HomeMy WebLinkAboutDrain Layers Permit 270 Diane Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5949
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Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated 40 at premises' owned by "i elo elow w at
whose ad ress is A ts 6, and to
Lay Ho a Drain, �C' _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 ') ,
INDUSTRIAL WASTES ( ) , OR ( )
f
Connection will be made with ` f„1 `
Show sketch of proposed work or furnish 'two (2) copies of separate drawings,
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OSHA REQUIREMENTS MUSr BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to {J
the holder of Drain Layerfs License No. " Permit will expire thirty
(30) days after date of issuance. The un ersigned 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 .. _
Licensed Drall Layer
The above named Drain Layer has a valid 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:
41 � �G�
_ J Engineering 'Dept. Date
Permit Fee Paid Check Number
Connection Charge Receipt No. Dated -"'
Issued by /3��i✓�✓l r_-:�
INSPECTION p
Date work started Z/ Date completed
Sufficient notification rece ve : �- es No
Special Conditions
AP P
Inspector Date
-7 D TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION s/ 5` QJ NO YES N/A DATE INSPECTED
-29 9-3 4
1. Is Permit On Job Site �29-
2. Police Notified
3. Safety Items In Place
a. Shoring, Trench Box, Ladder
b. Hard Hats U
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 OK _
9 . Joints Properly Done
10. Backfi:lling (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