HomeMy WebLinkAboutOnsite Sewage Disposal System Construction & Installation Permit0 0
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATIO
Authority: Chapter 381, FS
Chapter 10D-6, FAC
Applicant Permit Number
,N-Z o f .05 Cw Pc� Lar s
------------ PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL
Septic tank orGG��,,��
aerobic unit t gallons
Septic tank or
aerobic unit gallons
Graywater
tank gallons
Laundry
waste tank gallons
Other Requirements:
Treatment Tank
Grease
interceptor gallons
Dosing tank gallons
Minimum Draintrench
Size
Square Feet
Square Feet
Square Feet
Square Feet
(a) Installation must be in accord with requirements of chapter 10D-6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.
OR Minimum Absorption
Bed Size
35x Square Feet
216 Square Feet
3�
Square Feet
Square Feet
(c)
Final installation inspectior
i PT=a is required before the system iss r
(d)
Invert of -et#er
(1(� I ( ( FS to be � �,
Invert of stub -out for
to be
benchmark.
Invert of stub -out for
to be
benchmark.
Invert of stub -out for
to be
benchmark.
A () q' S ( r QQ
X 5 �, ��
(e)
Fill quality and quantity:
n �z
EXCAVATION MUST BE CHECKED
BY THIS DEPARTMENT PRIOR TO
DRAINFIELD INSTALLATION.
a 1
ilk-t6&1 Tn 'E` Ce=Rp 79Z C&OFCr FF�rA1�.€R
L
(f)
Other: IF AREA OF
DRAINFIELD IS SUBJECT TO SATURATION FROM ROOF
DRAINAGE,
1-0 ROOF MUST BE GUTTERED PRIOR TO FINAL APPROVAL.
4-V tyP-e, QA Clina�
l e%s d� IA/&�ga� `�A TES .
-- - - -
Construction authorized by:
St. Lucie County Public Health Unit
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO. 139100 SQUARE MILE 39
HRS-H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Numbe,5744-001-4015-0) _ Page 1 of 2