HomeMy WebLinkAboutDrain Layers Permit 109 Austin Circle F
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N120 5946
19�
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer n med h rei to perform the work indicated below t
!1GZ t at premises owned byZ----V�� '���,,, �
whose address is g c4
and
Lay House Drain, Repair ouse Drain, Lay Main, Other�� Pto
for EA�.�`0 occupancy or use, with
Family Units, with &a cres.
=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 furnish 'two (2) co—pies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS-
Desired Starting Date y....Z} � 3 Estimated Time for Completion
Permit to be issued to 6�
the holder of Drain Layer's License IT6. ag Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Lager 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/o-r
CHD Permit No.
Signed 16.
ticen-soW Dr n Layer
The above named Drain Layer has a valid 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:
z-a,
Engin ring Dew pt. Date
Permit Fee" Paid $ j.0 Check Number �V"L'ly
Connection Charge Receipt No. :qNn Dated
Issued by
INSPECTION
Date work started Date completed
Sufficient notification-rece ve : —Yes No
Special Conditions
APP
Inspector =Date
Y V TOWN OF SOUTH WINDSOR
SANITARY SEVER INSPECTION CHECKLIST
r ��}i� I
FUNCTION �� G & t NO YES N/A DATE INSPECTED
1 . Is Permit On Job Site
2 . Police Notified
3. Safety Items In Place
a. Shoring, Trench Box, Ladder _V 4
b. Hard Hats _
C. Pumps
4. Proper Material
a. Pipe _
b. Pipe Bedding _
C. Backfill
d. Warning Tape —
e. Pipe Cap or Plug
f. Cleanouts
g. 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 OK lo_w -
9 . Joints Properly Done _
10 . Backfilling (12" Lifts ) _
& Compaction
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
17 . Installation agrees with plan _
18 . As-Built plans recorded
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