HomeMy WebLinkAboutMisc.Br -os County Health Depar+•lent
201 North Texas Ave.
* Bryan TX 77803 -5317 OSSF #: 200 5 5 _ 5785
(979) 361 -4440 & Grid:
4 New OSSF /New Bldg
APPLICATION FORA LICENSE TO OPERATE AN ON -SITE SEWAGE FACILITY
** VALID FOR ONE YEAR FROM DATE OF PURCHASE **
Date: 12/5/2005 Mobile Home 3 Bedrooms: 1,152 Sq Ft ❑Well on site
Legal
Block: Lot: 9
Location: S W PARKWAY (@ FM 2154 College Station TX 77845
Owner: WOODLANDS OF ATHENS COTTAGE RENT LLC
Mailing address: 126 BRIARCLIFF RD NO. 9, ATHENS GA 30606
Fee: $200.00 Payment: CK# 2781 12/5/05
OSSF Installation and Licensing Procedures:
❑Public Water
❑Engineered
3
Phone: (706) 552 -3980
Total payment: ! $20 0.00
1. Contact Registered Installer and /or Site Evaluator.
2. Submit a site /soil evaluation with OSSF design.
3. Upon receiving letter of "Authorization to Construct" from our office, excavation may begin.
4. Inspection shall be performed by BCHD during construction.
5. Upon approved final inspection, an OSSF "License to Operate" will be issued.
6. A fee and site visit will be required before a current OSSF license will be issued.
7. OSSF Licenses are Non - Transferable.
Note: It is the sole responsibility of the property owner to maintain and correct all
malfunctions occurring with their OSSF system. Prior to performing work on an
OSSF, consult with the BCHD to determine if a repair permit is required.
FLOOD PLAIN STATUS = Within
Certificate of Compliance:
Completed By
Lot Size:
Date
12/5/2005 01:48 PM R -07
w
0 6q
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AUTHORIZATION TO C NSTRU T
AN
ON -SITE SEWAGE FACILITY
LANDOWNER NAME ;
PHYSICAL ADDRESS ) ;` L , .
DATE /TIME: k § -,i0 ( CHESS (PERMIT) # a-a -,, a-
_cs- (18,..)
t DESIGNATED REPRESENTATIVE NAME: ` i° NUMBER: C3 ` `
INSTALLER NAME:
NUMBER:
1 The Brazos County Health Department (BCHD) Environmental Health Services (EHS), has received and reviewed the
t On -Site Sewage Facility (OSSF) design for the above described property. The OSSF design complies with the
minimum requirements of the TNRCC and the Brazos County Health Department. Authorization
i granted for one year from the date of issue. Any change in design must be reviewed and app o ed BCHDct is
t _
THIS TAG MUST BE POSTED ON JOB SITE BEFORE CONSTRUCTION BEGINS
Brazos County Health Department
201 North Texas Avenue, Bryan, Texas 77803
(979) 361 -4450 phone or (979) 823 -2275 fax