HomeMy WebLinkAboutDrain Layers Permit 10 Sedgewick Circle TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 6576 Contractor MICHAEL WILCOX
Location 10 SEDGWICK CIRCLE Address EAGLE EARTHWORK SERV .
Type Work NEW SAN LAT 101 N MOUNTAIN ROAD
CANTON CT 06019
(� phone No. ( ';60 )G93-?_027
Date I lisp Needed _- / " Datens
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Time Insp Needed I lrTE j Time Insp,
Inspected By
Work i n Progress La�e�Q l�c� ! -er � 0� iTG�
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Input Date A18 -1�0
Permit No. 6576 Permit Date 03/05/1997 Town of South Windsor, CT
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Expiration Date 04/04`%1997 Drain Layer Permit
Descrip:
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Applicant Location
Name MICHAEL WILCOX A;��fr� ' i0 SE�DGWICK CIRCLE
Addr. EAGLE EARTHWORK SERV, vp� lpt� [ANO BUILDERS
101 N MOUNTAIN ROADS
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CANTON CT .0 6`bt
Phone No. (860)693-2027 a
The Drain Layer as gt� �# #s -t4r* a x 1 i ense issued by the
state and hereby agreo's. , � d c ��t r s set forth in the
attached 'Conditions' A 71 w,Yjc ^,k ' i ra £ with Town of South
Windsor standar s, a 1 1 t d' ' equi ecneni s �{ ` 4,ttached conditions .
Issued By t"
)ate Ins c ed g7 Itspisci�,®ci' By
d
co^ TOWN OF SOUTH WINDSOR
1 SANITARY SEWER INSPECTION CHECKLIST
FUNCTION -- NO YES N/A DATE INSPECTED
1. Is Permit On Job Site
2 . Police Notified
3 . Safety Items In Place
a. Shoring, Trench Box, Ladder 9D.. 3
b. Hard Hats
C. Pumps
4 . Proper Material
a. Pipe
b. Pipe Bedding SEL
C. Backfill — - 3
d. Warning Tape
e. Pipe Cap or Plug 3
f. Cleanouts 9
g. Fittings 3
h. Manhole
i. Cover & Frame — -
5 . Existing Lateral Cap Removed PID
in Presence of Inspector
6 . Lateral probed and found
to be- clearLZ
7 . Pavement Cut Properly
8 . Trench & Bedding OR
9 . Joints Properly Done
10 . Backfilling (12" Lifts) rD
& Compaction
11 . Manhole Inverts Built SAD
12. Subbase Material Placed 0 (�
13 . Base Material Placedb
14. Blacktop (Temp) w/Proper
Grades & Slopes
15. Pressure Test
16 . Mandrel Test ID
_1341
17 . Installation agrees with plan �Il
18 . As-Built plans recorded ''`,
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 , k—h Lot # _
Street No. ! treet Name
Premises owned by: ��lh 041 A d ll yj4&5
Name of Firm: it T k16 Phone: 673 ZvZ7
Address of Firm: / A169' 'N o u n i4 e �NI DX�
TIE OF WORK:
Lay House Drain Repair House Drain ;
La Main La Lateral or y y f Commercial/Industrial
Building of acres
Connection will be made with
Proposed Start Date Estimated time for completion �7p
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR
STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO
THE PERMIT
Permit is to be issued to �� ri(/r t 6GD� the holder of Drain
layer's License No. 2 7g ff 4 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: A2U Print Name fl,�ChQel 4 j,-k ox
Licensed Drain Layer
Date: " 5-g 7