HomeMy WebLinkAboutDrain Layers Permit 21 Rockwell Court f� TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5,956
Pursuant to written application, permission is hereby granted to the
Li ensed Drain Layer name d, herein to perform the work indicatg below t
at premises owned y �o
whose address is -
Lay House Drai , Repair ouse Drain, Lay Main, Other to
for occupancy use, with
Family Units, ith 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 FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 3Q Permit will expire thirt
(30) days after date of issuance. The undersigned DrainLayer hereby agrees
y
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<.
4ic 'led ain Layer
The above named Drain Layer has a valid license iE ued by the .State of
Connecticut and has filed a satisfactory bond and insurance policy in the,
name of the Town of South Windsor:
=C;V
Engineering Dept. Date
r�
Permit Fee Paid $ Check NumberycUG�
Connection Charge Receipt No. /5/ Dated -G�yf-;�'�
Issued by �/7jf/�/�
INSPECTION
Date work started r"' 93 Date completed Sufficient notification rece ve 'yes No —'---��
Special Conditions
AP P R '•-
1 Inspector Date
TOWN OF SOUTH WIN OR
° SANITARY SEWER INSPECTION CHECKLIST
FUNCTION 5l��!� NO YES N/A DATE INSPECTED
_ � T-L)&C//Z*
1. Is Permit On Job Site �'-�
2. Police Notified
3. Safety Items In Place
a. Shoring, Trench Box, Ladder f
b. Hard Hats pJ _
C. Pumps
4. Proper Material
a. Pipe _
b. Pipe Bedding
c. Backfill
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 _ C
7 . Pavement Cut Properly
8 . Trench & Bedding OK �p _
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