HomeMy WebLinkAboutDrain Layers Permit 6 Jared Court ;tomY9.. { 3 -1'+ .. .Ju
TOWN Of SOUTH WI N DSOR
\�•'�� DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
C DRAIN LAYER'S PERMIT N 5947
Z , 19 3
Pursuant to written application, permission is hereby granted to the
Licens d Drain Layer named herein to perform the work indicated below at
F ]� remises owned by
w ose address is s` O.�" and to
Lay House Drain, RepAir0gouse Drain, Lay Main, Other ✓,
for occupancy or use, with
Family Units, with acres.
Type of " Sewage'-fto -be connected under this permit: SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ); OR (
Connection will be made with S'rjpC-
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date ],/-23 - -3 Estimated Time for Completion
Permit to be issued to
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 the reverse side
thereof. Applicant has received Town Permit No. and/or
CHD' Permit No. /
Signed
icens D Y Layer
The above named Drain Layer has a -valid icense issued by the State of
Connecticut and has filed a satisfactory bond ;and insurance policy in the
name of the Town of South Windsor:
Eng 8 iaierin 'Dept. Date
Permit Fee Paid $ p'���j Check Number
Connection Charge Receipt No. l42201� Dated LA
e
Issued by
INSPECTION q
Date work started 2— l.� Date completed
Sufficient notifica on ece ve : es No
Special Conditions
APPROVED - -Z3y9
nspector Date
�bM
TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST Ak4 ,57V-7
FUT;CT_I e`er q V— �, NO YES N/A DATE INSPECTED
1 Is Pernut. On�Job Site
2. Police Notifie�["
3. Safety Items In Place
a. Shoring, Trench Box, Ladder
b. Hard Hats
C. Pumps
4 . Proper Material
a. Pipe _
b. Pipe Bedding
c. Backf ill
d. Warning Tape _
e. Pipe Cap or Plug
f. Cleanouts
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) A
& 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