HomeMy WebLinkAboutDrain Layers Permits 280 Kelly Road 1500017 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/28/2015
GIS ID:49500280 FEE: 60.00
MUNIS APPLICATION# 201500393 EXPIRATION DATE: 05/28/2015
APPLICANT LOCATION
NAME: WASTEWATER SERVICES, INC ADDRESS: 280 KELLY ROAD
.ADDRESS: 21 COURTNEY DRIV11 OWNER: HOLGERSON FRANCES J
ELLINGTON,CT 06029 29- kjll Y ROAD
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 `CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
i Q ,
ISSUED BY DATE INSPECTED INSPECTED BY
4/28/2015 8:44 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: f,:S e�cQl ? CONTRACTOR: 0&1�P i
LOCATION:
TYPE OF WORK: CAj Le i D.s Co Dh
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 80
WORK IN
PROGRESS:_
Pvc SiJirL 35-
4c, L ��b L'v.-12.v� e,`� �Q�� �eh+a e - —cry q r� S,lt 40
u� ► f Fer.� e.t, ,o ' rro,"..S� 4 3�Y r' Crr..e- 1.l 1 541►le
pa.J P"
T Wyk- G
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED 2rYES ❑ NO
AS-BUILT:
INPUT: — DATE: \`
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALT.
SOUTH WINDSOR,CT
FEE$60.00
: .Location,of proposed work: ` 2 ?o 9C L I-r*-
Stxed No. Streef Name
Premises owned by: . U i./d e h( v.t L 46 4q
Name of Finn: S k:iIpf 4JA-s IrZ A/�m 2 Phone; S6a S S Z 33 Z-
Address of FitYm: Z! Co k t-fw -Ll 91�-L/AJ 670
TYPE OF WORK:
Lay House Drain Repair House Drain ;
LIdinm ; �Lateral for CommerciaVIndusbial
g of awes
Cone tlon will be made with sb� 3 5- Pyc
Ewing Water Supply: Public Water_ Well K
Proposed Start Date� Estimated time for mrhpledon
ALL WORK TO BE IN ACCORDANCE Wti'H.TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDMONS ATTACHED TO THE PERMIT
V.
Permit is to be issued to _ `f0lt &/AIL' the holder of Drain
Layer's Udense No, o zo 77 z T- . Only holders of P=1, P-7. or W 9 licenses
wiU be issued a permit. PERMIT WILL EXPIRE THIRTY(30)DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the teens
and conditions set forth in the permit and attached thei to.. Applicant has rea Wed
Town Street excavation Permit No. and/or C DnnDOT Permit No.
PLEASE NOTE;
CBY. D-No. 70/ Sl 70 4-74-3 rmal 'iTARt'SsWER•LATERAL
rS wzrmm75FEET OFA WELL
r-rNIISTBEAIR TESTED
Sin : f �S C� -hF2
9 Print Name:
Lkensed Drain Layer
Date: 4-.2 7
Surd FWns\PmftWMCA'n0N FOR DRAIN LAYERS PERMlt doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: q - ,a I - 15-
BUILDING ADDRESS a80
STREET : Kell" PZ om
SUBDIVISION:
NORTH ARROW
I y I (
At
E
:
y - if
1
f I
ZPa eclAy
"tom
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
1 C(Joc�rxl
STREET ADDRESS ( , SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
960- 8�IS- 133 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER