HomeMy WebLinkAboutDrain Layers Permit 40 Pheasant Way TOWN OF SOUTH WINDSOR
�? DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
Lai
DRAIN LAYER'S PERMIT 5986
W 19
Pursuant to written applications permission is hereby granted to the
Licensed Drain Layer ;famed herein to perform the work indicated belowat
Gc� R.� a t m s e s o ne d by
- ,
whose add ess is ('
Lay House Drain„ Repai House Drain, : Lay Main, Oth r to
for occupancy or use, with
Family Units, ,wi h ac�-
Ti�pe of Siwage- to -be connected under this permit : S`ANITARY` SEWAGE
INDUSTRIAL WAST$S (.,.),, OR, ,( ,
Connection will be made with S 5 Pry/
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date E timated Time for Completion
Permit to be issued to lhp k P1 35? 5
the holder of Drain Layer' License No. Zojr '�, 0 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 revers-. side
thereof. Applicant hasireceived Town Permit No. and/or
CHD Permit No.
Signed
Licr ed ain Layer
The above named Drain Layer has a valid licenissued by the State of
Connecticut and has filed a satisfactory bon and insurance Policy in the
name of the Town of South Windsor: '
E�glnee<i)4 Dept. Date
Permit Fee Paid $ 7_-;_0 ) Check &L&ber /05
Connection Charge Receipt No. 4-3a& Paged
Issued by_—T,-L
/fJ
INSPECTION
Date work started Date completed 7_. 1 Sufficient notification ece ve ; 4--"yes No
Special Conditions
je
APPROVE .
nspector �.,�
To " OF SOUTH 'WaiDSOR
SANITARY SEfiiER INSPECTION CHLCSLIST
N NO YES N/A DATE: INSPECTED
1• Is Permit On Job Site
Z• Police Notified `
3 • Safety Items In Place
a. Shoring, Trench Box, Ladder
b. Hard Hats
c. Pumps —
4. Proper Material
a. Pipe
b• Pipe Bedding
C. Backfill _
d• Warning Tape _
e. Pipe Cap or Plug
f• Cleanouts --�_
9• Fittings
h. Manhole v
i • Cover & Frame
5 . Existing Lateral Cap Removed
in Presence of Inspector
6 . Lateral probed and found
to be clear
f
7 . Pavement Cut Properly
8 - Trench & Bedding pR
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
f
16: Mandrel Test
17. Installation agrees with plan
18 . As-Built plans recorded