HomeMy WebLinkAboutDrain Layers Permit 39 Deepwood Drive TOWN OF SOUTH WINDS OR
3 O
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITSo
5948
A , 192
Pursuant to written application, permission is hereby granted to the
Licensed Drain La er named herein to perform the work indicated be o,w at j
DU at premises owned by
whose addr a is and to
Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE JJ ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with3�
f
Show sketch of proposed work or furnish 'two (2) copies of separate drawings:
C6 % b : pro G? , -
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired. Starting Date — T-74.7)Tr Estimated ime for Completion_,2�
Permit to be issued to
the holder of Drain Layer's License No. 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.
Signed i.
License Drain Layer,
The above named Drain Layer has a val d 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: y,
Engineering Dept. Date
Permit Fee Paid $ ��R•-"'"" Check Number
Connection Charge Receipt No. Dated L/ -/ <j
Issued by
INSPECTION
ate work started Date completed
ufficient notification receive-T.— es No
ecial Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTED
1 . Is Permit On tTob Site 3
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 ie
c. Backf ill
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 L
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
TOWN OF SOUTH WINDSOR
.SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: A k 53
BUILDING ADDRESS OR LOT N':
STREET:
SUBDIVISION:
NH STATION : +
NORTH ARROW INVERT ELEV:
TIE TIE
_FT
HOUSE rl -FT.
LATERAL LATERAL MOUSE
CONNECTION STUB STUB
t]`> CONNECTION
FT /
BU LDING INV. EL INV.ELEV. 1= INV. ELEV. INV. ELEV. FT.
(1 EXIST.) � BUILDING
O F EXIST.)
TIE
TIE
'? � 5 � LG c\ . n
i
C
NH STATION : +ti `�
Z
G--� INVERT ELEV:
CONTRACTOR (PRINT)
NAME OF C;ONTRACT2RCS SUPERVISOR(PRINT)
STREET ADDRErS I NAT E
!� DATE
70
�r►' sir i' �) � 2 ,
TOWN STATE
ZIP INSPECTED BY TOWN DATE
k
LEPHONE NUMBER
MITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER