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r=-R- TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
_ - DRAIN LAYER'S PERMIT .,
Pursuant to written application, permission is hereby granted. to the
Licensed Drain Layer named herein to perform the" work indicated below _t
5.;7 . at premises owned by:. Toe Irl=,ar 1
whose address is _l Z 71> S, -, and to
Lay House Drain-, Repair House Drain, - Lay Main, Otheri ,Pr,
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.
OSHA REQUIREMENTS MUST BE 7OLLOWED
CONDITIONS-
StartingSPECIAL "
Desired Da
te to Estimated .Time for Completion
Permit to be issued . to •',� S v = 6 C/ic, -v,-��'
the holder of Drain Layer's License No. 2p8 341R . Permit will expire thirty
(30) days after. date o'f ,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. 4�;1.23 and/or
CHD Permit No.
Signed M&62
Licensed Drain 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 $_ r' S CC) Check Number, 12W*1
Connection Charge Receipt No. .C/L,� RC� Dated
Issued. by13�
INSPECTION -
Date work started "'.Z -9 Date completed -2 -
Sufficient notification rece ve : 17 Yes No
Special Conditions e
APPROVED: Z
Inspector Date
TN JAC1y�
COMPA-4Y
i Other Locations:ily'
x. 150 UNIVERSAL DRIVE(Rear) _.___P.HgNF,203 .77�548_
AR
97 OLD POQUONOCK ROAD 1-800-423-0112 COLTON ROAD PHONE 203 739 5457
BLOOMFIELD,CT 08002 FAX 203 288 0867 EAST LYME,CT 06333 FAX 203-739-8513
WATER/SEWER TEST REPORT
PROJECT/LOCATION:
r
INSPECTOR: TESTED BY:
DATE OF TEST•. 199 CONTRACTOR ►1'�'15G
HYDROSTATIC TEST
WATER MAIN TEST❑� 'SEWER MAIN TEST LENGTH OF TEST:
STATIC PRESSU�E: TEST PRESSURE:
ALLOWABLE LEAKAGE: ACTUAL LEAKAGE:
TEST RESULTS: PASSED ❑ FAILED ❑
T.
REMARKS:
_ IRA- ..
AIR TEST`'
. MANHOLE TE$T PRESSURE TEST RESULTS
NUMBER, IN P.S.I. TIME OIL- REMARKS
j OR STATION. START STOP DROP IN ON. y TEST
I`K
4 i
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SIGNED.
INSPECTOR "TESTOR ;
JIL- 49
ire
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SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:_g - Z (o - 94. TIME: Io 16
BY: i2Lm FOR LOCATION: !4 7 1- 2Ha�, F
DAY INSPEC . NEEDED Z to ._ f� TIME:
TYPE OF INSPECTION:
( �} SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
q INSPECTION REPORT
DATE: / Z TIME: zz �S INSP:
CONTRACTOR: _ WEATHER:
ci
WORK IN ROGRESS: �f
LZ
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AREA OF CONCERN: r.
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1 f ; 12 o .l1, 2- 7._
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SPECIAL INSTRUCTIONS: