HomeMy WebLinkAboutDrain Layers Permit 360 Nevers Road 7-01oIN OF SOUTH WINDS )R INSPECTION R P"-RT
'ermit No . 6604 Cont Factor ALFRrD -P?'1LI & SONS
-ocat.-ion 0360 NEVERS ROAD Address 45 EVANS ROAD
ype Wor{\ NEW SAN LAT— pOp ,vc.�`f P . O, P. `Dv F
.ROC,4:Y P.ILL CT 06067
)ate Tnp Needed Date Ocp, ll�
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dime In p Needed �`� T.iR2$ r}"l l zws/��!
Inspected By
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(.=ermit No. 6604 own of South Windsor, Gr
Permit Date 04%30 j 1 997 orai n L.ayer Permit
E:xp i t at i can Date
E)escrip : 1-0 REPLACE: EXPIRED Pf f;Mil
Apia I i cant Lo(;at, i on
s 1 ' �
Name ALF ' EIS GH1 &' SC)14S. �tCli r . c) s6{ Nt Vr✓Eta ROAD
Addr . 45 tVAbtlS ROAD '6,vin6r rMAPL..E, t_.E-AF t:UN.�TRUCTION ING r
P.O. BOX 365 � 7 -7-
ROCKY HILL CT 015,067 � �' �{�F� t--'11GE7
Phone No. (860 )721 --7926 ,
1
The Drain Layer assigned tbi s permit has a va 1 c1. l`i ef�nse sued by the
state and hereby agrees_ to all the terms aril cc�nditicns set tort.•h in the
attached 'Conditions ' All work sha1 1 be An, accardarvce with 1 own of South,
Windsor standards , all ,OSHA,„requirements, and-.the, attached randitions .
!!!
Issued By Title , , _ c�. ,�7^. x'L- . _
i (�
Date Inspect` d - 7 _.- -- — - Insper.ted E3y
TORN OF SOUTH RIPDSOR
SANIMARY SEWM INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTED
1 . Is Permit On Job Site q p/
2 . Police Notified Ra
3 . Safety Items In Place
a. Shoring, Trench Box, Ladder _ !'
b. Hard Hats rr
c . PumpsI �r
4 . Proper Material
a . Pipe
b. Pipe Bedding !�
c. Backf illy lr
d. Warning Tape 9 D t�
e. Pipe Cap or Plug 91) it
f . Cleanouts .8—
g. Fittings D �{
h. Manhole
{ - ep !'
i . Cover & Frame KD A
5 . Existing Lateral Cap Removedi� !�
in Presence of Inspector
6 . Lateral probed and found �p
to be clear /'
7 . Pavement Cut Properly
8 . Trench & Bedding OR f!
9 . Joints Properly Done !c
10 . Backfilling (12" Lifts ) (RD c r
& Compaction
11 . Manhole Inverts Built D f(
12 . Subbase Material Placed KD
13 . Base Material Placed
D rr
14 . Blacktop (Temp) w/Proper 9D or
Grades & Slopes
15 . Pressure Test
r�
16 . Mandrel Test
17 . Installation agrees with plan R➢
18 . As-Built plans recorded p ��D r�_
APPLICATION FOR DRAIN LAYERS PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
Location of proposed work: 3 o NZ,I!r5 Laz P Lot #
Street No Street Name
Premises owned by: &nz ' �UL_trx,
Name of Firm: r' Phone: 22 j 7 g2�
Address of Firm: L/S
TYPE OF WORK:
Lay House Drain X Repair House Drain ;
Lay Main Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with JI1 -7—
Proposed Start Date S Estimated time for completion /
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR
STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO
THE PERMIT
Permit is to be issued to i5 the holder of Drain
layer's License No. 02 ?")q9 y 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
Licensed Drain Layer
Date: 3d 9