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HomeMy WebLinkAboutDrain Layers Permit Wyndemere Court TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT 6100 Purs ant , to writt�en' Application, permission is hereby granted to the Licensed rain Layer named herein to perform the work indicated below at a at premises owned by &Tz�lr /--V",/>Vc_4- whose- addtess is ,� So wig c%Sow a and to ay House Drai /�u/ Repair House Drain, Lay Main, Other , for. % , occupancy, or use, with Family ni s, with , acres. Type of Sewage to.. be connected under this permit: SANITARY SEWAGE (,� , INDUSTRIAL WASTES ( )'," OR ( ) �/�✓ /YT/��%c/ Connection will be made with Show sketch of proposed work or furnish 'two (2) copies of separate drawings 2-0 OSHA REQUIREMENTS MUST BE FOLLOWED SPECIAL CONDITIONS Desired Starting Date Estimated Time for Completion Permit to be issued to the holder of Drain Layer's Vicense No. , 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. an CHD Permit No. S i$�n L- censed Drain Layer The above named Drain LayerrN as a valid license issued by the State of Connecticut and has filed a sati4factory bo d and insurance policy in the name of the Town of South Windsor: n ine g Dept . Date ix, Permit Fee Paid $ ZL-s60 Check`, mber / 3 Z Connection Charge Receipt No. 4-41, ated -//3[`4 Issued by INSPECTION Date work started Date cotapleted b- 3 - l Sufficient notificaulon ce vea: yes No Special Conditions APPROVED• - \ Inspector te THE.JACK FARRELLY .COMPANY Other Locations 150 UNIVERSAL DRIVE(Rear) PHONE 903-777-6548 CONSTRUCTION MATERIALS PHONE 203-243.9714 NORTH HAVEN,CT 06473 FAX 203.777-3147 97 OLD POQUONOCK ROAD 1-800-423A112 COLTON ROAD PHONE 203739 5457 BLOOMFIEL4,CT 06002 FAX 203 286-0867 EAST LYME'CT 069M FAX 203-789.8513 WATER/SEWER /TEST: REPORT PROJECT/LOCATION: INSPECTOR: TESTED BY: If$rite. DATE OF TEST: ` 3 CONTRACTOR: HYDROSTATIC TEST WATER MAIN TEST 0 SEWER MAIN TEST l LENGTH OF TEST: STATIC PRESSURE: TEST PRESSURE: ALLOWABLE LEAKAGE: ACTUAL LEAKAGE:. s TEST RESULTS: PASSED❑ FAILED O REMARKS: x AIR TEST MANHOLE' TEST PRESSURE TEST RESULTS NUMBER' IN P.$.L TIME OF REMARKS OR STATION START STOP DROP IN MIN. TEST Q © v* 4S I certify that the above information is a true and accurate account of the tests performed at this location. SIGNED INSPECTOR T QT-..` SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: ! � TIME:— / Z- 3 O BY: FOR LOCATION: DAY INSPEC. NEEDED �p `.� - 4 TIME: TYPE OF INSPECTION: ( ) SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( / ) OTHER dt� 7—EST' INSPECTION REPORT DATE: 6- -3- TIME: ,15 INSP: CONTRACTOR:— WEATHER: WORK IN PROGRESS: ,azA #a�Lj 1�4 (76 AREA OF CONCERN: SPECIAL INSTRUCTIONS: