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. ^ .• PROJECT NAME: t PROJECT NO: ISO-CcY�Cv PROPERTY ADDRESS:-, a _ DRAWING NO: MAIN LOCATION: STREET�I DATE INSTALLED:jI-13-©Z PROPERTY OWNER NAME: x.34/0 `/36 MH 1?i 1 S TO MH PROPERTY OWNER ADDRESS: MAIN STATION: r tUN IHACTOR: 1 IP'"�TEEZWYE TYPE SIZE & TYPE DOUBLE TEE/WYE SIZE & TYPE SERVICE PIPE " IAM L 7,F -- CONNECTION ® MH: INVERT ® DEPTH MAIN C/0 A (LT)IC (L B (RTC (RT LOT- � u vimCiVJIUN ALL PERTINENT ITEMS o FLOW V �C W LEFT DOWNSTREAM RIGHT MH # I �i S UPSTREAM LIST QUANTITIES FOR PAY ITEMS HERE: BY: i I WASHINGTON COUNTY INSPECTOR DIVISION OF PUBLIC WORKS �WASHINGTON COUNry, MARYLAND WATER AND SEWER DEPARTMENT CONTRACTOR'S REPRESENTATIVE CO. NAME: DOUBLE GRAVITY SEWER LATERAL CONNECTION SHEET MAY 2001 1 S --13.2A M1 O_$X to Washington County, Maryland Department of Water Quality 16232 Elliott Parkway Williamsport, MD 21795 74 240.313.2600 PUBLIC WATER/SEWER SYSTEM CONNECTION PERMIT Type of permit: RES Type of service: SEWER Service Area: Maugansville/Orchard Hills Building Permit No.: WASHCO account No.: 0 Service Area No.: 150 Permission is hereby given to: Property Owner: MAPLE VALLEY PROPERTIES Applicant: ARTERY CUSTOM HOMES LLC Street: 7200 WISCONSIN AVENUE # 1000 City: BETHESDA State: MD Zipcode: 20814 For property located at: Street: 13610 CORELLO DRIVE City: HAGERSTOWN State: MD Zipcode: 21740 Is the property in a subdivison? YES Subdivision name: MAPLE VALLEY Subdivison lot no.: 59 Subdivision phase: B Subdivison section: Additional remarks: Will DWQ need to connect the lateral to the mainline? Permit No.: 2965 Issue Date: 8/5/2003 *Void Date: 8/5/2004 Fees paid in full? YES Date fees paid: 8/4/2003 Type of EDU: RES Number of EDU's: I Gallons per day allocation: 200 DWQ connection fee: $2,800.00 Misc. connection fees: .00 City fees paid to (city): City fees (amount): $1,200.00 Total fees charged: $4,000.00 Water & Sewer Department notes: *Connection related comments: This permit is good for one year from issuance date. A fee differential may be charged to reflect allocation fee increases if property is not connected by the permit void date. When connecting to a public water/sewer system, the installation of the connection and the abandonment of the previous private system shall conform with the provisions of Maryland State laws and County policy. This permit does not supercede any local ordinance that is in effect with regard to road excavations, plumbing permits, etc. ALL OTHER PERMITS, STATE AND LOCAL, MUST BE OBTAINED BY THE PROPERTY OWNER AND ALL RESPONSIBILITY CONNECTED THERE WITH REMAINS WITH THE PROPERTY OWNER. Signed:6'l,'u4j 13 r j Date: 8/5/2003 INSPECTION: At least 48 hours notice prior to requested date is required. ON SITE INSPECTION will be made by a Inspection Date: Washington County Plumbing Board 80 W. Baltimore Street Hagerstown, MD 21740-4727 Phone: 240.313.2460 Plumbing Inspector: �8- 'm