HomeMy WebLinkAboutDrain Layers Permit 12 Jonathan Lane J
OWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5931
19 i 9 /93.
Pursuant to written application, permission is hereby granted to the 1
Licensed Drain, Layer named herein to perform the work indicated below t
Z4he-- a pre e owne by L/ x Ca.
,
whose address ois 9� ✓,✓yr,l lYl.. �. �c� K--, and to
Lay House Drain, Repaii House. Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage- to be connected under this permits SANITARY SEWAGE ( �
INDUSTRIAL WASTES ( ) , OR (- )
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
4s her
OSHA REQU f=LMUS �BFIOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
e uc �o
the holder of Drain Layer's License No. 2opy, 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 PermitNo. and/or
CHD Permit No. i
Signed
License rain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
„ E ineering Dept. Date
Permit Fee Paid $A5 Check `N ber Oooa46�1
Connection Charge Receipt No. en
LIOQ 1_1 ated
Issued by
INSPECTION -
Date work started Date completed ^^ /
Sufficient notifica on rece v es No
Special Conditions
Inspector Date
a
TOWN OF SOUTH WIMSOR
/ S SANITARY SEWER INSPECTION CHECKLIST
FUNCTION � NO YES N/A DATE INSPECTED
,
1. Is Permit O(i Job Site
2. Police Notified
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 k
h. Manhole
i. Cover & Frame
5. Existing Lateral Cap Removed
in Presence of Inspector
6 . Lateral probed and found
to be clear
LS��
7 . Pavement Cut Properly
8 . Trench & Bedding OR
9 . Joints Properly Done _ �� �s 9,3
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 planCLy3
18. As-Built plans recorded