HomeMy WebLinkAboutDrain Layers Permits 39 Glenwood Road (2) 1500045 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/29/2015
GIS ID:35700039 FEE: 60.00
MUNIS APPLICATION# 201501020 EXPIRATION DATE: 08/28/2015
APPLICANT--. ; LOCATION
NAME: WASTEWATER SERVICES, INC ADDRESS; 39 GLENWOOD ROAD
ADDRESS: 21 COURTNEY DRIVE OWNER: CORCORAN DOROTHY J
ELLINGTON,CT 06029 39 GT EI�FWOOD 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`ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY 7/29/2015 11:06 AM DA INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO..: GAD �� CONTRACTOR: k)
LOCATION: 3 9 G e W onc;Q
TYPE OF WORK: Nt-.-,,,7
DATE INSP NEEDED: DATE INSP:��
INSPECTED BY: 8-t>
WORK IN
PROGRESS:(t14S�"G - er y,'c�s t�nc� 6 a( �, '' ✓c SY>ie
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SEPTIC TANK PUMPED, SMASHED, FILLED � WITNESSED 9- ES ❑ NO
AS-BUILT:
INPUT: C DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT ,
TOWN OF SOUTH WINDSOR
1540 SUUJVANAVENUE
PUBLIC WORKS DEPARTMENT
SOUTH WINDSOR,CT
FEE$60.00
-Location of proposed woic: .39 61_e 4 Guoo r7 Lot#
Street No. Simms Name
Premises owned 1 V: . C o c o 7r l d
Name of Rrm:_ �Slcc Ems i.�A s-r�w ,q-T�rL Phone.. -aa0 F75 Z 3 s Z_
Address of Rim., 2t Cb-u rzTn� y c�rc, �,� GZ�J
TYPE OF WORK: x
Lay House Drain • Repair House Drain ;
Lay Main_; Lay Laferai for Commercial/Industrial
Building a of acres
Connection will be made with 5'3)72- 35
Esdng Water Supply: Public Water_ Well
Proposed Start Datie L" 22 Estimated time for completion tl
ALL WORK TO 6E IN ACOORDANCE WITH.TOWN'OF SOUTH WINDSOR STANDARDS.,
ALL OSHA.REQUIREMENTS AND CONDI[ IONS ATTACHED TO THE PERMIT
Permit IS W be issued to X--0�- of Drain
L.ayeeS L kense No. 0 �7 2 1 5 Only holders of P- P-7. W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30) YS AFTER
DATE OFXSSUANCE. The undersigned Drain Layer hereby agrees to all the teffns
and aondidons set forth In the permit and attached f wreto.. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
d/s 3 / PLEASE NOTE:
CBYD No. - 00 ZFA'SAXrrARYSZffR•L47EA4L
IS WITHIN75 FEE TOFA WELL
ZT MUST E'EAT TESTEi D
Signed. Print Name: 7,-j 4 i
Licensed Drain Layer
Date:
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: r
BUILDING ADDRESS 3
STREET : �kn wood izi
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NA OF CONTRACTORS SUPERVIS R (PRINT)
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STREET ADDRESS SIGNAT E
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TOWN STATE ZIP INSPECTED OWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER