HomeMy WebLinkAboutDrain Layers Permit 48 Hitchcock Way TOWN OF SOUTH WLNDSOR INSPECTION REPORT
Permit No. 6578 Contractor M CHAEL WILCOX
Location 48 HITCHCCCI' WAY Andress EAGLE EARTHWORK SERV .
Type Work NEW SAN LAT 101 N MOUNTAIN ROAD
CANTON CT 06019
,N�unePve:. (860 )698-2027
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Permit No. 6578 Town of South Windsor, CT
Permit Date 63/17/1997 Drain Layer Permit
Expiration Date 04/16/1997
Descrip: LOT 14 AVERY MEADOW
Applicant Location
Name MICHAEL WILCOX .' TCHCOCK WAY
Addr. EAGLE EARTHWORK SER
NO BUILDERS
101 N MOUNTAIN ROAD
CANTON CT�O K
Phone No. (860)693-2027
The Drain Layer as 9� s � s a , i ense issued by the
state and hereby agre �'' d =tom s set forth in the
attached 'Condit 1 k � _ dvw with Town of South
Windsor standards, all „. A4 ched conditions.
Issued By
Date Insp®cted � ���� l 7 ., - °p� By
TOWN OF SOUTH WINDSOR
SANTTARy SEWER INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTED
1. Is Permit On Job SiteLI
2. Police Notified
3 . Safety Items In Place
D ���
a. Shoring, Trench Box, Ladder
b. Hard Hats KD 3 g
c . Pumps
4 . Proper Material
a . Pipe R
b. Pipe Bedding AI?
C . Backfill /0*
d. Warning Tape RD 3
e. Pipe Cap or Plug _
f . Cleanouts R Q_ 3�8
g. Fittings RD _
h. Manhole RD /8
i . Cover & Frame --
5 . Existing Lateral Cap Removed
in Presence of Inspector
6 . Lateral probed and found
to be clear
7 . Pavement Cut Properly I�
8 . Trench & Bedding OR \L `�
9 . Joints Properly Done /8
10 . Backfilling (12" Lifts) 9 3«
& Compaction
11 . Manhole Inverts Built 3119
12 . Subbase Material Placed RD `$
13 . Base Material Placed i1J 4/9
14 . Blacktop (Temp) w/Proper RD V'r
Grades & Slopes
15 . Pressure Test R D Y/S-
16 . Mandrel Test PD 31le
17 . Installation agrees with plan
18 . As-Built plans recorded 3//3
APPLICATION FOR DRAIN LAYERS PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULL[VAN AVENUE
SOUTH VIMSOR, CT
FEE$25.00
Location of proposed work GL Lot #
Street No. Street Name
Premises owned by: NdI7/I ar,�q y
Name of Firm: Phone kg3 ,76 z7
Address of Firm: f D cD
TYPE OF WORK:
Lay House Drain X ;_ Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 1�!►c
Proposed Start Date Estimated time for completion l�
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 910A� the holder of Drain
layer's License No. _z7611& . Only holders of P1 P 8b W8 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 thereto. Applicant has received Town Street
Excavation Permit No. and/or ConnDOT Permit No.
Signed: Print Name
9
Licensed Drain Layer
Dater f 7