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OSSF Permit Application Residential_6_12_2020Please direct all documents and questions to: Jordan Wilson Designated Representative 1100 S. Mayhill Rd. Denton, TX 76208 (940) 349-8619 OUR CORE VALUES Integrity  Fiscal Responsibility  Transparency  Outstanding Customer Service ADA/EOE/ADEA www.cityofdenton.com TDD (800) 735-2989 CITY OF DENTON RESIDENTIAL ON-SITE SEWAGE PERMIT APPLICATION Date: ___________________ Permit Number: ____ Please check the following type of OSSF:  New construction Aerobic treatment ($500.00 fee)  New constriction Non-aerobic treatment ($300.00 fee)  Repair, Extension, Alteration ($200.00 fee) Property Owner's Name: _______________________________________________ Permanent Mailing Address: ___________ Owner’s Telephone Number: ( ) ____ Site Address: ____ Owner’s E-mail: ______________________________________________________ Plat/Subdivision Name and Phase: _________________________________________ Lot: Block: Tract: ______ Abstract: _______________ Amount of Acreage: _________ Installer's Name: ____________________________________ Installer's Telephone Number: (_____) __________________ Installer's E-mail: _________________________________ _ Installer's License Number: ___________________________ Installer's Mailing Address: ______________________________________________ Designer’s Name: __________________________________ Designer's Telephone Number: (_____) _________________ Designer's E-mail: __________________________________ Designer's License Number: _____________________ (R.S. or P.E.) Designer's Mailing Address: ______________________________________________ City of Denton OSSF Permit Application Page 2 OUR CORE VALUES Integrity  Fiscal Responsibility  Transparency  Outstanding Customer Service ADA/EOE/ADEA www.cityofdenton.com TDD (800) 735-2989 I. Required Information: a. Please circle the type of residential building, which will use the On-Site Sewage Facility. Single Family Home Duplex Apartment Manufactured Home Multiple Homes b. Total square feet of living area: . c. Number of bedrooms: _______ d. Estimated wastewater discharge to the OSSF: gallons per day. e. Will water saving devices be used?  Yes  No f. Will the kitchen have a garbage grinder/disposal:  Yes  No h. Indicate type of water supply.  Private well  Public water Permits are required for any new water wells within the city limits of Denton. Please contact Environmental Services (940) 349-8619 for more information. Name of public water supply: _________________________ ID#__________________ Mailing address of the public water supply: ______________________________________________________________________ II. Statement of justification. Is the residential building located more than 600 feet from the City of Denton sewer system?  Yes  No III. Electrical Permit Requirement: An electrical permit shall be obtained from the City of Denton’s Building Safety Division and issued to a licensed electrical contractor authorizing connection of the electrical components from an on-site sewage facility to the electrical wiring system serving any building located in the City of Denton. Inspections shall be completed for all new installs and alterations. Contact the Building Safety Division at (940) 349-8360 for more information. IV. On-Site Sewage Facility Planning Material. All planning material must comply with the City of Denton Code of Ordinances and on-site sewage facility standards and administrative rules adopted by the Texas Commission On Environmental Quality. V. Submittal details of the on-site sewage facility materials. 1. Survey of the lot or tract, whereas the location of 100-year flood plains and flood ways shall be indicated. 2. Soil analysis and site evaluations shall be prepared for each lot or tract. 3. Overall site plan (drawn to scale) showing the location of all components of the on-site sewage facility, include the location of water wells, waterways (lakes, creeks, etc.) or any other appurtenance, and the size of each lot or tract must be clearly indicated. Replacement areas for OSSFs must be addressed in the design. City of Denton OSSF Permit Application Page 3 OUR CORE VALUES Integrity  Fiscal Responsibility  Transparency  Outstanding Customer Service ADA/EOE/ADEA www.cityofdenton.com TDD (800) 735-2989 4. The OSSF design must give all pertinent information regarding all components of OSSF treatment and disposal systems. Estimated wastewater discharge into the OSSF shall be indicated on the design for each facility connected to the OSSF. The design of all OSSFs located in 100-year flood plains are subject to special planning requirements. The OSSF design must show that the location of the OSSF will not result in damage to the OSSF or result in contamination from the OSSF during flooding. 5. Variances from OSSF construction standards and administrative rules shall comply with 30 TAC Section 285.3 (h). VI. Fees. Submit the application and pay the appropriate permit fee to the Building Safety Division located at 215 E. McKinney Street. VII. Right of entry. The owner/applicant shall provide the City of Denton with the right of entry onto his property for the purpose of inspecting the installation of the OSSF to determine compliance with the OSSF Rules promulgated by the Texas Commission on Environmental Quality. If there are any questions regarding the OSSF permitting process please contact Jordan Wilson at (940) 349-8619; or email OSSF@cityofdenton.com. Please complete the following statement and have it notarized before filing this application. I, am the owner/applicant for a City of Denton On-Site Sewage Facility Permit, and hereby certify that the above information is true and correct to the best of my knowledge. Signature of Applicant ____________________________________ Sworn to and subscribed before me the undersigned authority this the day of , 20 . Signature of Notary Public