HomeMy WebLinkAboutdrain layer permit 33 Niederwerfer Road (2) ® molauflillimmayI!Xo]
■ ■■■■■ ■■ ■ ■�."' ■
■ ■ ■ fit Him
■■■I■■■ ■■I■ ■■■■ I■■I ■■
MEN 0 ma 2
■■■■■ ■■ .. ■ENE■t■■�r ■
■■■■■I■II■ rrr wrr ■ ■� ■ ■■■■■■
■■ ■■ rr►r■■s ■ � rrr�■■■■
■■®■■ ■ I�■ ■■ . ■■
r �� AWr , ,,
THE JACK CONSTRUCTION MATERIALS PHONE 860-243-9714
_' • 97 OLD POQUONOCK ROAD 1.800-423.0112
FARRELLY 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-0 f v we r,.1- l
INSPECTOR: Ge rni c t cu 6-Q I. TESTED BY:
DATE OF TEST: CONTRACTOR: -4� (cz,'j s4 e v C4 c).,
HYDROSTATIC TEST
WATER MAIN TEST❑ SEWER MAIN TEST U,-" LENGTH OF TEST:
STATIC PRESSURE: TEST PRESSURE:
ALLOWABLE LEAKAGE: ACTUAL LEAKAGE:
TEST RESULTS: PASSED ❑ FAILED ❑
REMARKS: rest k1kefoN +Ct� ,1"o '•J 21a{ <,i 4,i o
{
t
AIR TEST
MANHOLE TEST PRESSURE TEST RESULTS
NUMBER IN P.S.I. TIME OF REMARKS
OR STATION START STOP DROP IN MIN. j? TEST
7ti.�CG.k'X'�J S't �•+.5 2» l S- �_ l 3�£+7�a r oQ
I certify that the above information is a true and accurate account of the tests performed at this location.
SIGNED: p, � ° - S. Tl
INSPECTOR TESTER
11, >!�� -•2N /-j SAX c�
4e-
(71
359.5 TO' S Mg
X 60.3
� a m
10" x m
X. 0 ain? x 10�, 0
. _1..._ G 12'• C9 .399.4 6 MAPLE A PL E
a
.no
—D 15 CP EET D IN
T 49 6 c SNET
212
25. 359.5 M 105 00
r
X 6 369.3 m
r— —� I •�t211 _ �5,
#F 43 * 33 /
! STY. FR. 1425
i 1 STY. FR I STY. FR.
T.F. 36 0.61 T.F. 3 66.12 r T F I 3T0.02
L u/c �
X.365// 369.5
x �1*
TTE , 'KENNET C. F
A NANCY.. WA (3. A V A, W LL D B.
`W ARI YN I.
= 2 r 4 I s /Aa �? /W c�{�
20 LAT. 7.6'0 ` 2-0'1.At. x 8,z'n 40),
7�O 6 Nutmeg Drive
P.O. Box29 INVOICE
/ Ellington,CT 06029
(860)875-2332 3878
8 7 8 6
i septic tank pumping • repairs • installation • excavation • sewer&drain line ins•7tatll7atilon/cleaning
NAME
DATE
JOB LOCATION
PHONE -
BILLING ADDRESS
❑CASH ' t
HECK # ❑CHARGE ® S
✓(QTY) DESCRIPTION OF LABOR/MATERIAL '
umpin4) f
AMOUNT
Digging/Locating j
Manual Snake
Risers/Covers
Baffles
Drain Cleaning
Jetting j
Service Call
Real Estate Inspection
Repair
Test Holes
TAX
SIGNED
TOTAL
a �
BALANCE
DUE
PLEASE PAY FROM THIS INVOICE
A 1 1/2 %service charge will be added if not paid in 10 days.