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General Permit No. GNEVOSDS09 - page 2 / 3

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The following information must be included with the application:

General Site Information:

_______   Business Description (church, school etc.): _____________________________________________

_______   Assessor’s Parcel Number (APN): _____________________________________

_______   Property Area (in acres): ___________________________________________

_______   Distance to Public Sewer (if any): ______________________________________

_______   Water Supply (city or well): ___________ Well:   Depth: __________ (ft) Seal (if any) _________(ft)

_______   Is proposed location within 100 year or 50 year flood zone?: _________________

OSDS Information:

_______   Number of proposed OSDS Tanks: ____________________

_______   Size of Proposed OSDS System(s): ___________________(gallons)

_______   Tank Model(s): ______________________ Distribution Box Model(s): _______________________

_______   Is this a denitrifying, mechanical or aerobic OSDS System  _________________________

_______   Existing OSDS Systems (if any): Total Tanks___________ Total Volume: ____________ (gallons)

_______   NDEP Permit (if any) : _______________________________________________

_______   Total volume of OSDS systems in this property : ______________________(gallons)

Site Plan:

_______   Site plan drawn to scale – 2 sets needed

_______   Setbacks shown and in accordance with NAC 445A

_______   Location of test pits within proposed absorption area

_______   Please verify that OSDS system will only treat Domestic sewage.

osds cALCULATIONS:

_______   Calculations Submitted

_______   OSDS Size based on Occupational Flow: ______________________________________________

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