HomeMy WebLinkAboutDrain Layers Permit 1335 Main Street i
OF SOUTH VINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
--- ----- _DRAIN LAYER'-& PERMIT — --- - - —-
H'f _ a., , 1993
Pursuant to written application, permission is hereby granted to the
Licensed ,Drain Layer named herein to perform the work indicated below at
/33 MY at premises owned by A0�6,A _Y,4/44f /c
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,
t
EXrgr- u4'i'EI2AL.
SPECIAL CONDLTIONS OSHA REQUIREMENTS. MUST BE FOLLOWED
Desi 11 red Start ing .Date Estimated Time for Completion, UK
Permit to be issued to ..� (-� `J�/�-j =f . �Gt -'f' lam►: Its
the holder of Drain Layer's License No. Z07-1' %) 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 Per t No. and/or
CHD Permit No. �.
Signed �.
/�� censed Dra n Layer
The above named Drain Layer has a void 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 $ T Check Number
Connection Charge Receipt No. > 7�'J Dated
Issued by
INSPECTION
Date word started 2?-}3 Date completed
Sufficient, notification rece ve : es No
Special Cotfditions
AP P e 'ZT 9
nspector Date
TOWN OF SOUTH WIPDSOR -
- 2.-7 _ I SANITAR _Y INSPECTION CHECKLIST
rr
FUNCTION 7� NO YES N/A DATE INSPECTED
13zIr, « Z
1. Is Permit On 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 k
b. Pipe Bedding
C . 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 OK _
9 . Joints Properly Done
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 plan
18 . As-Built plans recorded