HomeMy WebLinkAboutDrain Layers Permit 45 Brian Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5942
Pursuant to written application, permission is 9 192j--
hereby granted to the
Licensed Prain Lave arced herein to perform the work indi a; ed be ow at
L(( fI at premises owned by %y�� "G
whose address is
Lay House?Drai,n,� JC Repair House Drain, Lay Main, Other and to
for occupancy or use, with /
Family Units, with G � / acres.
Type of Sewage to be connected u er his pe mit : SANITARY SEWAGE INDUSTRIAL WASTES ( ) , OR ( ) '11) -
Connection will be made with ���
Show sketch of prop work or= sh 'two 2) copies parate drawings.
cayt�
OSHA REQUIREMENTS UST BE FOLL WED
SPECA C NDITION
Desired tartan jDFate o?I A�o/Z 3 Estimat Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 20 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/or
CHD Permit No. a
Signed % 1A.1
Licensed Drain Layer
The above named Drain Layer has a vali 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:
i-� 411 3
ngi ring Dept. Date
Permit Fee Paid $ i�,'5, 00 Che P Number " ,
Connection Charge Receipt No. _k� Q`j Dated
Issued by �
INSPECTION
Date work started -4iL�
3 Date completedSufficient notificaf' or 'e _ eS No T- --�
Special Conditions
APPROVE -2 j,
Inspector Date
TOWN OF SOUTH WINDSOR
..SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
�{- BUILDING ADDRESS OR LOT N°: 'y
STREET:rri
SUBDIVISION:
n
G
ce " NH STATION : +
ZNORTH ARROW INVERT ELEV:
CA oif IS 77
r" J 10% /Cry]
TIE / TIE
FT -FT,
HOUSE LATERAL LATERAL HOUSE
ONNECTION e STUB STUB CONNECTION
FT. FT.
BUILDING INV. ELEV. INV.ELF . � INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.). (IF EXIST.)
f�
TIE TIE
E
bH STATION : +
\ INVERT ELEV:
� �_ -J c�TIP,' / �M �GC►VG, O l`S _J ry L��
CCONTRACTOR (PRINT) NAME OF CONTRA TORS SUPERVISOR(PRINT)
, 23
STREET ADDRESS I E DATE
CT
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER
k 9� TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION �� 594. z_ 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
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 �p
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
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 T_t3.-97