HomeMy WebLinkAboutDrain Layers Permit 1523 Main Street (3) - ' TOWN OF SOUTH WINDSOR INSPECTION REPORT
/Per4it No. 7090 Contractor GARRISON SAND & GRAVEL INC.
Location 1523 MAIN STREET Address 278 PALMER ROAD
Type Work NEW SAN LAT CHAPLIN CT 06235
Phone No. (lb( 465- 9248
La 940of C66r-7 450- 66zo
Date Insp Needed te ps 1pQ
Time Insp Needed cAu Co�3Q(tAc.Trft:` T`tmeInsp; :� -3
Inspected By
Work in Progress
l
I�
it
�I
Input— Date ��I , 9ti�_
m1ti 7090 Town of South Windsor, CT
Per it Date',11/18/19 .9 Drain Layer Permit
Expiration Date 12/1`--87'1999
Desch p: CONNECT PUMP CHAMBER TO EXIST. LATERAL (PERMIT #7033 EXPIRED)
1 Applicant Location
Name ;bARRI�ON SAND & GRAVEL INC<e. ,; Addr,. 1.523 MAIN STREET
Addr. 278 PA�MER ROAD psr' ., EI IS ELIZABETH J
CHAPLIN CT :0 .
Phone No.
The Drain Layer ads i.grledt th`4's permi t ;has ua7 i 1.i cense issued by the
state and hereby J ,Y` 'ri1 4,t4rms .--and'` tt nd--i tiohs set forth in the
attached 'Conditions' . All wdrk Shah b yi n accordance with Town of South
Windsor standards, a 1 l'- OS1 ,, raga r. i eh and the attached conditions.
(j
Issued By ( "�Z►JA }s - �cT �Gl�k (L
Date Inspected y_ _, Inspectec
rf"
4NOV116 99 11:45 FROM:8LAKE EQUIPMENT 860-243-3996 T0:8606447280 PAGE:001
Blake Equipment Co. 61 West Dudley Town Road
doom_field Ck. 06002
860 8181344
Far $60 243 3996
Pages (10)
.Date: November 16, 1999
To: Town of South Windsor Engineering Dept
From: Tom Urge
Attn: 1'o.]fume It.1Kay Concern
.Reg: 1523 Maim Street Sewage Pump Station
Attacked please find for your use submittal data for the above referenced pump statiom
PYease call with any questions or concerns
Sincerely
Tom Urgo�
-,NOV 41 6-99 11:45 FROM:BLAKE EQUIPMENT 860-243-3996 TO:8606447280 PAGE:002
_ Fllaka' -
81LRKE EQUIPMENT COMPANY, INC. 61 West Dudley Torun Pd.. Bloomfield.CT 06002 660-243-1491
FAX 860.243-3996
August 30, 1999
South Windsor Res demo
14'dia x IT deep precast concrete wetwell with hatch(H-20)
2 WGI.20.21 Myers Grinder PCs*,2 BR 230v.,single phase
2 SRA.125 Myers slide rail system
2 sets stainless steel slide rail pipe
2 stainless steel Sifting chain
z 2" FVC bag check valves
2 2"PVC ball valves with cxtendod handles
discharge pipe.in the wetwell in 2"PVC
1 Duplex cwtrQl psuel with high water storm (suppliedloose)
4$oat.swirclus
1 watertight junction box
NOM.-
I. No earthwork is include4'in this quota
2. All applicable permits by others.
3. R J.Smith Equipment will provide a 1'f nee main wdvt t for connection to underg ound
piping by others
4. F.).Smith Equipment will provide a"booe ac the proper influent pipe locaelan. Connecd n
of the influent pipe to the concrete wet well by odors
5. F,J.Smith Equipment will install a 4"PVC vent providod it is located within 4'of the
wetwell. Fit is not, we will supply the vent riser fir installation by others
6. F.1.Smith will wire the pump statkm to a junction box in the concrete wetwell. All other.
wiring and conduit by others.
7. Control panel supplied loose for installation by others
8. Additional field poured concrete may be necessary for buoyancy reasons. This edcfidonal
concrete,if necessary,is by others
9. This quare is based on a telephone conversation. If there is more to the sPedfication or
drawing than we have,tit quoted price may chaw-
YPICAL INSTALLATION
M
MIEX CONCRETE GRINDER PUMP STATION
m REMOTE MOUNTED CONTROL PANEL
(1) 20 NIN. CLEAR
¢00£LS; W620. WGL20 OPENII6
CL
-NOTE. 1) 19TERNED2ATE RAIL SUPPORT REOUIRFD FOR CONTROL NOUNTIN6 �10
BAS3h6 OVER 16 FEE1. ERACKET. 551
2) 1F UB1N0 PLASTIC HOLDDOW ASSEMBLY, '
ADDITIONAL LO6ER HOL.DOMN MU6T 6'E USED '
FOR 5ASINS 12 EEF7 AM OVER.
W020 WoLZO RAIL SUPPORT
00 __ DUPLE%.CONTROL?ANEi
11 CLF.EX &44=701R BON, H I. OR STEEL DBASIN�H A7CH O _L
STRICT. PLASTIC .
m 11
- 3O M N.
w r VALVE EXTENSION HANCLE CLEAR -
EY COHJWIT SEAL / OPEMI ND 5�
0 (REO'0- BY OTHERS)
�_ ■ 0
I I1
. 1E .r
42
- 1 1/4'SALL10.4. VALVE,
7AUE UNf ON, BLOCKt`1
2'CONDUIT'..
M LIFTCUT CHAIN, 1/4'
1
T TCP HCLDDOW
CLl
1 1 1/4' ANTISIPRON
"7INLET PIPE 1 VALVE, PVC 1AS RED-D.) i
00lIr •''f 1 1/4' RISER PIPE
H DISCHARGE LEVEL
HIGHVATER "ALARM" LEVEL F-, "
(w LAG PIMP "ON" LEVEL 1 S - - _
� RAILS, 1^ PIPE s I
IL )i
H
LEAD PUMP "ON" LEVEL BOTTOM 1-10LDOOMTQ 46
d CIA. H
W
GUIDE PLATE
w PUNPS 'OFF'LEvo_
Q SYINO CHECK VALVE d
48 IN DFSDONr�MT ASS'Y. 1
r . 4
Q 3J9-E 2 1 4/4^OISCFTJSRGE PIPE rNxHOR 46UST D'G.
ry ry scot $O P(IG+ (6) RFID
D.
LL Q OISCHAROe CASE
►1aDEL 2HV ORINCER PUHP i
lD
r-1
a-1
Ql 25.AN95
lcn
7 J
Z e
- e I
NOV-116,99 11:46 FROM:BLAKE EQUIPMENT 860-243-3996 TO:8606447280 PAGE:004
AV
12:07 P.Ids
,Cj C1.7� ��tgI6NCG
_ .. ot,�
�r
d.A (30q 5
1
f � l
z6
;'`
TOTAL P.02
,NO1',-b6-99 11:46 FROM:BLAKE EQUIPMENT BGO-243-3996 TO:8606447280 PAGE:005
WGL20.2 HP Grinder Pump
for Residential, Commercial
and Industrial Applications
ADVANTAGES BY DESIGN
IDEAL FOR V$E IN PRESSURE SEWER SYSTEMS.
A Recessed impeller provides steep non-overloading
operating curve.
DURABLE MOTOR WILL DELIVER MANY YEARS OF
RELIABLE S99VICB.
■ Oil-filled motor for maximum heat dissipation and
constant aring lubrication.
Recessed impeller reduces radial bearing loads,
increases bearing life,
■ High torque capacitor start single phase or three
�• phase motors for assured starting under heavy
load.
A Optional seal leak probe warns of seal leak
Ocondition,helps prevent costly motor damage.
�L ■ Single phase motors have bn-winding current and
temperature sensitive overload,
U� THE WGL20 IS DESIGNED FOR EASY MAINTENANCE,
I S1IN ■ Shredding ring dr?d grinder impeller are replace-
trble without dismantling pump or motor,
PRODUCT CAPABILITIES
Capacities To 40 GPM 150 LFM
Hearts To 105 ft. 32.3 In
Liquids Hat-idling dornestlC raw sewage
intermittent Llgitld Temp. up to 140'F up to 60•C
Wending lmulailQn Temp, 2b6°F 130°C
(0C=B
Motor Electrical Dota 2 HE 3450 RPM
oinglo phone motors are 1 ph-capacitor start/run.
copLcitor siart type.MyrtM 208 or 230 volt;bO Hz
conlroi panels or capocitor kits
are recommended for proper g Ph-induction run
operation and v vtrontvl 208.230.460,575 volts.60 Hz
7hira Party Appr(wals` GSA, UL,cUL
Acceptable pH Range 6-9
Specific Gravity .9- 1.1
Viscosity 28-35 SSU
t 4scharge,NPT 1'/4 in.
THE MURS W`G'iL20 IS A VERSATILE 2 HP Min.Sump Diameter
SUBMERSIBLE GRINDER PUMP DESIGNED SPECIFI- Simplex 24 in, 61.0 cm
CALLY FOR USE IN PRESSURE SEWER APPPLICATIONS Duplex 36 tn. 91.4 cm
OR IN SYSTEMS WITH LONG DISCHARGE RUNS OR Note;comet factory for applicowns outside of Ittese recommendotions.
1UGH STATIC HEADS. It features a patented Culter •Models'"ilh third party Cgprovaks)are Clearty marked on individual
mechanism and recessed impeller design to effec- Pumpn`mool0e4'
tively rnascerate typical domestic sewage solids into GomWiction Matericas
a fine slurry. Motor Housing.Seal cast Iron,Class 30.ASTM A48-7
The WGL20 can be installed in a variety of packaged Housing.Cord Cap,
systems. Factory-assembled simplex or duplex volute case. Recessed
packages with guide rail systems or suspended Impeller
systems are available, Myers,also has complete'turn- Power Cord'w/seal probe 1; 1415 SOW/SOW-A
key systems to make selection simple, individual rail wlo seal probe 15'1414 SOW/SowA
components care also available for installation in on- Mechanical Seals- Std, dbl.tandem carbon a ceramic
site concrete systems. Myers offers a complete line of Opt. tungsten carbide
submersible sumli, sewage, effluent, grinder, rion- Pump,Motor Stroll 416 SST
clog wastewater pumps, controls, basins, and acces-
sories, For additional information, please contact
--------Your local Myers representative or the Myers- - Shredding Ring, _ 440 SST,-58.60-1lockwell--- -
Ashland, Ohio sales office at 419-289-1144. Grinder impeller
WHERE INNOVATION METTS TRA.DITTON
Nov_r1499 11:46 FROM:BLAKE EQUIPMENT eGo-243-39% TO:e6064472eo PAGE:006
WGL20
•2 HP Grinder Pump
for Residential, Commercial
and Industrial Applications
srATaR DIMENSIONS
2 rip.3450 RPM,1 and 3 GABLE ENTRY SYSTEM
phase. Press fit for Provides ctotole seat 1Dirnensions In MMI
perfect alignment and protection. Cable jacket
best heat transfer. OJI- sealed by compression w
filled motor conducts fitting. Individual wires
heat and lubricates sealed by compression 7�/„" (67)
beatings. grommet. Power cord
can be replaced without
disturbing motor.
r
OVERLOAD-REM SENSOR
(1 phase only)Protects
motor from bum-out due (]14T,
to excesslVe heat from 'A" Lifting Eye "a'
anv overload condition. (2441
AutornaliCally resets
when motor has cooled. I'/z NPS
BALL BEARINGS
Upper,apd lower ball
bearings Support shaft
and rotor rind take nodal
and radial loads.
HEAVY 416 SST SHAn
Corrosion resistant, 185ha"
Reduces shaft deftectfon (465) 1 rh- NPY
due to grinding loads. i
r Doubl SEALS
Double tandem mechanl-
Cal shaft seals protect
motor. Oil-filled seal f
( Chamber provides --I file)
continuous lubrication.
- PERFORMANCE CUM
aINo _ Submersible Grinder
VOLUTE CASE M s.+,, r� pumps
Cast iron 1'/4"NPT 30
vertical discharge, i
BO ,
20
�'r�'rilgr --
SEAL LEAK PROBE(Opt-) IMPELLER 'o
Detects waler In seal
housing,activates Cast iron recessed re
warning light in Control Impeller handles ground ,
panel. Slurry without clogging or
GRINDER ASSEMBLY binding. Provides rc lip r�,l -•^"•_.�. ;
Grinder impeller and unobstructed flow )
shredding ring are
�D
replaceable without passage. Reduces radial S :
dismatltling pump.. loads. Pump-out vanes
Constructed of 440 SST help Keep trash from a"
- ---- - hardened to 56.60
seal.redtrce5 ressure Gt 120 160 am
Rockwell. seat laces, r
K3140 5198 F.E.Myers,1101 Myers Parkway,Ashland,Ohio 44805-1969
Printed in U.S.A. 419/289-1144,FAX:419/289.6668,wvww.fsrnyor6.00m
Myers(Canada),26.9 Trillium JDdv4,Kfthanr,,OnW rio N70 4WS ?
5191748.5470.FAX:5191744-2553
NOLI-16-99 11:47 FROM:BLAKE EQUIPMENT 860-243-3996 TO:8606447280 PAGE:007
Pump Performance
- - Total
Head SUBMERSIBLE GRINDER PUMPS
in
M. F1. MODEL: WGL20
32 5Y'z Dia. Imp.
SPEED: 3450 RPM
100
28
5 '
24
20
60
16 334
12
314
8
20
FT
U-S-Gal 10 20 30 40 50
titers 38 6 114 151) (189)
Available[Models Motor Electrical Data
NEC
Start Run Run Start Run Code Service
Standard HP Volts Phase Amps Amps KW KVA KVA Letter Factor.
WOL20-01 2 200 1 50.0 15.0 2.8 10.0 3.0 F 1.25
WGL20-01(LI7) 2 200 1 50.0 15.0 2.8 10.0 -� 3.0 F 1.25
WGUO-03 2 1 200 1 3 30.0 9,5 1 9 10.4 3.3 F 1.25
WGL20 21 2 230 1 44.0 12.0 2.8 10.1 2.8 F 1.25 f
WGL20-21(LD) 2 230 1 44.0 12.0 2.8 10.1 2.8 '- F 1.25
WGL20-23 2 230 3 27.5 8.4 2.9 11.0 3.3 F 1.25
WGL20-23(LD) 2 230 3 27.5 8.4 2.9 11.0 3.3 F 1.25
WGL20.43 2 1 460 3 13.8 4.2 .2.9 11.0 3Y F 1.25
WGL2043(LD) 2 460 3 13.8 4.2 2.9 11.0 3.3 _ K_ 1.25�'
WGL20-53 2 575 3 11.0 3.4 2.9 11.0 3.3 F. 1.25
' e
a AIL. to
i
F E.Myers.1101 Myers Parlomy,Ashland,Ohio "805-1969
419/289-1144 • FAX:419/28"658 • vw WfetdYers.ccm
K3584 6f98 - __ P iintm In I I S A.
NOUj16y99 11:47 FROM:BLAKE EQUIPMENT 860-243-3996 TO:8606447280 PAGE:008
WGL20 GRINDER PUMP
SPECIFICATIONS
EMMIP MODEL-Pump shall be of the centrifugal type Myers model WGL20 or equal with an integrally built in
grinder unit and submersible type motor. The grinder unit shall be capable of macerating all material in normal
domestic and commercial sewage including reasonable amounts of foreign objects such as small wood,sticks,
.plastic,thin rubber,sanitary napkins,disposable diapers and the like to a fine slurry that will pass freely through
the pump and 1-IN'discharge pipe. Discharge shall be IAA"NPT
OPERATING CONDITIONS-Pump shall have a capacity of GPM at a total head of feet and
shall use a 2 HP motor operating at 3450 RPM.
MOTOR- Pump motor shall be of the submersible type rated 2 horsepower at 3450 RPM. Motor shall be for
single phase 200 volts ,230 volts_.. or three phase 208 volts_,230 vofts ,460 volts or 575
volts . SingTe phase motors shall be of capacitor start,capacitor run. NEMA L type. Three phase motors
shall be NEMA B type.
Stator winding shall be of the open type with Class B insulation good for 1302 C(266°F) maximum operating
temperature. Winding housing shall-be filled with a clean high dielectric oil that lubricates bearings and seals and
transfers heat from windings and rotor to outer shell. Air-filled motors which do not have the superior heat dissipat-
ing capabilities of oil-filled motors shall not be considered equal.
Motor shall have two heavy duty ball bearings to support pump shaft and take radial and thrust loads. Ball bear-
ings shall be designed for 50,000 hours B-10 life. Stator shall be heat shrunk into motor housing.
Single-phase motors shall have a heat sensor thermostat and overload attached to the top end of the motor
windings to stop the motor if the motor winding temperature reaches 200'F. The high temperature shutoff will
cause the pump to cease operation, should a control failure cause the pump to run in a dry wet well. The thermo-
stat shall reset automatically when the motor cools to a safe operating temperature.
Three-phase motors shall have two heat sensor thermostats attached to top end of motor winding and connected
in series with the magnetic contactor coil in control box to stop motor if motor winding temperature reaches 2212 F.
Thermostats shall reset automatically when motor cools. 1
The common motor pump and grinder shaft shall be of#416 stainless steel threaded to take pump impeller and
grinder impeller.
SEALS•-Motor shall be protected by two mechanical seals mounted in tandem with a seat chamber between the
seals. Sea]chamber shall be oil filled to lubricate seal face and to transmit heat from shaft to outer shell. 's
Seal face shall be carbon and ceramic and lapped to a flatness of one light band. Lower seal faces shall be
carbide(optional).
An electrode shall be mounted in the seal Chamber.to detect any water entering the chamber through the lower
seal. Water in the chamber shall cause a red light to turn on at the control box. This signal shall not stop motor
but shall act as a warning only, indicating service is required.
PS!_ME1MPELLER-The pump impeller shall be of the recessed Myers type to provide an open unobstructed
passage through the volute for the ground solids. Impeller shall be cast iron and shall be threaded onto stainless
steel shaft.
r
S
NOV-1i,-99 11:47 FROM:BLAKE EQUIPMENT 860-243-3996 TO:8606447280 PAGE:009
J
GRINDER_CONSTRUCTIO.bI--Grinder assembly shall consist of grinder impeller and shredding ring and shall be
mounted directly below the volute passage. Grinder impeller to be threaded onto stainless shaft and shall be
locked with screw and washer. The shredding ring shall be pressed into iron holding flange for easy removal.
Flange shall be provided with tapped back-off holes so that screws can be used to push the shredding ring from
housing. All grinding of solids shall be from action of the impeller against the shredding ring.
Both grinder impellers and shredding ring shall be of 440C stainless steel hardened to 58.60 Rockwell C-
CORROSION PROTECTION-All iron castings shall be pre-treated with phosphate and chromic rinse and to be
painted before machining and all machined surfaces exposed to the sawage water to he re-paintad. Ad!fasteners
to be 302 stainless steel.
POWER CORD-The motor power cord shall be 14.5 SOW/SOW-A and shall be fastened by means of a card grip
in the top of the pump. The top of the pump shall contain a waterproof junction box which will provide space to
connect the power cord to the motor leads. The motor leads shall seal between the motor housing and junction
box by means of a rubber compression fitting around each wire. Power cord shall have a green carrier ground
conductor that attaches to motor frame-
i;
i
I
4
F.E.Myers,1101 Myers Parkway,AOLVW,Ohio 44 005-1 969•419.269.1144• FAX 41NS9.6658
K3485 11/96
,NOV-16-99 11:48 FROM:BLAKE EQUIPMENT 860-243-3996 TO:8606447280 PAGE:010
CGL, CG, CNC, CWFiV3 and CWHV4
Single Phase Simplex and Dupler Control Panels
-- __ For 2-5 HP Single Phase Submersible
Grinder Pumps and 1-5 HP
Single Phase Submersible
Non-Clog Pumps
YERS HAS RE-ENGINEERED THE CONTROL
PANEL LINE FOR IMPROVED DURABIMTY,
RBLIAB11M AND ECONOUY.CAD flexibility
enhances our response time to help us better
meet your control pones requirements.Contact
your Myers distributor,or the Myers Ohio sales
office at 419/289-1:144 for more details.
ADVANTAGES BY DESIGN
QUA=ELECTRICAL COMPONENTS ASSURE
RELLABLE,AUTOMATIC PUMP OPERATION
•IEC horsepower-rated motor contactors rated
at over I million Cycles,
■CG.CNC,CWHV3/4 have f pole arnbient-
'• compensated bi-metal overload relay.
■CGL has Mixon overload.
■Designed for use with standard mercury float
switches.Uses three for simplex(off-on-alarm),
four for duplex Cott-on-override-alarm).
simplex !Solid:slate alterfiating relay(on duplex only)
to equalize pump wear.
■Override relay to start second pump if first one
fails for any reason.
CORROSION RESISTANT FOR LONG LIFE
■Weathertight NEMA 4X fiberglass enclosures
with aluminum back panels.
MEETS NEC AND UL(508)STANDARDS FOR
SAFETY
•UL-approved panel designs(label installed
only on request).
■Individual pump circuit breakers.
■Separate control and alarm fuses.
Duplex
WHERE LI NOVA770NMESTS TRADMON
mwrse
ISO 9001 Certffisd Comp=y
IOV .799 11:48 FROM:BLAKE EQUIPMENT 860-243-3996 T0:86fJ644728[J PAGE:011
C
STANDARD PANEL FEATURES FOR CGL
4 17 16 7 1 @ COR1 MOK-UMSTANT
EXCI.0$=MMA 4X
2 (D•ALi MWIM RACK PAM
IEC MOTOR CON=7030)
Silver cadmium ozlde
n 11 ca�tcrcts
0 4Q POMP CIRCUIT SREAURS
8 �, 10 @ CONTROL CIRCUn r=
lamp
- 12 Q ALUM C MCMT FOSS
®, lamp
0 Q START WM=C.RMA1Y(S)
9 • ® sr MM43 C"ACITOR(S)
Oq RIIiIIr S CAPACITOR(S)
HAND-OFF-AUTO$WrrCH
to Momentary in--hand
t l 11IId1[oN OVERLOAD
5 b 14 15 Q PUN PRON LIGHT(Amber)
simplex
l3 SEAL LEAK LIGHT(Red)
Only on units with dwacior
TUM NAL FLOW
GROMW LQG(S)
4. 17 16 7 1 la FLASKING ALARM LIGHT
Mounted on top of
2 enclosure(red)
l7 SOLID STATE M&SHIM
18 OVER11=RIMM In event
a e 8 of first pump failure
(duplex only)
° 19 ALTZERATOR RELAY Solid
State(duplex only)
11
3.
e _ e 10
rM
-r
b �
15 19 1 15 18
ORpls=
- - - - - --- - '�a 90
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF.SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
_ TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work: .S J, Lot #
Street No. Street Name
Premises owned bv.
Name of Firm: ter#Scx J 'V ' Phone: Go - y5�5'1�
r Y
Address of Firm: 5_3 &Lll r /mil C�,I o lll n -0� el
TYPE OF WORK:
Lay House Drain V Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with ly
Proposed Start Date44 Estimated time for completion //A
ALL WORK TO BE IN ACCORDANCE WITHI TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to - the holder of Drain
Layer's License No. c o-la86o.1, Only holders of P1, P7 & W9 licenses will
be issued a permit. 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 attached thereto. Applicant has received Town Street'Excavation
Permit No. and/or ConnDOT Permit No.
Signed: Print Name: 26 a'c
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION:-f- :
NORTH ARROW
....._ , I
! I �
I
r� >
C TRACTOR RINT) NAME OF CONT CTOR'S UPERVISOR (PRINT)
tf-�� 1411wex, a,,�STREET ADDRE SIGNATURE
T- f ��8r`pq DATE
TOWN _- i- STATE _ ZIP - INSPECTErBY TOW _ -
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER '
V
_a
TOWN OF SOUTH WINDSOR
STAFF SITE CHANGE
FOR SITE & SUBDIVISION
GENERAL:
CHANGE ORDER CONTACT PERSON Phone No.
Address - <Site Name " P&Z No.
Owner Phone No.
Contractor
Signature of Owner Date:
Signature of Design Engr. - Dater .. s
CHANGE: (Describe location and nature 'of change. Include
Four (4 ) copies of plan/profile of Change. )
Reason for Change: (Why is change required)
APPROVALS: (As Re ired
�r
Dir. Of Planning „ /, r� --9�c� Date:
Town Engineer Date:
Dir. of Public Works Date:
Other: Date:
STAFF COMMENTS:
White - Town Engineer Yellow - Applicant
Pink - Director of Planning Goldenrod - Engineering Department