HomeMy WebLinkAboutDrain Layers Permit 2 Sedgewick Circle TOWN OF SOUTH WINDSOR INSPECTION REPORT
tv
Permit No. 6623 Contractor MICHAEL WILCOX
Location 2 SEDGEWICK CIR Address EAGLE EARTHWORK SERV.
Type Work NEW SAN LAT 101 N MOUNTAIN ROAD
CANTON CT 06019
P?-i�eq No (860)693-2027
Date Insp Needed
Time Insp Needed
Inspected By �_ v �tk EX
z
Work in Progress ,
/
i
±�
r -
r2 v
Date c 0 S C)
L
Permit No. 6623 Town of South Windsor, CT
Permit Date 06/09/1997 Drain Layer Permit
Expiration Date 07/09/1997
Descrip: LOT 10 SEDGEWICK
Applicant Location
Name MICHAEL WILCOX Addr� 2 'SEDGEWICK CIR
Addr .. EAGLE EARTHWORK SERV \ M 4wn�r MAtiNARINO BLDRS
101 N MOUNTAIN ROAD
CANTON CT >00
Phone No. (860)693-202.7
The Drain Layer as nehs _ s V �d cense issued by the
1
state and hereby agree to t�►e end �di�tiQrs set forth in the
attached Conditions t�1rn4 inn_ aoc a with Town of South
Windsor standards, al �H ��q` i�- eat ched conditions.
Issued By �2 `=
Date Inspected �/ `( 7
5e�Zwr� lrc�P
TOWN OF SORTS WINDSOR
Sa* ITARY SENM INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTEr
1 . Is Permit On Job Site RD
2 . Police Notified l�
3 . Safety Items In Place
a. Shoring, Trench Box, Ladder2 l
b. Hard Hats /r
c. Pumps mac) fi
4 • aroper Plpeaterial G)
b. Pipe Bedding r�P �S f,
C. Backfill RD It
d. Warning Tape 75 _
e. Pipe Cap or Plug !i
f . Cleanouts
g. Fittings RI
h. Manhole
i . Cover & Frame K D
5 . Existing Lateral Cap Removed
in Presence of Inspector
6 . Lateral probed and found
to be clear
7 . Pavement Cut Properly Z 6111
8 . Trench & Bedding OR 4L 411
9 . Joints Properly Done ICJ 1 /�
10 . Backfilling (12" Lifts) 4 11
& Compaction
11 . Manhole Inverts Built 9D
12 . Subbase Material Placed ell
13 . Base Material Placed 611i
14 . Blacktop (Temp) w/Proper
Grades & Slopes
15 . Pressure Test D
16 . Mandrel Test N D To/
17 . Installation agrees with plan
18 . As-Built plans recorded A � fi
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"Z Lot # 1
Street No. Str et Name
Premises owned by: /' `nT� 1-016
Name of Firm: Phone: 6 S3 0O Z7
Address of Firm:_10( IUQr fA M' rrU D,y ?2,411-
TYPE OF WORK.
Lay House Drain _; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
c(
Connection will be made with
Proposed Start Date Estimated time for completion 7�
ALL WORK TO $E IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR
STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO
THE PERMIT
- r...
Permit is to be issued to the holder of Drain
layer's License No. 27911h Only holders(of P1, P7 & 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 Town Street
Excavation Permit No. and/or ConnDOT Permit No.
Signed Print Name �� h
g
Licensed Drain Layer
Date:
��� �