HomeMy WebLinkAboutDrain Layers Permit 301 Griffin Road f-
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N"n 5944
Pursuant to written application, permission is hereby granted to the
Licensed Drai�iv
er named herein to perform the work indicated below at
-� at premises owned by y ,y�i� c�,J`i�9�
whose address is _ rI-/ IAI -
La House Drain and to
Y , Repair House Drain, Lay Main, Other 7—
for occupancy or use, with -�
Family Units, with acres. _
Type of Sewage to be connected under this permit : < Y SE
SANITARWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish "two (2) copies of separate drawings.
OSHA UI TS M S F L WE r ,
SPE IAL CO DITIO S
OF
Desi ed Starting Dateimated Time for Completion_
s�
Permit to be issued to /��������.,;, �G ,
Completion—
the holder of Drain Layer's License No. a 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. ;k o R 2,
F? /
Signed
. Licensed Drain ayer
The above named Drain Layer has a valid license issued b the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
Engineering Dept. Date
Permit Fee Paid Check Number y 60��
Connection Charge Receipt No. ".Z/`a`fJ/ ✓Dated
Issued by
INSPECTION
Date work started —� ate completed Z0-
-Sufficient trotificarlon receive : es No
Special Conditions
APPROV -
- — ---- --— - --- - - —__�
--
- ---- - Inspector Date
TOWN OF SODTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION 30 � NO YES N/A DATE INSPECTED
1 . Is Permit On Job Site f/' - 2 0'^�
2. Police Notified
3 . Safety Items In Place
a. Shoring, Trench Box, Ladder t/
b. Hard Hats
c. Pumps �✓
4 . Proper Material
a. Pipe
b. Pipe Bedding
C. Backfill
d. Warning Tape
e. Pipe Cap or Plug
f. Cleanouts _1G
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) 1
& 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: b 0 C
BUILDING ADDRESS OR LOT N' : G,, '= ,-,n Q
STREET: 701 6�f`
SUBDIVISION:
G 71-4
NH STATION : +
NORTH ARROW INVERT ELEV:
S�
TIE TIE
F T. _ -FT
HOUSE _�� Fl- L LATERAL _ HOUSE
CONNECTION a ST STUB CONNECTION
FT. 3.Y1
BUILDING INV. ELEV. V.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.)
O F EXIST.)
TIE TIE
lul-1 STATION : t
hh INVERT ELEV:
CONTRACTOR (PRINT) NAME OF CONTRACTO ir
UPERVISOR(PRINT)
C'o?a CC H- r-
STREET ADDRESS y SIGNATURE DATE
V6014ill w C�� oG6a
TOWN STATE ZIP INSPECTED BY TOWN DATE
--(-•a03 ) ;2q;l 0a3
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER