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TROJECT NAME: PROJECT N0: 68
PROPERTY ADDRESS: -o rs Za �21 / M71 17Y19 j"lSfCC-��
DRAWING N0: ia
MAIN LOCATION: STREET ASEMENT Sr, Ce G�• DATE INSTALLED: --- �`�-- 3
PROPERTY OWNER NAME:
PROPERTY OWNER ADDRESS: MH 13C)8 TO MH 1,309
MAIN STATION: '�F.S-4� 5- Lcrf
CONTRACTOR:..--
CONNECTION ®MH:
SIZE & SPE SIZE & TYPE SIZE &TYPE INVERT ® DEPTH
TEE DOUBLE TEE/SERVICE PIPE MAIN CSO A B (LT) C (L1
67,B5cg. 9U 6-66R. ZL
Scil. `fu 'Sr.'
5i
/� i6
B (RTC (R1
v �ivry nL-L FLK IINENT ITEMS
FLOW A Y
DOWNSTREAM
MHN 13y�
LIST QUANTITIES FOR PAY ITEMS HERE:
BY: J �(► ��
WASHINGTON COUNTY INSPECTOR
DIVISION OF PUBLIC WORKS
c� WASHINGTON COUNTY, A4ARYUNO
WATER AND SEWER
DEPARTMENT
LEFT
RIGIIT
UPSTREAM
MH N 1307
CONTRACTOR'S RtPRESENTATIVE
CO. NAME:
DOUBLE GRAVITY SEWER LATERAL
CONNECTION SHEET
r.
MAY 2001 5— 33.2A
A0.,
.•k
REQUEST TO ALTER SANITARY SEWER
SERVICE LATERAL
TO: Washington County Water and Sewer Department
16232 Elliott Parkway
Williamsport, MD 21795
We hereby request permission to install the house lateral described below, at
StrwetNanie: _- �vST cca74'r
Lot Number: p f J
Manhole: / 30 To Manhole: _ 13G 7
Station: _ / f-S�-/
(Y:ft:) Right
( j�) From % to Inc. S4C � / � Grade
( ) From standard lateral to drop at cleanout
aQoP y5
(�) Depth at cleanout I owl 2 5 95 Z a ---aid
This request is made on this date 3 - S-0
BY: u
REPRESENTING: D . to Cywrz�, r
Representative
APPROVED BY: Washington Count Water and Sewer Department
WCWSD Representative
�% 070;f od Washington County, Maryland
g4 A Department of Water Quality
16232 Elliott Parkway
Williamsport, MD 21795
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.: NA
WASHCO account No.: 0
Service Area No.: 150
Permission is hereby given to:
Property Owner: CREATIVE INVESTMENTS
Applicant: CREATIVE INVESTMENTS
Street: 10715 DOWNSVILLE PIKE SUITE 102
City: HAGERSTOWN
State: MD
Zipcode: 21740
For property located at:
Street: 1USTICE COURT
City: HAGERSTOWN
State: MD
.iOL Zipcode:21740
is the property in a subdivison? YES
Subdivision name: FREEDOM HILLS
Subdivison lot no.: 20
Subdivision phase: 1
Subdivison section: NA
Additional remarks:
NA
Will DWQ need to connect the lateral
to the mainline? NA
Permit No.: 3462
Issue Date: 01/20/2005
*Void Date: 01/20/2006
Fees paid in full? YES
Date fees paid: 11/19/2005
Type of EDU: RES
Number of EDU's: 1
Gallons per day allocation: 200
DWQ connection fee: $1,800-00
Misc. connection fees: $300.00
City fees paid to (city): NA
City fees (amount): $1,800.00
Total fees charged: $3,900.00
Water & Sewer Department notes:
NA
*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.
W hen 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: 64 ) 6'` Tr j Date: 01/20/2005
INSPECTION: At least 48 hours notice prior to requested date is required.
ON SITE INSPECTION will be made by: Washington County Plumbing Board
80 W. Baltimore Street
OPO` Hagerstown, MD 21740-4727
Phone: 240.313.2460
Ir -
Inspection Date: 165 Plumbing Inspector: