HomeMy WebLinkAboutDrain Layers Permit 74 Rugby Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITN 5968
19
Pursuant to written application, permission is hereby granted to the
Li c nsed, in Layer mel herein to perform the work indicated below at
-77
at premises owned by
whose address is k L.� -15' - '7� 9U lay and to
Lay House Drain, _Repair House Drain, Lay Main, Other
for _r occupancy or use, with /
Family nits, 'with acres. '
Type of Sewage to be connected under this- permit: SANITARY SEWAGE 0o ,
INDUSTRIAL WASTES ( ) , OR { )
Connection will be made with �#pli
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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,ywNrTA nY
T- ----- OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date' z C Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will 'expire thirty
(30) days after date of issuance. The undersigned Drains 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
CHID Permit No. ,
Signed
Licensed Drain'Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory bond and in urance policy in the
name of the Town of South Windsor:
n ine g Dept. - Date
Permit Fee Paid $ 7�r C)CJ Chec mber Cwf/-
Connection Charge Receipt No. Dated S�/5 f9
Issued b
INSPECTION
Date work started .0- 193 Date completed
Sufficient notificaf on received: es No
Special Conditions
APPROVE � .� 2O•�3
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION � + S NO YES N/A DATE INSPECTED
1 . Is Permit On Job Site -2
2. 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 _
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 OK _
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