HomeMy WebLinkAboutDrain Layers Permit 023 Arnold Way 1900012 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/15/2019
GIS ID: 04500023 FEE: 80.00
MUNIS APPLICATION# 201900079 EXPIRATION DATE: 02/14/2019
APPLICANT LOCATION
NAME: SKIPS WASTEWATER ADDRESS: 23 ARNOLD WAY
ADDRESS: 21 COURTNEY DRIVE , OWNER: SALAFIA-WELCH HEATHER L&
23 ARNOLD WAY
ELLINGTON,CT 06029
PHONE 860-875-2332
WORK DESCRIPTION: NEW SEVER 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.
ISSU 'BY DATE INSPECTED INSPECTED BY
1/15/2019 2:22 PM
TOWN OF SOUTH.WINDSOR INSPECTION REPORT
c
PERmrr NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK: ` 16'GJ
DATE INSP NEEDED; DATE INSP 1
INSPECTED
WORK IN
PROGRESS: I V0 WL� ►2 Y✓ m
�W �� ���>I,.z,� - �-fay..-e. ���,�,�.. / � • ��l�u � �rr'. `�,�
SEPTIC TANK PUMPED,SMASHED, FILLED � WTIVES.SED ErYES [] NO
AS-BUILT:
INPUT: iN` DATE:
*lnollWira ms M Tom of South Windsor MpstTft RM�U 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE $80.00
Location of proposed work: 2 3 gfz N 01- w Lot #
Street No. Street Name
Premises owned by: An y //f A-171f/2 s Ac,41elw_
Name of Firm: (S�i PS Gv/3r� "/ �Z Phone: W o-?7 -Z 3 3 2_
Address of Firm: 2/ C lz -7V P/ .4-4. G rc 1\,/
TYPE OF WORK:
Lay House Drain X ; 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 w r` P V G
Existing Water Supply: Public Water Well
Proposed Start Date 4 z - 9 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 7711'Ll , the holder of Drain
Layer's License No. u z v 7?Z 5 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. 0/ 9 0 300 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE AIR TESTED
Signed: -� Print Name: 7YV?%719'( G✓��lc-f/i;
Licensed Drain Layer
Date: 9
standard Forms\Permits\WUCAnON FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: / /a z 19
BUILDING ADDRESS 13
STREET : AANQLb WAY
SUBDIVISION:
NORTH ARROW9��;�
Jm-
I
CONTRACTOR (PRINT) J� NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
o6 DATE
-OWN STATE ZIP INSPECTED BY TOWN
DATE
4r
-PHONE NUMBER
-E - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER