HomeMy WebLinkAboutDrain Layers Permits 42 Longmeadow Drive (2) 1800025 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 04/26/2018
GIS ID:54670042 FEE: 80.00
MUNIS APPLICATION# 201800559 F EXPIRATION DATE: 05/26/2018
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APPLICANT
LOCATION
NAME: SSC CONSTRUCTIQNoLLC ADDRESS . 4HONGMEADOW DRIVE
ADDRESS: 1700 SAYBROOK RabA O�WTER TOLD,LAND XVIII LIMITED PARTNERSHIP
MIDDLETOWN, C 1 ObS�, 250 GIB�ALTAR ROAD
HO S"H,$ M,PA 19044
PHONE
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WORK DESCRIPTION: NEW S4WEP zO IN CTION 'y
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THE DRAIN LAYER ASSIGNED TO THI.&IP11 IIT�I 1S 1 VALID LY ENSi;ISSLjl;13 BT'TI STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORr1 H=T1 THE�ATTACHID�CQIpITQNS' tLORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUII M - .. AIrID , ATTACHED CONDITIONS.
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ISSUED BY DA INS ECTED INSPECTS BY
4/26/2018 2:20 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: . CONTRACTOR_,�G -OYISIEJAPI)
LOCATION: LI
TYPE OF WORK: Y\ n I''► '
DATE INSP NEEDED: DATE INSP.' 1
INSPECTED BY: g
WORK IN
PROGRESS: c�c��' i t. i�' s �" Aj
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT:_ o.,�, I - DATE:
S/molloy/forms 2014 Town of South Windsor INPSEcrlON 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
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Location of proposed work: \C)og Lot #
Street No. Street Name
Premises owned by: �ot� r�5• ��-
Name of Firm:���c c �,str�'c���'1 ���- Phone: �6c�. 2sc�• 2-3 t 3
Address of Firm: 17oo 5'�-,jb tact-v %"c-k)-2Ac��n C-
TYPE OF WORK:
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 b" SZ)iZ
Existing Supply:Water Su 1 : Public Water Well
Proposed Start Date 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 ��tiU� �-- fix"\`'', 40 the holder of Drain
Layer's License No. 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. -Z4 rI-70Ll 22,5 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED .
Signed: Print Name: SGtL,,c a—
Licensed Drai. Layer
Date: ��• 2 6
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: -416r4 ,
BUILDING ADDRESS :
STREET :
SUBDIVISION: c� �
NORTH ARROWfill
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGKAfURE
imJcj 1 C.- 1 � s,� `" 5r/Zs// DATE
TOWsN� STATE ZIP INSPECTED BY TOWN
�� ` j DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER