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'VASHINGTON COUNTY SANITARY DISTRICT
,88 W. WASHINGTON STREET HAGERSTOWN, MARYLAND 21741-0571 (301) 791-3083/3084
P.O. BOX 571
PERMIT TO CONNECT TO PUBLIC SEWERAGE/WATER SYSTEM
Permission is hereby given to
PERMIT NO,
DATE
SUBDISTRICT Ido - ' o
Maugansui i i=:/Orchard Hills
For Property Located at:
Owned by: Address: '43
Y ? r,�, ��ivaniA AVPO"('- iia � rstQWA,—Qin
Type of Connection: To Service Connection
Type of Service: Residential
Commercial
Meter Size
Connection Fee
To Main Line:
) Units Other
Industrial
Date Paid
To connect to a public sewerage/w,ater system (with proper abandonment of previous private system). The installation
of the connection and the abandonment of the previous private system shall conform with the provisions of the
Laws of the State of Maryland and Washington County Sanitary District Specifications.
This permit does not supersede any local ordinance that is in effect with regards to road cutting, etc.
ALL OTHER PERMITS, STATE AND LOCAL, MUST BE OBTAINED BY THE PROPERTY OWNER AND ALL RESPOW
SIBILITY CONNECTED THEREWITH REMAINS WITH THE PROPERTY OWNER.
l
Secretary -Treasurer
Building Permit No.
INSPECTION: At least 48 hours notice prior to requested date of inspection is required.
ON SITE INSPECTION will be made by: Washington County Plumbing Board
33 W. Washington Street
Hagerstown, Maryland 21740
Telephone: 791-3146
Permit Fee
Final Inspection Made BY: Date
Plumbi Inspector
OFF-SITE INSPECTION (in Public Rights -of -Way and Easements) and certain
ON-SITE INSPECTION in accordance with applicable approved construction drawings will be made by:
Washington County Sanitary District
33 W. Washington Street-P.O. Box 571
Hagerstown, Maryland 21741-0571
Final Inspection Made By:
DISTRIBUTION: Permittee Plumbing Bo
Field Office
Date
WASHINGTON COUNTY SANITAR)�&DISTRICT
WASHINGTON COUNTY, MO.
SANITARY SEWER LATIP
'! CONSTRUCTION REC(iki
S015 -3-S
Project: MauQansville Orchard Hills Sanitary Sewerage Collection System
/t 316a1)
Street (or location): C,�t T 1 3E ��Nw. QvE.i 1' ter, cif r1 H,0f _
Contractor: Lisbon Contractors Inc.
MH 645d TO MH 65a
Date Installed iv - Z¢ -B3 Wye Sta. On Main 14--V.3+g7-
.
WTL
NOTES:
JILL-TI"'
uGrin
IrrL.
�n�.nv•
�nIa,Vu
SIZE
TYPE PIPE
C.0•
C.O.
LATERAL
LENGTH
LENGTH
S.,x�..
4,-.,r
>aZ16
/2.3VF.
*Horz.= To
Drz
Pve
St' d.
-rod---
ES
NOTES:
I -EE .
*'Slope + Horz=Tota
Drop 23 L .F. 1 (,0 tJ5.G =21.6
Depth of Cleanout Iz.a VF. ®Flow Line
Cleanout Is' From -,t- MAIN
Layed 41 Z ti Af=T1=—+-,DFZ0S='
ti►Cl) Basement Service
MH# GS4
G►�ouyb
Z'S�ua-:Ca,o
MH#4.SS
----—C.o. ---
Z '--sTu LS't� G4P
Amounts per ing t work completed this period eviewed nd approved.
BY
UCSD InSpecItor Contractors Rep.
(Form WCSC-4)
W
Washington County Sanitary District
SEWER SERVICE LOCATION
Subdistrict No. SD#15
Contract No. SD15- 3-S
�3�a3
Property Address: li3-2 Pennsylvania Avenue
Place an 'X' in the sketch below to indicate where the property
owner wants the service connection (lateral) to enter the
property. Place a wooden stake in the ground at that location.
'EASEMENT
NT SEWER
T SEE
7
(2 )
i 886
/ (2432)
�0, /
AMHS015-655
5
2 )
The undersigned agrees that the Sanitary District may
excavate an additional five (5) feet inside the property
line so as to facilitate, and make less expensive, the owner's
connection to the lateral and to prevent damage to the cleanout
which will be installed by the District at or near the property
line.
Date: 5 14l5In /70rs
Owner
Owner
Attest: i
Was . Co. Sanit4ty District
(Form WCSC-1)
Replaces Form WCSC-56