HomeMy WebLinkAboutDrain Layers Permit 206 Buckland Road 800003 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 01/23/08i`"+
GIS ID: 15300206
FEE: 60.00
MUNIS APPLICATION# 200800062 ''
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NAME: : `LOCATION
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ADD < ,i$l 2;I <<BUCK AND ROAD
ADDRESS: P O BOX 581
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SIMSBURY,CT 0607Q �fr�'x"` :��:�-<.;.:.:.,:;" ` ARRION&ROY TRUSTEES
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KX,AND ROAD
H` IIDSOR CT 0607 PHONE 4
860-651-(J� 3 �``
WORKDESCRIPTION: LAY 600
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THE DRAIN LAYER ASSIGNED TO This P�Rv 'H� ;A S}� E
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T,AX+T E AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTHI' I3F.AI2i YE `.y (IS .,t'ALI *61&SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDxT k'pSIY .U3 ;FAD 1IF>ATTACHED CONDITIONS.
ISSUED BY -\ DATE INSPECTED INSPECTED BY
1/23/2008 11:53 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 80D003 CONTRACTOR: S i vn6 C f d
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LOCATION: ®(o AUAL-f oq d ��
TYPE OF WORK: Sewer
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: 1
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AS-BUILT:
INPUT: DATE: " -
W/2007 Town of South Windsor INPSECTION REPORT 07
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: B'oGGU_3 CONTRACTOR:_ 1
LOCATION: c A /10�
TYPE OF WORK: ,5",-,l✓
DATE INSP NEEDED: DATE INSP: ca o rG
INSPECTED_6Y: �-
WORK IN
PROGRESS:
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AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: a0 6
a Lot # -
Street No. Street Name
Premises owned by:
Name of Firm: `
Phone:
Address-of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main . oa '
Lay-Lateral'for Commercial/Industrial
Building of. acres
Connection will be made with
Existing Water Supply: Public Water Y'/ Well
Proposed Start Date
Z _ Estimated time for completion a? LO e�
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 <'-"' , � ��h,�,�s
Layer's License No.�,1/�? [9�n1?2�Q�n the holder of Drain
will be issued.a • 71• Only holders of P-1. P-7 or W-9 licenses
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.
Town Street Excavation Permit No. Applicant has received
and/or ConnDOT Permit No.
-CBYD No. L�00 803c)'::,q$6
6/1
Signed: Print Name: oUrOA wr�.r-�
Licensed rain Layer
Date•_/-- 2 2 o Q
Standard Form0er nIts\APPUCATION FOR DRAIN LAYERS PERMIT.doc
THEJACK CONSTRUCTION MATERIALS PHONE 860-243-9714
97 OLD POQUONOCK ROAD 1-800-423-0112
FARRELLV • BLOOMFIELD,CONN.06002 FAX 860-286-0867
COMPANY 150 UNIVERSAL DRIVE(Rear) PHONE 203-777-5548
• NORTH HAVEN,CT 06473 FAX 203-777-3147
COLTON ROAD PHONE 860-739-5457
EAST LYME,CT 06333 FAX 860-739-8513
149 SOUTH WEST CUTOFF PHONE 508-752-PIPE
WORCESTER,MA 01604 FAX 508-797-4455
176 CHASE RIVER ROAD PHONE 203-759-1135
WATERBURY,CT 06704 FAX 203-759-7522
WATER/SEWER TEST REPORT
PROJECT/LOCATION: f�l �c L. t r1 c�' Ss r t-E c. .i S ti t ,Cr ��U C :I ' `, 1 t�
INSPECTOR: t✓P i r5: C L17r n t_�C TESTED BY:
DATE OF TEST: / 1 CONTRACTOR:
HYDROSTATIC TEST
WATER MAIN TEST❑ SEWER MAIN TEST Q LENGTH OF TEST:
STATIC PRESSURE: TEST PRESSURE:
ALLOWABLE LEAKAGE: ACTUAL LEAKAGE:
TEST RESULTS: PASSED ❑ FAILED ❑
REMARKS:
AIR TEST
MANHOLE TEST PRESSURE TEST RESULTS
NUMBER IN P.S.I. TIME OF REMARKS
OR STATION START STOP DROP IN MIN. TEST
3
I certify that the above information is a true and accurate account of the tests performed at this location.
SIGNED: ��.- C;`'� •�.k�.r.�r .. ��1� �� �!
INSPECTOR TESTER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL: FIELD
LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS . , . /�,t/
STREET � � �c✓ /��
SUBDIVISION:
NORTH ARROW
r ftL �
st '�
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
crvtS z;: DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW CONSUMNG ENGINEER / DEVELOPER