___________________

Nr.APM:

(Proiectant)

AGENTIA DE PROTECTIE
A MEDIULUI-BRASOV

FISA TEHNICA
ANEXA LA CERTIFICATUL DE URBANISM NR.______/_______________
ELIBERAT DE________________________
In vederea emiterii Acordului Unic,pentru obtinerea acordului de mediu
1.DATE DE IDENTIFICARE A OBIECTIVULUI DE INVESTITII
1.Denumire_______________________________________________________________________
2.Amplasament___________________________________________________________________
3.Beneficiar_______________________________________________________________________
4.Localizare amplasament in planul de urbanism si in raport cu pozitia fata de arii
protejate sau zone tampon, monumente ale naturii sau arheologice, zone cu
restrictii de construit

5.Proiect
nr.__________________elaborator______________________________________________
6.Valoarea estimativa a lucrarilor________________din care pentru protectia
mediului____
7.Perioada de executie
propusa_______________________________________________________
2.CARACTERISTICELE TEHNICE SPECIFICE ALE INVESTITIEI
1.Enumerarea lucrarilor necesar a fi executate(compartimentare, destinatia
incaperilor, montarea de utilaje, instalatii,
echipamente)______________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
__________________________________________________________________________________
2.Materiale
folosite___________________________________________________________________
3.Inaltime cladire, numar de
nivele____________________________________________________

4.Suprafata
construita________________________________________________________________
5.Amenajari
exterioare________________________________________________________________
3.MODUL DE INDEPLINIRE A CERINTELOR AVIZATORULUI
1.Modul de alimentare cu apa, debite necesar a a fi
asigurate_________________________________________________________________________
___________________________________________________________________________________
2.Mod de evacuare ape uzate si
pluviale_______________________________________________
3.Mod de incalzire si/sau producere apa calda sau
abur_______________________________
Cand lucrarile prevad instalarea unei centrale termice proprii se vor preciza:
a) combustibilul folosit, consum
mediu_________________________________________
b) inaltime
cos_________________________________________________________________
4.Mod de alimenntare cu energie
electrica_____________________________________________
5.Mod de gospodarire deseuri si substante toxice,
periculoase_______________________________________________________________________
___________________________________________________________________________________
6.Amenajare spatii verzi___________________________________________________________

4.MODUL DE INDEPLINIRE A CONDITIILOR SI RESTRICTIILOR IMPUSE

1.Descrierea instalatiilor de preepurare ape uzate astfel incat sa se asigure
respectarea limitelor impuse prin NTPA 001/2002 sau NTPA oo2/2002,aprobate
prin HG 188/2002
masuri:___________________________________________________________________________
___________________________________________________________________________________
2.Instalatii care asigura incadrarea in limitele prevazute de ord. 462/1993,a
efluentilor
gazosi emisi in atmosfera de suese

stationare_________________________________________________________________________
__________________________________________________________________________________
3.Amenajari pentru protectia impotriva zgomotului si incadrarea in limitele
prevazute de STAS
10009/88_________________________________________________________________________
___________________________________________________________________________________
4.Lucrari si dotari pentru protectia solului si
subsolului________________________________________________________________________
__________________________________________________________________________________
5.Dotari si masuri prevazute pentru controlul emisiilor de poluanti in mediu:
supravegherea calitatii factorilor de mediu si monitorizarea activitatilor destinate
mediului__________________________________________________________________________
___________________________________________________________________________________
INTOCMIT *)

*)Nota:punctele anterioare(1,2,3,4)se completeaza de proiectant

Vazand specificarile prezentate in FISA TEHNICA privind modul de indeplinire a cerintelor de
avizare, precum si documentatia depusa pentru autorizarePAC/PAD/POE, se acorda:
AVIZ FAVORABIL
In vederea emiterii Acordului Unic fara/cu urmatoarele conditii____________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_______________________________
(nume, prenume, semnatura)

Data:_______________________________