SEWER SYSTEM CONNECTION PERMIT
APPLICATION
Town of
South
(845) 434-6320
(845) 434-7972 Fax
NO PERMIT WILL BE ISSUED WITHOUT A UFPO CASE NUMBER AND PLOT
PLAN
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Date of Application: |
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Property Owner Name : (Please Print) |
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Mailing Address: |
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Telephone No: |
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Contractor Name: (Please Print) |
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Mailing Address: |
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Telephone No.: |
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Insurance Carrier & Policy No.: |
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SBL No. |
Property 911 Address: |
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Building Permit Issues: Yes □ No □ |
Building Permit No. |
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Impact Fee Paid: Yes □ No □ |
In District: Yes □ No □ |
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Size of Service: |
Tap Required: Yes □ No □ |
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Road Cut Permit Required: Yes □ No □ |
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Road Cut Permit No. : Town □ |
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Tap to be performed by: Town □ Contractor □ |
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Tapping Contractor: (please print) |
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Contractor Address: |
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Contractor Telephone: |
Contractor Cell Phone: |
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Date work is to begin: |
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UFPO Case No. |
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Water System Connection Permit No. |
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Date Issued: |
Issued By: |
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Tapping Fee: |
Inspection Fee: |
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Method of Payment: Cash □ Check □ Check # Money Order □ Money Order # |
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The UNDERSIGNED hereby agrees to do all specified herein and
in full compliance with the Town of
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It is the responsibility of the Property Owner
and or Contractor to contact the Underground Facilities Protective Organization
(UFPO), 1-800-962-7962, to obtain a case number. The case number must be
indicated at the top of this page. No Permit will be issued by the Town of
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Property Owner Name: (Please Print) |
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Property Owner Signature: |
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Contractor Name: (Please Print) |
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Contractor Signature: |
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This application must be signed by both the
Property Owner (s) and the Contractor before the permit will be issued.
A RED Municipal Service Connection Permit will be issued upon approval of this
application. This Permit must be displayed at the job site until all work has
been completed, inspected and approved.
This Page Must be Read
and Initialed by the Property Owner
SPECIFICATIONS FOR SEWER LATERAL INSTALLATION
All excavation
for the sewer tap shall be made by the owner at the owner’s expense, and shall
be done under the supervision of the Wastewater Collection System Department.
Where the
excavation crosses or borders a County or State road, a permit from the
appropriate agency must be obtained and attached to this application. For
County roads contact the Sullivan County Department of Public Works,
All lines from
the house to service connection must be four (4) inch or larger PVC pipe or
other suitable material approved by the Wastewater Department. All standards of specifications shall be
current and up to date. All joints shall be tight and waterproof. Pipe shall be
bedded on a crushed stone material and backfilled as indicated in the typical
trench detail attached. Pipe shall be laid at a minimum ¼” per foot pitch unless
otherwise approved by the Town inspector. Any piping that is buried shallower
then three (3) feet in depth shall be a minimum of SCH 80 PVC pipe.
The building
sewer lateral shall be installed in a trench separated not less than five (5)
feet horizontally, where possible, from any underground water service pipe.
Pipe shall be laid
as nearly as possible in a straight line. There shall be no use of 90° elbows.
When two (2) or
more 45° elbows are used in the piping from the house to the service
connection, additional clean-outs must be provided. Approved clean-outs, set at
a angle of 45° shall be used at changes of grade or line, and at 50 foot
intervals where the lateral is over 100 feet in length.
Bedding and
backfill must be provided according to ASTM D2321 standards. (1)
Whenever practical, the sewer lateral for new
construction shall be brought to the building at an elevation below the
basement floor. In existing buildings
where no plumbing facilities are provide in the basement, the sewer lateral may
be above the basement floor. The amount of earth cover shall be sufficient to
afford protection from frost.
The Town
inspector, or their representative shall inspect the work at all stages of
construction. The applicant shall notify the Town when is to begin and when it
is ready for inspection. Backfilling shall not be done prior to inspection. The
inspection will be made within twenty-four (24) hours after notification by the
applicant. (2)
All costs and
expenses incident to the installation and connection of a public sewage system
or building lateral to the Town of
No person shall
make a connection of roof downspouts, exterior foundation drains, sump pumps,
swimming pools or other sources of surface run-off or groundwater to a sewer
lateral or building drain, which is connected directly or indirectly to a
public sewer.
All excavations
for sewer lateral construction shall comply with all Federal, State and local
Safety Regulations. All streets, sidewalks and other public property disturbed
in the course of the work shall be restored in a manner satisfactory to the
Town inspector or their representative.
At such time as a
public sewer becomes available to a property served by a private sewage
disposal and or sewage system, the property owner shall be required to abandon
the existing septic tank, cesspool or other private sewage disposal facility. The
aforementioned facilities shall be cleaned of sludge and removed or filled with
a suitable material as directed by the Town inspector or their representative.
Property Owner
Initials: _____________________________________
This Page Must be Read
and Initialed by the Property Owner
CONDITIONS FOR SEWER LATERAL INSTALLATION
The property owner and or
contractor shall provide and utilize all appropriate work zone safety
equipment. This equipment shall be in place prior to the beginning of
construction and shall remain in place until all construction is completed,
inspected and approved.
The following shall not be
discharged into the Town of
Water from cellar drains, roof
downspouts, areaway drains, sump pumps, garage drains, swimming pools, cooling
or refrigeration equipment blow-off, drip or steam exhaust, cesspool and septic
tank waste.
The permittee and contractor shall
adhere to all conditions stated in the Town of
The permittee shall be responsible
for locations and maintenance of the installation to the Town’s sanitary sewer
lateral spur or interceptor.
The Town makes no warranty of the
location of the lateral spur house connection.
The permittee or contractor shall
not cover the installation before inspection is made by the Town Inspector
The permittee shall be held
legally responsible for adherence to all of these conditions.
This permit shall not relieve the
permittee or contractor from obtaining any additional permits which may be
required by Law, Ordinance or Regulation of the State of New York, Sullivan
County, Town, Incorporated Village, Public or Private Utilities and any other
agency having jurisdiction therein.
The permittee or contractor shall
submit a Plot Plan along with this application indicating the following:
1.
The building
2.
The existing septic
system (where applicable)
3.
The Town sewer main
4.
The length and size of
pipe
5.
Location of all
clean-outs
6.
Depth of installation
7.
Location of all elbows
A limit if not more than three (3)
outstanding permits will be issued per contractor at any give time unless prior
approval has been received.
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Property Owner Initials: |
Plot Plan
↑ North