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Per-M I t.,, No . 6597 Contractor J & H SLATER CONST CO
Locatior.) HERITAGE DRIVE Address 75 COMMERCE WAY
Type Work NEW SAN LAT SOUTH WINDSOR CT 06074
Phone No. ( ,360)526--5252
Date Insp Needed �_1> q Date Insp,
Time Insp Needed _ ---- Trtme Insp. - G- -'!
Inspected Syvl�r (uY
work it, Progress1, S k
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Input i .., �' ' Date .
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Permit No. 6597 Town of South Windsor- , G
Permit Date 04/25/ 1997 Drain Layer Permit:
Expiration Date 05/25/1997
Descrip :
Applicant Locat;i on
Name J & H SLATER CONST CO Addr . 6 HERITAGE DRIVE
Addr . 75 COMMERCE WAY ()wner RSK KELLCO
SOUTH WINDSOR CT 06074
Phone No. ( 860 )528-5252
The Drain Layer ass i griad this permit has a" va 11 d, ;license issued by the
state and hereby agrees to alA 'the terms and conditions set Earth in the
attached 'Conditions ' All 'wo,r^k steal I., be' in accordanda with Town of South
Windsor ;standards , all, OSHA; r•equiremen' ts, ' end the attached conditions .
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Issued By �`it �� �r ��,�{ T"i�t
f
- - - - le c
Inspected By
Gate inspected
30117 c/ TO1M OF SOUTH WI DSOR
p SaNrrARY SEWER INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTEI
1 . Is Permit On Job Site 0 �3b
2 . Police Notified �� �f
3 . Safety Items In Place If
a . Shoring, Trench Box, Ladder �u
b. Hard Hats
C . Pumps
. Proper Material
a . Pipe
b. Pipe Bedding
C . Backfill
d. Warning Tape
e. Pipe Cap or Plug AD
f . Cleanouts 9-0 _
g. Fittings �u 77
h. Manhole �D
i . Cover & Frame ff
5 . Existing Lateral Cap Removed it
in Presence of Inspector
6 . Lateral probed and found
to be clear
7 . Pavement Cut Properly RD If
8 . Trench & Bedding OK
/r
9 . Joints Properly Done Id
10 . Backfilling (12" Lifts )
& Compaction
11 . Manhole Inverts Built K-D !r
12 . Subbase Material Placed
13 . Base Material Placed RD f/
14 . Blacktop (Temp) w/Proper
�J o`
Grades & Slopes
15 . Pressure Test
16 . Mandrel Test if
17 . Installation agrees with plan
18 . As-Built plans recordedU ,!
APPLICATION FOR DRAIN LAYERS PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
Location of proposed work: 6 7� 7�1E Lot # 2
Street No. Street Name
Premises owned by: 111A�54
Name of Firm: d d W�5,—, 6 Phone: Sou' S-ZSZ
Address of Firm: �S �&4&-E 161AV
TYPE OF WORK:
Lay House Drain Repair House Drain ;
Lay Main Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 6 f�G
Proposed Start Date 5V-Zf Estimated time for completion ,-5d Z�+S
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR
STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO
THE PERMIT
Permit is to be issued to � ��� , (.O/F� �j the holder of Drain
layer's License No. 0077,E 9 Only holders of PI, P7 & W9 licenses will be
issued a permit. 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 attached
�///}J/thereto. Applicant has received Town Street
Excavation Permit No. -/� and/or ConnDOT Permit No. ZII,3�'
Signed: Print Name �/f3y115 lC �
Licensed Drain Layer
Date: 4z-z - /`^/7