HomeMy WebLinkAboutDrain Layers Permits 67 Glenwood Road (2) 1900063 TOWN OF SOUTH WINDSOR, CT
PERIV1I?T NUMBER
DRAIN LAYER PERMIT
5
DATE: 06/03/2019 x,. ;::...
GIS ID: 35700067
MUNIS APPLICATION# 201901084 FEE: 80.00
' EXPIRATION DATE: 07/03/20I9
APPLICANT
NAME: WASTEWATER SERVIGESD$A SKIPS LOCATION
ADDRESS 67 1LNWOOD ROAD
ADDRESS: 2I COURTNEY DRIU$ __ARK >Y NICKLOS&LORISSA
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ELLINGTON,CT 0 ?29 !�? 'GLE�WOOD ROAD
PHONE
WORK DESCRIPTION:
NEW SEWE} CONNECTI�I'J
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THE DRAIN LAYER ASSIGNED TO THI9ttfEIITAND HEREBY AGkEES TO AL
HAS A Vt ,I�t�ICIdS ISSUL�D T
THE TERMS AND CONDITIONS SET FORT, T1V THE;ITTACHED` NDIW,IQNS' ORK SHALL BE IN W HL
THE TOWN OF SOUTH WINDSOR STANDARDS,AL.L• OSHt RE(I �kEMlx�titI S,Aia1D'T ATTACHED CONDITIONS.
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ISSUED B DATE INSPECTED
6/3/2019 8:42 AM INSPECTED BY
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DATE INSP NEEQE
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S/ma{toy/foims 2014 Town of South Wmdwr•INPSECRON 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
Location of proposed work: 6-2 64 e w w o L"b / Lot #
Street No. Street Name
Premises owned by: /V/c '��
Name of Firm: �rPS G�'` ��- Phone: Fr)_ F7s- 2 33 2
Address of Firm: < <'6�4 fz -rM 'y c0rL 4- /' ' 9_12 A(
TYPE OF WORD:
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 'PU G S- �2 3 4'
Existing Water Supply: Public Water je_ 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 lv ��L��, the holder of Drain
Layer's License No. 0 7 -_ r7? 25 Only holders of P-1,,U- 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. 9 2 Z 0 3 2 PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE-AIR TESTED
Si9 ned. L Print Name: /V 7mZ /95 �-
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICA7ON FOR DRAIN LAYERS PERMIT REVISION 3/2018.doc
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Drabek, Bernard
From: callcenter@cbyd.com
Sent: Thursday, May 30, 2019 11:11 AM
To: CBYD
Subject: Locate Request - 20192203292
Attachments: 20192203292.PDF
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(CALL BEFORE YOU DIG -CT) 05/30/2019 11:09:23
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1-SW SWINDS
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*** REMOTE BATCH ENTRY***
***** ROUTINE *****
TIME..11:09 DATE..05/30/2019
REQUEST NO...20192203292
LATITUDE..41.825639 LONG ITUDE..-72.521865
TOWN......SOUTH WINDSOR
ADDRESS...67
STREET....GLENWOOD ROAD
NEAREST
CROSS STREET..HIGH RIDGE DR
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TYPE OF WORK.....SEWER SVC INSTALL MACHINE EXC
AREA IS MARKED...YES
REMARKS:
CONNECTING HOUSE TO PUBLIC SEWERS.WORKING FROM BACK OF THE HOUSE TO FRONT.
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START DATE......06/04/2019 START TIME..00:01
CALLER..........MR GRADY OLIVER
CALL BACK.......
PHONE#.........860-896-8191
FAX#...........860-871-1587
ALT. PHONE#....860-871-2616
EMAIL ADDRESS...INFO@SKIPSWASTEWATER.COM
CONTRACTOR......SKIPS WASTEWATER SERVICES
ADDRESS.........21 COURTNEY DRIVE
CITY............ELLINGTON
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS
STREET
SUBDIVISION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
ZI C0007ilel-� A,- /44
STREET ADDRESS - SIGNATURE
CT CAL•,O 9 DATE
/TOWN STATE ZIP INSPECTED BY TOWN
t.'. L 0) DATE
TELEPHONE NUMBER
WHITE -- TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER