number) DATE
South Windsor 122 Beelzebub Rd 4/14/11
OWNER OF WELL
INDIVIDUAL BUILDER El OTHER(Specify)Contractor
OWNER'S ADDRESS
First Choice Home Services 2 Teault Rd Stafford S rin s
Est.No.of
PROPOSED DOMESTIC BUSINESS FARM TEST People being
USE OF ESTABLISHMENT WELL served.
WELL
PUBLIC 1:1INDUSTRIAL Q AIR a OTHER WTPT L AR NDONMENT
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)
6
Indicate North
r
welt -t-o
ta°
Approximate number of feet from well to
nearest source of possible contamination:
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 is not valid until all information is filled in and it has been counter-signed by
the Director of Health or his agent.
APPLIC T(Signature) APPLICANT'S ADDRESS REGISTRATION NO.
Joel Staves PO Box 406 Willington 42
BY(T n Health Officer or Agent) DATE
2PPROVED ❑ REJECTED
< REMARKS
RETURN THIS COPY TO DEPARTMENT OF CONSUMER PROTECTION
STATF 'OF CON ,NECTIC. UT
-Q-r z 5-
DEPARTMENT OF CONSUMER PROTECTION
REAL ESTATL & PRO VESS IONA LTRADES
-
�VELL ABANDONMENT, VERMCATION 01' VXORK COMPLETED
all 1*011ONY regulations established under
tj'OUL ures followed: All procedures used to abandon a well shall 0
Section 25-128-56-2krid 25-128-57 of the State Of Connecticut Well Djrilling Board Regulations (see ilttach-
'I'llese regulations require that a registered well drilling contractor perform the work.
1;'01- NvItter supply wells attach completed form to Well Permit. For non-water I supply wells*attach sketch
of well location to completed form. Distribution: Department of Consumer Protection, Department of
1"livil-01irnell till Protection, Property Owner, Well Drilling Contractor, Local Director of Health.
Well infol-11111tion:
Town: Date wort: completed:
tartte of
06
A-Lid r ess
ljocalitni of well (if different from above):
ype of well (drilled, point, dub,.etc.): br'i'tk e Depth of well: 19)S
Diameter of well: 6 Length of casing.: U4naWN
Work details and other information:
Nftnle of registered)well drilling contractor performing work: 3,0 S�AVQn 5-
1:egistcj-ed well drilling contractor's license type & fi: Wj.-# _W3-#
Materigals used: amount of sand
amount and type(s) of grout
1)cscription ofwork completed:
jar
&ko
A#
00or C?f �4— -VAY-
SiUlled: (well drillino La
165, C--apitol A\venue, 1-1,IrtfORI, Cortn'ecticut 06106-1630
Fax: (860)566-7630 9 IDD: (860)566-1547
..'kit Affirmative,Action/-Eqiial Opportun'i y Employer
I:.I i-' L J I. 1'1.0 IN S I: L 1, ;:k 13--A.1\4 1.)0 N iN 1,Ii N T
(Agickau"N A Ct.PllLl,":(iCwt Statu Agulll.:ies)'
1.1.11 IS �1,.111 uUt UV A SUUMC Ur Cant, Uf cont"mkintion ur polhaW of ground YyWor rmoull-ces.
pro,:,villl'ci sJl:'lll Ile liel-furclicd or directed by n registerml =3 driller. The i-eghterned well drUhn.-
!", !wl,kil-lus ihc ,Nork of a U.11 lit]Lill Inell t shall 1.),: -vspotisible- fur cull, \%-irl) rile procedure of.-lbandon-
nest, i,x or�6dcd in ON parr and skill nulOy the lucnl hcriLrh lWhOlity or.rhl.2 rilln"donment of the well.
L-,i93 I
—i ,i ,I :in), water we-ji or mhvr 4po urwcu the pruper PIMLIAdure and materials shall be used
jmq.-.grd 'to Ill-vvulit 1-liv. ell(rallUir Uf"w6me waraq cNeukdon of"wer between or arnwig pru-
ocher pruc"s rusulving in the ca"taini,"Liun or palluo,,n Agratind "nor resources.
U1 fc1l1pucary aballdOnOlCuf Or discuntinn"nee of the use of any well, Hie 1yell shall be Sealed With "I
—o :!not cAp r N", ns pmWed by Scuricin 25-12SA2 (c ii.
i- v-11 -i-ill bc chlurinatcd prior to abandoninelit wilig, .1 cliki-ine sAudon with it miaimum of one
jwr illilliun 050 PP411) lb etilli"Ima ru 15 quarts or hmach or 215% MOW
Imudred (SUO.) gallous uf ionur or three hundred thirty-three (333) flat ofsk 1) inch fl-ifirners' well.
.0; 1 A "cli Shall A dictalmd Avat land surMce to the entire depth or the well before it is scaled, to insure again3r rile
v."C!4t:c Of All) ob-ill-11c(i0il that will haerkre idth scaling uperallons,
m "CH I-Wrellbill befillml and smiled NvAh any urthv Allowing nimel-i.,ils: heai cement grout, sand.cemeni grout,
WOA"llw Qlay grout ur sand cQ or benronite cement grunt.
J Vic jeutit inatedal Will be }paced in such mwity to pl.,yent voids in the grout or dilution of the grout.
1N`Cll �UUSWUCted in .) Cu list))i da rod ruck I-orill."lliuLt, unly be tilled with line sand in the zone 6r zones ofconsoli-
"CL fhc by UY Me sand An shall be at I= rtru (11J) Wer belovy the butrom of the casing, find the remaining por-
A At: "011 shall be fillcd whih any or the rmued.1s sp,,titd in substrVan (q.
th-1 Any ,Nell Ur borc shall be .1baliduned in such a imuner that it clues nut become a channel for the vertical
CIticilt %N;IIL:I, or utht.1, subs"I" ru the PUMP grumm ,voter resutirves.
il.) bCvjj Nasiv di..'pusal Or oil Nvells Nvirll vnsillgs Urtte ufaji,j, breads, and extending belmi rile potable orotund walcr
—heN, JIQ Oc sualiza wish a water tigirr cap or wcW,d po,,
, kj_j L.;ljjii conipic:(jou Ljf jjUafjdj)jj ulen t ul*tile N%%l" the cup of tile cilsiug urgrulcr material vruty be ierminared .It least
julij 4l feet bClu%v file ground
1.ilcc Li*v 0 Ala)-2 1, 1!)931)
SKI.-I'a.1 Of" NNNN--1-h'LL LOCATION
loqqioll of well with dis(nnCeN to ttt least two permanent landmarks