HomeMy WebLinkAboutdrain layer permit 100 Griffin R 1000051 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 09/28/10
GIS ID: 39009999 FEE: 60.00
MUNIS APPLICATION# 201001328 EXPIRATION DATE: 10/28/10
APPLICANT" �o LOCATION
NAME: ENVIRONMENTAL SERVICES ADDRESS: 9999 GRIFFIN ROAD
ADDRESS: 90 BROOKFEILD STREET OWNER: WY OF SOUTH WINDSOR �. .
SOUTH WINDSOR,CT 06074 1540 SUL IVAN AVE
SOUTH WINDSOR,CT 06074
PHONE 860-528 9500
WORK DESCRIPTION: LAY NEW SEWER;MAIN EA$T WINDS(OR AND SOUTH WINDSOR
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUEDBY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH,&THE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,-.,ALL OSHA REQUIRE1vIENT5,AND THE>ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/28/2010 2:03 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: Cn J%✓rao m64 7L9
LOCATION: /00
TYPE OF WORK: ry(-J
DATE INSP NEEDED: DATE INSP: &Z7
INSPECTED BY: AD
WORK IN /
PROGRESS: ���vac�✓ ins1eJ ir puc S< lz
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: V�� DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
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: , C)In �z I f-r,A) +�� Lot #
Street No. Street Name
Premises owned by: ��,
Name of Firm:_ -ray I Phone:Ro of S'00
Address of Firm:_
TYPE OF WORK:
Lay House Drain • Repair House Drain
Lay Main • Lay Lateral for Commercial/Industrial
Building of— acres
J
Connection will be made with & I'U
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion y per' S
ALL WORK TO BE IN ACCO ANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to _M the holder of Drain
Layer's License No. (L-2 qq c_4 _, Only holders of P-1, t=�r W-9 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.
a�G 1 0 ,' 200 6`01 ��5� �s� C",d�r�,n 20 v�W
CBYD No. -�2_610 3 7 00 5c�� 96--lU(4 G21,r61k0 CIO
Signed: Print Name: � M/Q
U n Drain Layer
Date:
Standard Forms\PermitSWPLICATION FOR DRAIN LAYERS PERMrr.doc
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s 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074
AREA CODE 860/644-2511
R Co
SEWER TEST REPORT
PROJECT: qG
LOCATION: 'r,
DATE: /c) It li a
MANHOLE NO. TEST PRESSURE (PSI) TEST TIME RESULTS
OR STATION START STOP DROP START STOP TIME
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TESTED BY: C-1yy'rotj/I!4evi 52rv,`ces
INSPECTED BY: z z-
REMARKS:
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