HomeMy WebLinkAboutDrain Layers Permit 30 Brookfield Street r,
777777
f
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL .
DRAIN LAYER'S PERMIT NO 5977
i g
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
at premises owned by, J)=x4/ T
w44s'e address is and to;
Lay House Drain, 4-- Repair House Drain, Lay Main, Other
for iJuG occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE'
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of propjaw or furnish two (2) copies of separate drawAgs.
7AREOUTIM
MENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued toc�L-=�a� �
the- holder of Drain Layer's L cen'se No. ,i�d Permit will expire thirty
(30)-days after date of issusnce. 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.
Sign --`
v LiceFfsed Dra n Layer
The above named Drain Layer has a valid license issued by the State of
L
Connecticut and has filed a satisfactory and and nsurance policy in the
name of the Town of Southindsor
J
Eng ne r ng Die Date
Permit Fee P 'W Che N mber c
Connection Charge Receipt No. ' Dane
Issued by
r
INSPECTION
Date work started Date completed /
Sufficient notification receive : Z. es pNo '��'—
Special Conditions
AP PJ
Inspector Date
k
TOWN OF SOUTH WINDSOR
` SANITARY SEWER INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTED
F-
1. Is PermitOn Job ite
59 7 7
2. Police Notified
3. Safety Items In Place
a. Shoring, Trench Box, Ladder �p _
b. Hard Hats _
C. Pumps _
4 . Proper Material
a. Pipe - —
b. Pipe Bedding
C. Backfill —'
d. Warning Tape
e. Pipe Cap or Plug _A1
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 X
8 . Trench & Bedding OR A
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