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HomeMy WebLinkAboutSewageSTATE OF FLORIDA
y�T"e,r,r DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ,) r,71 1 -117)
APPLICATION FOR SEPTIC TANK PERMIT
+, I I
.,� �ti;� • ,c" "' ' ' AND FINAL INSPECTION FORM r
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Authority:
'6�= 3,e .
Chapter 381, 366, 387, FS �,t P,wjQ
Chapter 1oD-6,AE LUCIE COUNTY* h
DATE
y�_� HEALTH UNf�;
Permit Number _ ,
Name of Applicant �9L i/U
le Telephone No. _' ZS1, Z
Mailing Address of Applicant 571- .
. ST ,Zgf %"5 L.
'To Be Installed At: (Give Street Ad ress)• .z Do
S. -. 411
Lot No. _//�)44 Block No. Subdivision 2'r- f l '/ et Book e
9 Z Pa 35, S 27 SZl prf ,
Size of Lot. t �'E' By 2o42 - No, Living Units No, Bedrooms No. People i.
Type of Business-.P�oFfSS• 3
. No. T *lets -3
. -
No: Wash Basins No, Employees
Total Square Feet in Building 2 2 '�
`Note: Attach Site Location Map and Other Supportive Documents
D `� �, • �' S• I SD N d'��`�G• Signature f Applicant
7v Ly,ceZ Co V4c G -;C'-
§ITE
INFORMATION
.•��..,
Distance to Sanitary Sewer----..---.,,
Distance to Stream, Lake, Canal
Distance to Public Water Supply • A V,411Z iSL1�'
Distance to Private Wells)
Rainfall Data:_ % D'` 2
Is Area Subject to Flooding 7 __ /L)O
Does Site have Good Natural Drainage? —.-
Which Way Does Lot Drain ?_._._Ta Fie®-vT
Any Perimeter pitches?. ?• 515' Depth of Ditches
Is there Standing Water in Ditches? - WO
' Depth of Water in Ditches
Distance to Nearest Residence (North - East °'e'f South-- 3 d' West -- Are Buildings
in this Area on: Septic Tanks e%�s' Sand Filters
— Other
Any Known Drainfield Failures in this Area ti D
SOIL PROFILE
AND PERCOLATION DATA
12"
�'a St1tiP %-�...
Water Table At- inches
w
24"
Hard Pan . At inches .
j
Z
a 3V
�. Clay At — Inches
0
6!'
__
Muck At _�...Inches
CY
_J 48•0
°
Other A Inches
�G
Soil Classification:
601•
Percolation Rate: M 4 riL;
IN TALLATION
SPECIFICATIONS
Septic Tank Capacity:,
Drain, Tile (Linear Ft.): -
Dosing Tank Capacity: ' t �;'�
Sand Filter Size, (Sq,Ft.).
Grease Trap Capacity:
Absorbfion Bed Size: (Sq.Ft.)
Perforated Pipe: (Lineal Ft.)
Lateral Drainfield Size: (Sq.Ft.) _
Other Specifications:___ I
i
RECOMMENDATION: , :Approval
approval date Processed
Ana re of Sanitarian - County Health Department
ANAL INSrt:GI IUN UA7A
Date an ime of In3pection Type of Tank (Concrete; Fiberglass, Etc;) Size
Tank Installed . • - • ' nrainfield Size - No, Tile Feet
Dosing Tank Size- ..Grease TrapSize ``
Sand Filter Seze
Who Made Installation---t-"
9
RECOMMENDATION: A Poval , n
pp ®Disapproval l
WRS-H FORM 4016, AU948 6 128) Signature of Sanitarian i ; ' i' • `
2d ,J /
jv
SEPTIC TANK CONSTRUCTION PERMIT
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lino ,.far { a ; distance ,of ; 88.5 , feet' , to I the P0TI1'; I of 18EGIATEN
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