HomeMy WebLinkAboutDrain Layers Permit 047 Austin Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT `5972
y-7 2.Pursuant to written application, �9 3
permission P is hereby .granted to the
Licen aD a �La rer na�d Sher to perform the work indicated below t
t✓l/ at oremises own by p
whose address is S s�,-r /� �d, Yl Tape- a to
Lay. House rain, Repai House Drain, Lay Main,' Other
for occupancy or use, with
Family Units, Afith 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 furnish 'two (2) copies of separate drawings.
i
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Z7 Estimated Time for Completions
Permit to be issued to � S.
the holder of Drain Layer's License No.y X83o_. . Permit will expire thirty
(30) .days after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and con;£ii'tions set'. forth in the permit and the reverse side
thereof. Applicant has received Town Permit No. 'and/or
CHD Permit No.
Signed . GL1�
Lice ed YDIain Layer
The above named Drain Layer has a va14 license .issued by the State of
Connecticut and has filed a satisfactory bo d and insurance policy in the
name of the Town of South Windsor
E inee Dept. Date
Permit Fee Paid $ c '�i ,[ J Check tuber CSV� �
Connection Charge Receipt No. --=s. ated
Issued by
INSPECTION
Date work started Date completed
Sufficient notification � ` � ��n rece ve • es No
Special Conditions
APPROV D.
Inspector Date—
TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTI NO A YES N - --
_ / DATE INSPECTED
1. Is Permit On Job Site
A '4T 59-7
2. Police Notified
3. Safety Items In Place
a. Shoring, Trench Box, Ladder
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 OR
9 . Joints Properly Done .�
10 . Backfilling f 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 ,/