HomeMy WebLinkAboutDrain Layers Permit 07 Deerfield Lane 1500005 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 02/19/2015
GIS ID:27300007 FEE: 60.00
MUNIS APPLICATION# 201500131 EXPIRATION DATE: 03/21/2015
APPLICANT LOCATION
NAME: WASTEWATER SERVICES,INC ADDRESS: 7 DEERFIELD LANE
ADDRESS: 21 COURTNEY DRIVE OWNER: GRUCA PETER&CHRISTINA
ELLINGTON, CT 06029 7 DEERFIELD LANE
SOUTH-WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN THE'ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
r'l log Xa
ISSUED BY DATE INSPECTED INSPECTED BY
2/19/2015 10:01 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1.5-cen D15- CONTRACTOR: tk'06 .. Lk S1v) 0�
LOCATION: '� �et'�'-�t e I
TYPE OF WORK: e Lo -so nl!a D n
DATE INSP.NEEDED: DATE INSP:
INSPECTED BY: -8 b
WORK IN
PROGRESS: Cc n ly - 4-e-- �t�.s��„I t z� 1 (�`� F-/+L. Pl-1 w►p C I lc—n
LA 5 0- ve 5,04 r/O
CT - I'n `�e�,_CJ. a—z-14 , i�i�V-A - `�F- S G/4 q 0
�2It �P S'! "b W1`an-Q f�rsr►� 4�1 LJ�3
i�,57�i ILA
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED E YES ❑ NO
AS-BUILT:
INPUT: DATE:
—Y
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
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: Lot #
Street No. Street Name
Premises owned by: 'PF-7T7;L_ 6-72-u c A
Name of Firm: S K/os w A s G✓A T�T� Phone: 8%a 8 7� 2 3-S 2
Address of Firm: 2i Cau m TN F L �rZ E-1-L<j 6�
TYPE OF WORK:
Lay House Drain ; Repair.House Drain.
Lay Main : Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with P v c s3 g 3;
Existing Water Supply: Public Wateerr_ Well
Proposed Start Date z-/L/-5' Estimated time for completion 2 —z o—/
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 the holder of Drain
Layer's License No. o z 2 Only holders of P-1, -7b r W 9 licenses
will be issued a permit. PERMIT WILL EKPIRE 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.
PLEASE NOTE:
CBYD No. _ -o/ S6 7 000 96 lFA SAN,ITARYSkWER.LATERAL
IS MP7THIN75 FEE TOFA WELL
1'M11STBEAIR TESTED
Signed g Print Name:
icensed Drain Layer
Date:
® standard FormWermb\APPUCAMN FOR QRM LAYERS PERMIr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Z z 1 r
BUILDING ADDRESS 7
STREET : Pee. ice- /c
SUBDIVISION:
NORTH ARROW
"T 71
Iry
' ! I i
14 �• I
4r
itt
s
�b+i` s �✓r.s ti'.,%t Ser c`r�`e es AJ;-e a 1/'o e e!
CONTRA TOR (PRINT / NAME OF CONT CTOR'S /PE�VISOR (PRINT)
STREET ADDRESS SIGNATURE J
t�l 4 DATE
TOWN STATE ZIP INSPECTED BY TOWN
L6 0 j t z G DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER