HomeMy WebLinkAboutDrain Layers Permit 142 Scott Drive ' TOWN OF SOUTH if WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2597S
June 25, 1993 _19
Pursuant to writt�n application, permission is hereby granted to .the
Licensed Drain Layer :famed herein to _perform the work indicated ' below at
142 Scott 'Drive; So. Windscat premises owned by
whose address is and to
-Lay House Drain, X Repa-kr House Drain, , Lay Main, Other ,
for ` _____.occupancy or use, with
Family Units, with 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 furnis .'tw (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date `�/l3 Estimated Time for Completion
,'Permit to be issued to - L E_?/ C /•�
the holder of Drain Layer's License No.�-'� 4a Permit will expire thirty
(30); days after d`ate. of issuance. The. undersigned . 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'
L ce rysed Drain Lay
The above named Drain Layer has a valid license issued by the State of
f Connecticut and has filed 'a satisfactory bond and insurance policy in the
name of the Town. of South Windsor:
En ine g Dept. Date
t Permit. Fee Paid $ D'��,C� Check umber
Connection Charge Receipt No. Dated
Issued by G/
INSPECTION
Date work started ` Z —9 Date completed
Sufficient notification recelveav --yes No '
Special Conditions
+ APPROVES zR
Inspector Date'
TOWN OF SORTS WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION -. NO YES N/A DATE INSPECTED
1. Is Permit On Job Site (C)r ZB
s` A
pq
S9 7g _
2. Police Notified _
3 . Safety Items In Place
a. Shoring, Trench Box, Ladder
b. Hard Hats _
C. Pumps �f
4 . Proper Material
a. Pipe _
b. Pipe Bedding _
c. Backfill X
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 A
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 _