HomeMy WebLinkAboutDrain Layers Permit 29 Hazel Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'
S PERMIT19
19_
r
Pursuant to written application, permission is hereby granted to the
Licensed rain Layer_ "med herein to perform the work ' in cat' below at
i f 9 at premises owned by u" �' '^ -
whose address i Sand to
Lay House Drai, , Repair House Drain, Lay Main, Other ,
for I I /;._;;- .,v /=_)�,,r;t occupancy or use, with
Family Units , with acres. ,
-
Type of Sewage to ,be connected under this permit : SANITARY SEWAGE ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with 77 77,77
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
' P ,
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date r �?_,� , �� Estimated Time fo CompletionT t,
Permit to be issued to k,(�
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 t e ieverse side
thereof. Applicant has received Town Permit No.
CHD Permit No.
Signed
icen ed r in Layer
The above named Drain Layer has a valid 1�icense` isdu_Pd---6y the State of
Connecticut and has filed a satisfactory b nd and insurance policy in the
name of the Town of South Windsor:
nu
Jn ine r g Dept. Date
Permit Fee Paid $ �' ' Oc) Check. tuber S
Connection Charge Receipt No. :44( Dated 14 -3
Issued by
INSPECTION
Date work started - 2 6- �� Date completed l� 7
Sufficient notification receives: es No
Special Conditions
APPROVED: Z _9?
1 Spector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTED
1 . Is Permit On Job Site
2 . Police Notified —ice
3 . Safety Items In Place / -170,�
a. Shoring, Trench Box, Ladder
b. Hard Hats J
c . Pumps _
4 . Proper Material
a. Pipe ---- - - - - ---- -- --
b. Pipe Bedding
C . Backfill
d. Warning Tape
e. Pipe Cap or Plug _
f . Cleanouts
g. Fittings ox
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
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