HomeMy WebLinkAboutDrain Layers Permits 47 Benedict Drive 1900054 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
5.
DATE: 05/09/2019
GIS ID:09600047NA
4 FEE: 80.00
MUNIS APPLICATION# 201900906 y, 1 EXPIRATION DATE: 06/08/2019
41"61
APPLICANT x LOCATION
NAME: WASTEWATER SER.MRSI,D1 $KIPS ADDRESS "� BEI EDICT DRIVE
ADDRESS: 21 COURTNEY DRIlo.". OLLIA S ROBERT S&DORIS
BENI7rDICT DRIVE
k
ELLINGTON,CT 060
PHONE
WORK DESCRIPTION: SANIT)o Y4PAR U 5 i r
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THE DRAIN LAYER ASSIGNED TO THIS $ MI 'I Its S A 4�E ILA LI(;'111ISSIJED BY THIS STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR II`IN�THE 1TTAC D`C(,� TI SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAD�,AI;L OSHA'RI;GUIREINTS,AND TFIE ATTACHED CONDITIONS.
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ISSU D BY DATE I&SPECTED INSPECTED BY
5/9/2019 10:21 AM
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TOWM OF SQUT 1-MINDSORINSP�EC110. REPORT
PERMIT NO.: /,q D Co UP,
LOCATION; }
TYPE OF WQRK: G
PNEEDED' DATEINSP:.
DATE INS
INSPECTED Br.-A -- -
WORK.IN
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HED FILLED WrMESSED YES (] NO'
SEPTIC TANK PUMPED-1 SMAS _ , .
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S/moltcy(forms 2014 Tom of S.uth Windsor INPSWDN MEPOW 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: 4-7 IC%' Lot #
Street No. Street Name
Premises owned by: -OW C17-r- L ��
Name of Firm: S k�-t PS- 4J19'T7-T fJ19-rT- z Phone:
Address of Firm: 2-t Co"tI--77V f.7 4.-�'j6�1 A)
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 Pvc- S'Pjz- 3 5-
Existing Water Supply: 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 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. ;2 0 r 9 'R D 4- 3 g C PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
ZZL
Signed. Print Name:
Licensed Drain Layer
Date: - 9 - / �
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2016.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS 7
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CONTRACTOR (PRINT) NAME OF CO TRACTOR-S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
EL-Q N jLbt.j CO iJ tj Z DATE
TOWN STATE ZIP INSPECTED BY TOWN
�� .,�-���.� �•�S� DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER