HomeMy WebLinkAboutDrain Layers Permit 123 Spinners Run 4 TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
l 1S # Z 3 BUREAU OF POLLUTION CONTROL
2 3 DRAIN LAYER'S PERMIT N22 5970
445" 19 b
Pursuant to written application . permisson is ereby granted to the
Licensed Drain Layer named herein to perform the work indi ate=d . ow at/
at premises owned by - e4e
whose address is and to
Lay House Drain, Repair Howse Drain, Lay Main,- Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE (V) ,
INDUSTRIAL WASTES ( ) , OR
Connection will be made with
Show sketch of proposed work or furn s two (2) copies of separate drawings.
OSHA REQUIR ENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
.Desired Starting Date Estimated Time for Completion
Permit to be issued to 0
the holder of Drain Layer's License No. ) 974 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` the` reverse side
thereof. . Applicant has received Town Permit No ndfor
CHD Permit No.
S i&1n
Licen rain Layer
The above named Drain Layer has a valid lice ns issued by the State of
Connecticut and has filed a satisfactory nd and nsurance `policy in the
name of the Town of South Windsor
s ,
a E gin ing Dept. Date
c0
Permit Fee Paid $ ��,.� Cheer-umber. QT
Connection Charge Receipt No. .kpa�..j Dated
Issued by
INSPECTION
Date work started - Date completed 5-- 2-0.-"
Sufficient notifies on r ce ve :' :: es No
Special Conditions
APPROV
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTED
1. Is Pe t On Job Site --2�-p�
L-- s 9,70
2. Police Notified A,
3. Safety Items In Place
a. Shoring, Trench Box, Ladder A_
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 . - . Trepch & 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