HomeMy WebLinkAboutDrain Layers Permit 53 Carson Way ' •.x _ ,
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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5985
I I 91:L
Pursuant to written application, permission is hereby granted to the
�`` Licensed Drain����L��yer named re n to perform the work indicated below t
Ls+7��Ci4rS oy't�iyRG .T, 4V 1; premises ,owped by �' S
S SZ IQ l.'�,� r, krf Le d
whose address is Jh s^ /^ aid_ to
Lay. House Drain, Repaillvtiouse Drain, Lay Main, Other
for t occupancy or use, with
Family Units," Vith acres.,. . .
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( . "'OR
Connection will be made with SnR St�4JPr !�/ate
Show sketch of proposed workor furnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS. OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date Estimated Time for Completion /
Permit to be issued to �Q�1r/1 J9G'6CjE'S
the holder of Drain Layer's License No. WVg30 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' r'eceived' Town. Permit No. and/or
CHD Permit No..
SignedY A
ce6- Ale d D in Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory and and insurance policy in the
name of the Town of South Windsor:
J��i 1.l�
ngie in Dept. Date
Permit Fee Paid $'` Z,f�O� Chec Number
Connection Charge Receipt No. _ 33. Dated `711z/9
S
Issued by
INSPECTION
Date work started 7 — 9 93; Date completed 7-
Sufficient notification rece3 ve es No
Special Conditions
Of
APPROVED•
Inspector Date
TOWN OF SOUM W33WOR
SANIM Y SERER INSPECTION CHECKLIST
FUNCTION F. 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 v
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
9 . Joints Properly Done
10 . Backfilling (12" Lifts ) ✓
& Compaction
11. Manhole Inverts Built
12. Subbase Material Placed 1/
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 _