HomeMy WebLinkAboutDrain Layers Permits 172 Pepin Place (2) 1600079 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/18/2016
GIS ID: 70700172 FEE: 60.00
MUNIS APPLICATION# 201601711 EXPIRATION DATE: 12/18/2016
APPLICANTLOCATION
NAME: ATLANTIC EXCAVATION INC ADDRESS: 172'PEPIN PLACE
ADDRESS: 363 PARUM ROAD " OWNER: T&M BUILDING CO INC
COLCHESTER,CT 064J 5 110 BROOK STREET
fifJRRINGTON, CT 06790
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION FOR'BUILDING SO- NDSOR WOODS
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUEUBY 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.
1L -is -1
ISSUED ffy DATE INSPECTED PECTED BY
11/18/2016 11:31 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 16 00079 CONTRACTOR: A;-&,27)L
LOCATION: .
TYPE OF WORK: Y)F LJ ! ceu �o r►P� �� 1 /�q ° G� ��,,��oc�S
DATE INSP NEEDED: It DATE INSP: 1 1-22 I
INSPECTED BY: i-ee
WORK IN .
PROGRESS: iP� cNS�I���'',� c-i�S;.��� /JATIV/r_ 11AA VIAL (�rntl)
SEPTIC TANK PUMPED,SMASHED, FILLED N WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: ATE: Iv '
S/molloy/forms 2014 Town of Smdh Windsor INPSECTIOPt REPORT 14
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: llsftz.7c. i Y 8S-"A917 Lot # .43 ;
Street No. treet Name lvvvx PA--,
Premises owned by: 7/,71
Name of Firm: � CIO-, .74-�c . Phone:
Address of Firm: b��'3 ����. �, Caj��s i C% OC W/ -T
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 r C 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 ,z 14t& r— Fae ., .725an L?;;. the holder of Drain
Layer's License No. =r )P7. 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 attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. :�,2_0��'y�(n/Kf 5 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name:_ ac y
�,Lg
Licensed Drain 4yer-
Date: l
Standard Forms\Perm1t5\APPLICA1I0N FOR DRAIN LAYERS PERMrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 6
BUILDING ADDRESS m) , its
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N STREET
SUBDIVISION: ` )o
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CONTRACTOR (PRINT) NAM F C TRACTOR'S SUPERVI INT)
STREET ADDRESS `
L"f c. DATE
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TOWN ,% STATE ZIP INSP , D Y TOWN
<b�o- "):j�- 00 o DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER