HomeMy WebLinkAboutDrain Layers Permit 43 Hitchcock Way TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 6563 Contractor MICHAEL WILCOX
Location 43 HITCHCOCK .WAY Address EAGLE EARTHWORK SERV .
Type Work NEW SAN LAT 101 N MOUNTAIN ROAD
CANTON CT 06019
Phone No v (860)693-2027
Date Insp Needed _-.? " ' aenSp y7
Time I nsp Needed /4 tea. Time` n ,.
Inspected By AfK,,IA
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Permit No. 6.663 Town of South Windsor, CT
Permit Date 02/03/1997 Drain Layer Permit
Expiration Date 03/05/1997
Descrip ; 43 HITCHCOCK WAY LOT 11 AVER`( MEADOW
Applicant Location
Name MICHAEL WILCOX A,dr, 43 HITCHCOCK WAY
Addr . EAGLE EARTHWORK SEiV, Owner MANNARINO BUILDERS
101 N MOUNTAIN ROAD,
CANTON CT "06019
Phone No. (860)693-2027
The Drain Layer assignad this per mit, has a Valid license issued by the
state and hereby agrees to a 1 't the terms and condi tJ'tins set forth in the
attached 'Conditions ' . At work` ehali ba,' ifn::acQq dance with Town of South
Windsor standards, all OSHA requirements, and # " attached conditions .
Issued B �/ __
Date Inspected -I inspsGted By _Ir � -� --------- _
TOWN OF SOUTH WUMSOR
�13 l i /tc�cle Jvlay ' SAxT !ARY SEWER INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTED
1 . Is Permit On Job Site fU z�y
2. Police Notified 4-/
3 . Safety Items In Place 2Jy
a. Shoring, Trench Box, Ladder _
b. Hard Hats Jz D y
c. Pumps a �/
4 . Proper Material
a. Pipe 2f�f
b. Pipe Bedding �— a
c. Backf ill p)D a y
d. Warning Tape o a y
e. Pipe Cap or Plug ay
f . Cleanouts _ 2
g. FittingsZ a H
h. Manhole
i . Cover & Frame 1al�N
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 i�D ly
10 . Backfilling (12" Lifts)
& Compaction
11 . Manhole Inverts Built y�`(
12 . Subbase Material Placed
a)�
13 . Base Material Placed D :k/y
14 . Blacktop (Temp) w/Proper �I W
Grades & Slopes
15 . Pressure Test
16 . Mandrel Test _ iq
17 . Installation agrees with plan �I~l
18 . As-Built plans recorded ���
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: 91) jZfj j 00 Lot # l l
Street No. / / Street Name
Premises owned by: AAAWt'dD k, Mov 'l
Name of Firm: Mn4alLlo h dal` Phone:
Address of Firm: I/ D kk-i dR .
TYPE OF WORK.
Lay House Drain _; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Proposed Start Date �``� Estimated time for completion 2
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 A 4461 01lux the holder of Drain
layer's License No. 2 78 N . Only holders of Pl, 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 thereto. Applicant has received Town Street
Excavation Permit No. and/or ConnDOT Permit No.
o �.
Signed: Print Name Ai 4, 1 v k' X
Licensed Drain Layer
Date: -6Z
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