HomeMy WebLinkAboutDrain Layers Permits 350 Buckland Road (3) 1200026 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/22/12 - -,
GIS ID: 15300350
-� = FEE: 60.00
MUNIS APPLICATION# 201200739 may ' EXPIRATION DATE: 07/22/12
LOCATION
APPLICAN T y '%
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NAME: J&H SLATER CONS' CONOVO�1DDRES� 5( ULAND ROAD
ADDRESS: 75 COMMERCE WAIF 5 EI - t1 TICOJ INVESTMENT LTD PRTRSHP
No
SOUTH WINDSOR, . LI:NGTON RD
Poo- Am
� TTI INDSOR,CT 06074
PHONE 860-528 f—2 2 ,
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WORK DESCRIPTION: NEW SET � r—
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THE DRAIN LAYER ASSIGNED TO THIS 'ER Lrvm A s' I E_fiATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORT I I �A f - NORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAftSog- C�SJIA AN K TTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
6/22/2012 3:31 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /a 00oa( CONTRACTOR:
LOCATION: 350 9�c lcl a ad e-A
TYPE OF WORK: V'\y_L0 &.Q LA)-� CD-n rgc4 e S ldJ
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: Sp
WORK IN
PROGRESS: Cove" From 6 5+ 6 -b i ePf Fro-+
10)ng; uriw Fmo flo) 41roi,4 `i Scl, wp
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR, CT
FEE $60.00
.Location of proposed work: �� �u�l�� (�1? Lot #
Street No. Street Name
. 'Premises owned by: CI Im a uj s �LC
Name of Firm:__ Phone: c960-�Z �SZ�Z
Address of Firm: l O WA wt IZC-L. .
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main • Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date 6 S�I-Z- Estimated time for completion
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 �� 1��— the holder of Drain
Layer's License No. Only holders of P-1, P-7 or 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 ttached thereto.. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
PLEASE NOTE:
CBYD No.X0 I Z 66 3 S IZ IFA SANITARYSEWER LATERAL
IS WITHrN75 FEE T OF WELL
IT MUST BEAIR TESTED
Signed• Print Name: F}M►'lF5 (, tZ
Licensed Drain Layer
Date: �5�2
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATE R-A-'L-:.'-..F I E LD LOCATION
DATE- OF' CONSTRUCTION
BUILDING ADDRESS `/o : S'D 8u�k �h�f
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINTS
STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUM ER ,.
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING .ENGINEER / DEVELOPER
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m 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074
sos•co��� AREA CODE 860/644-2511
SEWER TEST REPORT
PROJECT: 21) + Aso A"c I Cwnmd lls 80%w
LOCATION: 13 well;"wck"d 9, . 3 cZ
DATE: 0l4lqS5
MANHOLE NO. TEST PRESSURE (PSI) TEST TIME RESULTS
OR STATION =RTSTOP DROP START STOP TIME
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TESTED BY: s ' 14 S I�
INSPECTED�BY:
REMARKS: