HomeMy WebLinkAboutDrain Layers Permit 269 Abbe Road TOW4 OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
�J
BUREAU OF POLLUTION CONTROL
1
DRAIN LAYER'S PERMIT 5979
"
e)0A/ , 19
Pursuant to written application, permission is hereby 'granted. to the
Licensed Dr Layer named herein to perform the work indicate ' b o at
at premises owned by Je�e.t' /7af 1�
whose address-lis ►�1 and to
Lay 'Hou a D_ ai , Repair House Drain, Lay Main, Other
for ca occupancy or use, with 2-
Family Units, with j _acres.
Type of Sewage to be connected under 'this. permit SANITARY SEWAGE (�) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furni h two (2) opies of separate drawings.
C Q�Q
Q
SPECIAL COND OSHA REQUIREMENTS MUS BE FOL WED
TI S�
Desired Start ng Date j + E timate Time for: Completion Cie,
Permit to be issued to
the holder of Drain Layer's License No Permit will expire thirty
(30) `days- after date of issuance. The undersigned Drain Layer hereby agrees '
to all the. terms and conditions set . forth in the permit and the reverse side `
thereof. Applicant has received Town Permit No. and Jor `
CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a val license issued by the State of
Connecticut and has filed' a satisfactory bond and insurance policy in the
name of the Town of South Windsor: '
Engineering Dept. . Date
Permit Fee Paid $ ,_25,00 Check Number ---*
Connection Charge Receipt No. Dated
�.
Issued by
INSPECTION
Date work started Date completed 7,
Sufficient notifica on received-.- es No
Special Conditions
AP
Inspector Date
INN N .
TOWN OF SODTS pINDSOR
SANITARY S INSPBCTION C RCK,IST
FUNCTION .2-6 9 a�
NO YES N/A DATE INSPECTED
1' Is Permit On Job Site
2. Police Notified / `
3. Safety Items In Place
I- Shoring, Trench Box, Ladder
b- Hard Hats
c. Pumps ✓ —
4. Proper Material
a. Pipe Y
b• Pipe Bedding
C. Backfill ✓ _
d- Warning Tape -LG
e. Pipe Cap or Plug —�
f- Cleanouts
9. Fittings
h. Manhole ✓
i- Cover & Frame
5 . Existing Lateral Cap Removed
in Presence of Inspector
-
6 • Lateral probed and found
to be clear
7 . Pavement Cut Properly
8 . Trench & Bedding pR
9 • Joints Properly Done
10 . Backfillin
(12
& Compaction Lifts)
11 . Manhole Inverts Built
12. Subbase Material Placed
. 13 . Base Material Placed
14 . Blacktop ( --�
Temp) w/Proper
Grades & Slopes
15 . Pressure Test
16: Mandrel Test
7. Installation agrees with plan
�• As-Built plans recorded