HomeMy WebLinkAboutDrain Layers Permits 28 Birch Hill Drive 1900085 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 07/16/2019
GIS ID: 11400028
FEE: 80.00
MUNISAPPLICATION# 201901441 ,5 EXPIRATION DATE: 08/15/20f9
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APPLICANT k LOCATION
NAME: WASTEWATER SERkIC-,S/DBA STRIPS ADDRESS 28 BIRCH HILL DRIVE
ADDRESS: 21 COURTNEY DRIVE K s x dWNER HIN06N THEODORE W&ROXANNE L
2$SYRG` I HILL DRIVE
ELLINGTON,CT 0029 ; hi .!x. ` r
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WORI{DESCRIPTION: NEW S4AftcO1 NZ:CTIO T t st
THE DRAIN LAYER ASSIGNED TO S A VA1xXD LICNE ISSUES$ 'TIIE'STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH ITV HE ATTACHED'C�1�I`IAI,L��RK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMEN 1'S ANp TII ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
7/16/2019 10:22 AM
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TOW#OF SOUTH-WINDSQR INS'ECWN REPORT
PERMIT NO.: :_aDD�'�f CONTRACTOR:'
LOCATION: r6
TYPE OF WORK.
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DATE INSP NEEDED: DATE INSP:. ? llq
INSPECTlED-BY:
WORK:IN
PROGRESS: -5b�� -3.�. �'o ,�
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SEPTIC TANK PUMPED,
SMASHED-
FILt.ED L � WITNESSED �S Q NO-
AS-BUILT.'
DATE: - . U-
S/mOmyMons qS&%dN KEPbW14 2014 Town of SaaHt Windsor INP j
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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: ' iz�,/a �° i� L n� Lot *
Street No. Street Name
Premises owned by: R O x Iq Al d �-' A/-Dsa tj
Name of Firm: Se%�' G�/ 7-E' � �yz , Phone:
Address of Firm; 2-1 Cc3-W 2— iZ,
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 C P VC'
Existing Water Supply: Public Water x 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 -7`r W 41-k'�/Z- th holder of Drain
Layer's License No. o zc� - j Only holders of P- P-7 r 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. a a r> ' 900 -7 7 9 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST SE.AIR TESTED .
Signe . Print Name: 7V
Li used Drain Layer
Date: 7-IC T l 9
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT REVISION 3/2018•doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS -�
STREET .
SUBDIVISION:
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NORTH ARROW Alf
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CONTRACTOR (PRINT) r NAME OF ONTRACTOR'S SUPERVISOR (PRIN )
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STREET ADDRESS, SIGNATURE
✓� C �, DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER ✓
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER