HomeMy WebLinkAbout395 Buckland Road (2) OCCUPATIONAL&PROFESSIONAL TRADES
WELL ABANDONMENT,VERIFICATION OF WORK COMPLETED
Procedures followed: All procedures used to abandon a well shall follow regulations established under
Section 25-128-56 and 25-128-57 of the State of Connecticut Well Drilling Board Regulations (see attach-
ment). These regulations require that a registered well drilling contractor perform the work.
For water supply wells attach completed form to Well Permit. For non-water supply wells attach sketch
of well location to completed form. Distribution: Department of Consumer Protection,Department of
Environmental Protection,Property Owner,Well Drilling Contractor,Local Director of Health.
Well information:
i
Town: To W A u/-P,17 0 2 Date work completed:
Name of Owner: 39 5 BuG� I a n Rood, LLB
Address: rbO�- Q(00mg-4 A-,e uJi�Jsorz CF 0&0HS
Location of well(if different from above): J9 u L l a r) lw a c�
Type of well(drilled,point,dug, etc.): dri Depth of well: `u 3 -4-
Diameter of well: G " S k e d Length of casing:
Work details and other information:
Name of registered well drilling contractor performing work: v 6 el c. Li,l e-b g.
Registered well drilling contractor's license type&#: wi-# w34 Lt6 Permit#0f aoolicable) 2(0 to
Materials Used: amount of sand
amount and type(s)of grout 6? ar s �v nY ce�i e„� q ro K f
Description of work completed: C /or,.Ig Al we�f rvn ,-m�� deep
6 well -JA t 4,,dS oT rz, J Re-70il— wd/
c JCre bz la w rxJe ba % ane,4—, n�, irc c%
Signed: (Well Drilling Contractor)