HomeMy WebLinkAbout175 Oakland Rd - Drain Layer Permit - Bldg 1 1800015 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 04/10/2018
GIS ID:65700175 AF, FEE: 80.00
MUNIS APPLICATION# 201800370 ' EXPIRATION DATE: 05/10/2018
APPLICAT'T LOCATION
NAME: GERBER CONSTRU(ft OQN CO ADDRESS 175 OAKLAND ROAD
ADDRESS: I NUTMEG DRIVE OWNER BE§VTATCH III LLC
ELLINGTON,CT 0602 6 EXECUTIVE DRIVE SUITE I00
' FAR�!IINGTON,CT 06032
PHONE 860-871-;6684
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WORK DESCRIPTION: NEW SEVEICt?NN �TIO1V FOR BERRY'1'ATGI III �'
BUILDII�' "(1) I01 lI2
THE DRAIN LAYER ASSIGNED TO THIS;I'EF2MZZ, I I HAS A VALID LIBNSE ISSUED BY THR STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH YN THEATTAG'HED`C N:DITIONS' L ARK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS A L OSIIA.REQiJI'REM)NTS,aND TH1 ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
4/10/2018 12:00 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONIRACTOR: � l" "r .�
LOCATION: i"7 ( QQjj
TYPE OF WORK: 61,Ja-, I. upu) LaWpf
DATE INSP NEEDED: DAIS INSP:-,ZZ
INSPECTED BV:
WORK IN
PROGRESS: ,.
SEPTIC TANK PUMPED,SMASHED,FILLED WITNESSED ❑YES ❑ NO' .
AS-BUILT:
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INPUT. DATE;
5/m6ilay/farms 2014 Town of South Windsor IrMitMON WOU 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR C0 M �---
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $80.00
Location of proposed work: t*7 S Lot #5 L D �--
Street No. Street Name
Premises owned by:
Name of Firm: Ve /'�� o C�,�s�.,z � � �P Phone: '56_0 6 7V /
Address of Firm: C �xec���� t� i�� , CT 96t o6o3Z
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 Fvrn co
i
Existing Water Supply: Public Water X Well
Proposed Start Date Estimated time for completion i 2 3r i
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 6 Atv Co;,J(vA-?^ -kNc- the holder of Drain
Layer's License No. 0--Lo%4s,L- 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. �0 70 19 S �� _ PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed. Print Name: Fo^
Licensed Drain Layer
Date: 11`/ljs
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 2017.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 1/.- 30 _ rs
BUILDING ADDRESS : pond
STREET 0
SUBDIVISION: rlr�kk �Tv_
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF,,CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS ii SIGNATURE
TOWN STATE ZIP INSPECTED BY TOWN
F G�` '3 7 b-_(Co g y -- - DATE
TELEPHONE NUMBER
WHITE -- TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER