HomeMy WebLinkAboutDrain Layers Permit 292 Sand Hill Road JV � TOWN OF SOUTH WINDSOR INSPECTION REPORT
Pe.r-mit No. 6624 Contractor SKIPS SEPTIC
Location 0292 SAND HILL ROAD Address 27 MUDDY BROOK ROAD
Type Work NEW SAN LAT ELLINGTON CT 06029`
e (860 )875-2332
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Date
Permit No. 6624 Town of South Windsor, CT
Permit Date 06/09/1997 Drain Layer Permit
Expiration Date 07/09/1997
Descrip:
Applicant �� „ Location
Name SKIPS SEPTIC C2 SAND HILL ROAD
Addr. 27 MUDDY BROOK ROAD � OWnerCHUMANN JOHN R
ELLINGTON CT O D 9
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Phone No. (860)875-2332
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The Drain Layer assre�� s =r ��as �) d 1cense issued by the
state and hereby agreles t l� tie nd OQ4 tA Qp s set forth in the
attached 'Conditions
' a 1 1 � � a�c� da with Town of South
,!Windsor standards, al .= ,S ix__- q i���� a �t�ched conditions.
Issued By
Date Inspected
`6/16/g7 Dhodkc(e TORN OF SOUTH WINDSOR
SArrrrAuy SEWM INSPECTION CHECKLIST
FIINCTION NO YES N/A DATE INSPECTE:
1 . Is Permit On Job Site 110
2 . Police Notified /p
3 . Safety Items In Place
a • Shoring, Trench Box, Ladder 6 �b
b. Hard Hats
c . pumps 7/o
4 . Proper Material
a . Pipe
b. Pipe Bedding
c. Backfill _ - 6
d. Warning Tape _ 6 f®
e. Pipe Cap or Plug
f . Cleanouts 6f6
g. Fittings b d
h. Manhole QD
i . Cover & Frame n 0
5 . Existing Lateral Cap Removed 90
in Presence of Inspector
6 . Lateral probed and found
to be clear /?® 00
7 . Pavement Cut Properly
8 . Trench & Bedding OK o//p
9 . Joints Properly Done
10 . Backfilling (12" Lifts )
& Compaction
11 . Manhole Inverts Built R1J 616
12 . Subbase Material Placed kD _00
13 . Base Material Placed 011\ 6 /
14 . Blacktop (Temp) w/Proper �®
Grades & Slopes
15 . Pressure Test ( ��
16 . Mandrel Test
17 . Installation agrees with plan
18 . As-Built plans recorded A0
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SAND HILL- ROAD
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: c Lot #
Street No. Street Name
Premises owned by; J6H� Scffu 41 fl A/
Name of Firm Sk-(P.S Or'prn C SE-R yiC E- Phone: '? 7,,1 u
Address of Firm: oZ7 174 ul�a�l c;eaok Z-b f�L L(N G'faA!
TYPE OF WORK:
Lay Mouse Drain Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with C 'Y'bx-
Proposed Start Date Estimated timefor completion
ALL WORK TO BE IN ACCORDANCE WITH, TOWN OF SOUTH WINDSOR
STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO .
tt THE PERMIT
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PefMt ES to Vu
-fie totder o ra in .
layer's License No. 0 6 Aa 9?A S' . Only holders of Pl, P9 & 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 Tow_ n Street
Excavation Permit No. and/or ConnDOT Permit No.
Signed: Print Name % tlt5 1��/ ,��,� 1/I :.
icensed ra
inlay6r
Date: oz�` l ?
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LOT 37
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