HomeMy WebLinkAboutDrain Layers Permit 9 Linda Lane (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
at premises owned by
whose address is and to
Lay House Drain, Repair House Drain, Lay Main, Other
for " occupancy or use, with
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.
. r
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date �' ' ' Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. -71 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 `
Licensed brain 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:
Engineering Dept . Date
Permit Fee Paid
$ Check Number
Connection Charge Receipt No. Dated
Issued by
INSPECTION
Date work started 9ZF✓ Date completed
Sufficient notification r celve : es No
Special Conditions
APPROV ; 7 - Z.(�—
Inspector Date
TORN OF SORTS WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION " ,r. NO YES N/A DATE INSPECTED
'4
1 . Is Permit On Job Site
�a �9 9 l)
2 . Police Notified
3 . Safety Items In Place
a. Shoring, Trench Box, Ladder
b. Hard Hats _
C. Pumps
4 . Proper Material q
a. Pipe XI
b-. Pipe BeddingC. Backfill
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 OR _
9 . Joints Properly Done _
10 . Backfilling (12" Lifts ) - i--
& 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