HomeMy WebLinkAboutDrain Layers Permit 11 Perrin Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5935
Pursuant to written application, permission is ,her" by granted to .the
Licensed Drai La er named here to . p,erform the work ind�Lcated belo at
AqQ
at premises owned by .�/yjG01'JS7
whbsj6 ddress is g' -and to
Lay House PTain, ". Repair Ouse:' i4 .n, Laq Main,- Othe.r
for '�'- <` ^s, f occupancy or use, with S/ '
Family Units, witfi acres. J.
Type of Sewage to be connected under this permit :5 vial fA N%S WAGE
I14D�TS�I,,a,I. ( )
C�r e iri%w 1� ma�'deth sa
3S
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
�j,.�PI; f
HA REQUIREMENTS MUST BE FOI v q
SPEC AL Ct�NDITIONS '
Desired Starting Date -$ 3 Estimated Time for Completion
Permit to be issued to b 4, Ca $
the holder of Drain Layer's Lj sg C40-'j;T,. Permit will expire thirty
(30) days after date of issuance. The und"ers %n d 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
').ice ed rain Layer
The above named Drain Layer has a valid license is ued by the , State of
Connecticut and has filed a satisfactory bond and insurance poli4j-YNthe
name of the Town of W1&tf( W1%4Tsor:
Bering Dept. Date
Permit Fee Paid $ 3,1 O0 Check Number
Connection Charge Receipt No. Dated
Issued by t cr ,
1
INSPECTION
Date work started 9 Date completed
Sufficient notification rece ve . G-Yes No
Special Conditions
APPROV
�apor Date
TOWN OF SOUTH WIN' OR
SANITARY SEWER INSPECTION CHECKLIST
FUN TION ° j NO YES N/A DATE INSPECTED
1. Is Permit On Job Site
2. Police Notified
3 . Safety Items In Place
a. Shoring, Trench Box, adde
b. Hard Hats
C. Pumps
4 . Proper Material
a. Pipe
b. Pipe Bedding X
C. Backfill —fi—
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 )
& 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