HomeMy WebLinkAboutDrain Layers Permits 247 Deming Street (2) 1800050 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/16/2018
GIS ID: 27600247 FEE: 80.00
MUNIS APPLICATION# 201801231 EXPIRATION DATE: 08/15/2018
APPLICANT LOCATION
NAME: WASTEWATER SERVICES/DBA SKIPS ADDRESS: 247 DEMING STREET
ADDRESS: 21 COURTNEY DRIVE OWNER: WOLF HELMAR&BEVERLEY G
ELLINGTON,CT 06Q29 . 247 DEMING STREET
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: NEW SEWER CONNECTION
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED$Y 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.
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ISSUM BY0 DATE INSPECTED INSPECTED BY
7/16/2018 3:05 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: aS ��a �u
LOCATION:
TYPE OF WORK: D D✓)
DATE INSP NEEDED: DATE INSP: 5} q
INSPECTED BY: �
WORK IN
PROGRESS. sop-
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SEPTIC TANK PUMPED, SMASHED, FILLECL WITNESSED EllES 0 NO
AS-BUILT:
INPUT: LW'� DATE: 1 d
S/molloy/fams 2014 Town of South Windsor INPSECRON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: 1-7 Sf- Lot #
Street No. Str t Name
Premises owned by:
Name of Firm: t# s �c �, �� Phone: Co
Address of Firm:
TYPE OF WORK:f
Lay House Drain , Repair House Drain ; Sanitary Disconnect
Lay Lateral for building with connection — or no connection ;
Lay Main
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with 6 SQ fZ S- PV-(
Existing Water Supply: Public Water Well vl
Proposed Start Date 7 Is 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 a � I��� the holder of Drain
Layer's License No. o'7o77z S 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. Zol Z900 H e o PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: ��1^?4 s `✓< ��r R
L censed Drain Layer
Date: 7 �� (e
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET : �),e.ate, 0
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER