HomeMy WebLinkAboutdrain layer permit 0000 Sullivan Avenue TOWN OF SOUTH WINDSOR INSPECTION REPORT
PervI t No. 7403
Contractor MID STATE SITE DEV. GIF�'J
Location SUL.LIVAN AVE. FROM Address P.O. BOX 654
Type Work SAN MAIN CANTON CT 06019 * 7-5v-5:1
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ppe No. ( 860 )693-6899
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OK SULLI��J
PerrNit -N9• 7403 Town of South Windsor, CT
Permit Date 04/10/2002 Drain Layer Permit
Expiration Date 05/10/2062
Dbscrip; INSTALL SEWER MAIN ON SULLIVAN AVE.
Location
Name MID STATE SITE DEV. Adar,.S IVAN AVE. FROM
Addr. P.O. BOX 654 owner RRWBERRY FIELDS
CANTON CT 06,019 �
Phone No. (860)693-6899
The Drain Layer ash ig�n�d . h7 s per m t Baas a vt '1 i d �,i-,,cense issued by the
state and hereby agrestpiIr: the tee sndotd!tions set forth in the
attached 'Conditions". AI -*tie }� box> n ac organ with Town of South
Windsor standards, all OSHA .l��gU'ti1e�11r8` n,d .~ p1e attached conditions.
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work: G 1 I O V4 r\ /,P—
Street No. Street Name
Premises owned by:
Name of Firm: St#Tzf Sl7`zf De (J Phone: �o3 c j
�
Address of Firm: 1�}l�1�� lA � /� y
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main 0 F ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Proposed Start Date_A 15 1- Estimated time for completion cA
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 ^'^' 4cPVf. the holder of Drain
Layer's License No. 28®s94- . 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: Print Name:
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
THEJACK CONSTRUCTION MATERIALS PHONE 880.243.9714 r
• 97OLD POOUONOCK ROAD 1-800-423-0112
FA RRELLY BLOOMFIELD,CONN.06002 FAX 860-28"867
i COMPANY 150 UNIVERSAL DRIVE(Rear) PHONE 203.777-5548
y • NORTH HAVEN,CT 06473 FAX 203-777-3147
I COLTON ROAD PHONE 860-739.5457
EAST LYME,CT 06333 FAX 860-739-8513
i
i 149 SOUTH WEST CUTOFF PHONE 508.752-PIPE
WORCESTER,MA 01604 FAX 508-797 4455
1
I
i
WATER/SEWER TEST REPORT
PROJECT/LOCATION: Aj J1ale /4')*,)1)1 Ira
f ,r
4 INSPECTOR: TESTED BY: �\It�i h .�F;r r-c ll
j DATE OF TEST: Z r"0 Z CONTRACTOR: 4
HYDROSTATIC TEST "`'
WATER MAIN TEST❑ SEWER MAIN TEST LENGTH OF TEST: 1L ?1n\yt
STATIC PRESSURE- ii TEST PRESSURE:`L 1
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
8 2 y 6
17. 5
I certify that the above information is a true and accurate account of the tests per rmed at this to-ation.
SIGNED:
INSPECTO TE4 -R
TRE JACK _ CONSTRUCTION MATERIALS PHONE 860-243-9714
• 97 OLD POQUONOCK ROAD 1.800-423-0112
FARRELLY' BLOOMFIELD.CONN.06002 FAX 860.288.0867
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 S60-739.8513
149 SOUTH WEST CUTOFF PHONE 508.762-PIPE
WORCESTER,MA 01604 FAX NO.7974465
L WATER/SEWER TEST REPORT
PROJECT/LOCATION: VI -5 i �{=I Z�Jlwu
C Au C
INSPECTOR: TESTED BY: r rY
DATE OF TEST:p (�j— ZL)rb-& CONTRACTOR:
Alad Yr- I HYDROSTATIC TEST
WATER MAIN TE SEWER MAIN TEST❑ LENGTH OF TEST:
STATIC PRESSURE: TEST PRESSURE:
ALLOWABLE LEAKAGE. `ACTUAL LEAKAGE:
TEST RESULTS: PASSED ❑ FAILED ❑ ( 1
REMARKS:
AIR TEST
MANHOLE TEST PRESSURE TEST RESULTS
NUMBER IN P.S.I. TIME OF REMARKS
OR STATION START STOP DROP IN MIN. TEST
201 All re
1 certify that the above information is a true and accurate account of the tests pert reed at this locati
SIGNED: ..�j -, ,j _
INSPECTOR • 1 TESTE,