HomeMy WebLinkAboutDrain Layers Permit 569 Griffin Road (2) - TOWN OF SOUTH
" WINDSOR
,�• . ,, � DEPARTMENT OF PUBLIC, Wipe
BUREAU OF POLLUTION CONTROL
V DRAIN LAYER'S
PERMT �r 5
959
Pursuant to written application,Licensed Drain La per�ission ' 19 �3
Layer named herein to is hereby granted
f'�vUC_ Perform the work indica ed to the
whose address is at premises owned by —� 'bel w at
Lay House Drain, /S G/[,C �d�¢f,/
for ..._Repair House Drain
Family , Lay Main and to
Units, with occupancy or use with Other
. --_
Type of Sewage tobe
connected under this
INDUSTRIAL WASTES
Connection will be (madeOwith) permit :. SANITARY SEWAGE
Show sketch of
Proposed work or furnish two
(2) copies of separate drawings,
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE
FOLLOWED
Desired Starting Date
Estimated Time for
Permit to be issued to Completion
the holder of Drain Layer 's `��
(30) days after dateLicense, No,
to all the.. terms and of issuanCe� �7— 7�_,• Permit will
The undersigned Drain La esPire thirty
thereof. conditions set forth I—the Layer he
CHD Permit ANol'icant has received permit and the r agrees
Town Perm t �o• reverse side
�•.
.Signed
The above named / / Licensed
Connecticut. and Drain Layer has �fiain: Laye
has filed a a valid license issued b
name of the Town of satisfactory bond and y the State of
South Windsor: '� insurance Policy in :.the
Permit Fee _ E i Paid $ eer Dept .
Date
Connection Charg
Check Nu e Recei ber
Pt No. '���
Dated ._...�.
Issued 11yr
INSPECTION
)ate work started / i3
>uffis -e-nt notificatr
special on
on ece ve Date completed
O,d �6 es No
v
------- --- AFFR E
Inspector
Date
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TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION 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. Backf it l
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 r�
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