HomeMy WebLinkAboutDrain Layers Permits 128 Farmstead Drive 1800008 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 03/05/2018
GIS ID: 31800128
3 FEE: 80.00
MUNIS APPLICATION# 20I80026 1t EXPIRATION DATE: 04/04/2018
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APPLICANT' Y= iF LOCATION
NAME: WASTEWATER SE%!'&. CESjAEA KIPu, ; ADDRF1yS 118 FA�2.MSTEAD DRIVE
ADDRESS: 21 COURTNEY DRIIv }th OWNER 1GIFtI�DEN MARY M
ELLINGTON,CT 0 FARMSTEAD DRIVE
,SOU 3Ir WINDSOR,CT 06074
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PHONE
WORK DESCRIPTION: NEWS WI
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THE DRAIN LAYER ASSIGNED TO THIS PE2i+II'T�HAS A VALID LICI+SIf ISSUED BYuIH STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR FU`N TH8.hTTAGH>D`CONDITIONS �[I,L WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND, 1;12EQt]IREM5N`I' AletD T1 E ATTACHED CONDITIONS.
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ISSUED 8Y DATE INSPECTED INSPECTED BY
3/5/2018 8:23 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: �'L122 CONTRACTOR: Wd64�-" X P42]z es
LOCATION: �4Plaf
TYPE OF WORK:' 12et,0 we-r
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 86
WORK IN
PROGRESS:
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Y
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/farms 2014 Town of South Windsor INPSECRON REPOT 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: /Z9 /-511/Vt S j .: Lot #
Street No. Street Name
Premises owned by: l
Name of Firm: S G"' ��s �� -��� Phone: o 6
r
Address of Firm:
TYPE OF WORK:.
Lay House Drain ; Repair House Drain ;
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 PVC 6" 5 DiL 3 s
Existing Water Supply: Public Water Well X
Proposed Start Date 7 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 Au''4 �� '"` C`� j � the holder of Drain
Layer's License No. 0 z o •"Z �- . 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. PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: �-��d Print Name:
Licensed Drain Layer
Date: L-Z 17
Standard Forms\Permlts\APPLICAnON FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WI N DSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 3 — d'' ���
BUILDING ADDRESS : 1 .18
STREET : Fav- tecs<
SUBDIVISION:
NORTH ARROW
I
21
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CONTdCT R (PRINT) NAME OF CO TRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS
��- SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
��'~r +� DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER