HomeMy WebLinkAboutDrain Layers Permit 205 Kent Lane y . r TOWN OF SOUTH WI NDSOR ; � {
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5976
19 L.3
Pursuant to written application, permission is hereby granted to the
License Dr/ai Layer nam d herein to perform the work indicated- below at
_ C at premises owned by 1 f�
whose address is �, S'6 o
Lay House Drain, Repair House Drain, Lay Main, Other ,
for lQ S�I) .rL�/r"4 occupancy or use,; with b N
Family Units, with acres.
Type of Sewage to be connected under this ,permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed :work or furnish 'two (2) copies of separate drawings.
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OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date 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 to ms and conditions ' set . forth in the permit`'and the reverse aide `
thereof. Applicant has received Town Permit No Viand/or
CHD Permit No. ,r ,
Signed
L c nsed. Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfacto y bpnd and -insurance policy in the
name of the Town of South Windsor
ngi ing Dept Date
Permit Fee Paid $ Z.. &Q Ch e�k Number 2.1 r-
Connection Charge Receipt No. aj . Dated &/, 9 3
Issued py c� ?
INSPECTION
Date work startedZ:2ate completed `
Sufficient notification recelvean. s No
Special Conditions.
nspector ate
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TORN OF SOUTH WINDSOR
SANITARY SERER INSPECTION CHECKLIST
FUNCTION :- � 0 57 NO YES N/A DATE INSPECTED
1 . Is Permit On Job Site "
S97b
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. Backfill
d. Warning Tape
e. Pipe Cap or Plug
f . Cleanouts
g. Fittings
h. Manhole �G
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 _e
9 . Joints Properly Done
1.0 . Backfilling (12" Lifts) _
& Compaction
11 . Manhole Inverts Built ai
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