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STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL ...... SYSTEM "g APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: [X] New System [ ] Existing System [ ] Holding Tank J ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: �Pr4 0AIVIOLLC (/ AGENT: ci'y ILt3�G� �,�� — TELEPHONEP2� !?[, v 6.73o MAILING ADDRESS: 7'7q pii/• ItIll W4 i �W, rt - J/r-L C/ --&Z TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: G6491-YZ 1 &G�f'i�' L55-WV'PLATTED: Y-OOS- PROPERTY ID #: (aG�W` 007 ZONING: P I/M OR EQUIVALENT: [ Y / N ] PROPERTY SIZE: L� ACRES WATER SUPPLY: [,Xj PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y(. DISTANCE TO SEWER: 1 ' FT PROPERTY ADDRESS: leg /00 tVAPi€ DIRECTIONS TO PROPERTY: ©� l.,V ow Lee BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 [J�] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC [ ] Floor/Equipment Drains [ �] Other (Specify) SIGNATURE: ra-64 O t/, PLS S'Zv DH 4015, 08/09 (Obsoletes previ� edit ons which may not be used) Incorporated 64E-6.001, FAC DATE: •� Z3! Page 1 of 4 r STATE OF FLORIDA PERMIT #. w " ' DEPARTMENT OF HEALTH ONSITE SEWAGE TREA"!NZXT AND DISPOSAL SYSTEM! SITE EVALUATION AND SYSTEM SPECIFICATIONS We APPLICANT: ,�D/�! ��G],�l f LCLI.�� % '��y AGENT: LAi1&y Ac- AS�4;r /NG "LOT: BLOCK: r SUBDIVISION: PROPERTY ID #:2��^ /©�-(✓,!'.,%�/� (Section/Township/Parcel No. or Tax ID Number] TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND'SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: (A YES [ ] NO NET USABLE AREA AVAILABLE: 7•Ze ACRES TOTAL ESTIMATED SEWAGE FLOW: rl�� GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE2] AUTHORIZED SEWAGE FLOW: fr(o0 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]. UNOBSTRUCTED'AREA AVAILABLE: fiy SQFT UNOBSTRUCTED AREA REQUIRE SQFT BENCHMARK/REFERENCE POINT LOCATION: P-OaD +tom- 46 vr- eff ELEVATION OF PROPOSED SYSTEM SITE IS `% NCHE� FT] [ABOVE /4Mr0_W`r)KN_CHMATat7t4EFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 15 'FT DITCHES/SWALES: /S` FT NORMALLY WET? [ ] YES Kj NO WELLS: PUBLIC: � FT LIMITED USE: (0-0 FT PRIVATE: 'Z.S FT NON -POTABLE: ,5b FT BUILDING FOUNDATIONS FT PROPERTY LINES: It FT POTABLE WATER LINES: 3 /0 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES L7{j NO 10'YEAR FLOODING? [ ] YES 1<1 NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SIT; 1 SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE USDA SOIL SERIES: DEPTH TO TO TO TO . TO TO TO TO TO MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:[PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / BELOW] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: PATE: / bj INCHES j?4--14AVD �L�+rfiuB yLS S2417 DR 4015, 08/09 (Obsoletes previous editions which may not/be used) Incorporated: 64E-6.001, FAC Page 3 of 4 I rd II II II II Ml PORCH L9 9'-8' CEILING I /� n v aa• crn aTnrrGn L3 FLOOQ PLAN 1/4 11 = I'-O" CONCRETE BLOCK EXTERIOR WALLS WITH TYPICAL STUCCO FINISH LINTEL SCHEDULE MANUFACTURED BY CAST-CRETE SAFE GRAVITY LENGTH TYPE LOAD 2'-10" PRECAST 11809 < APPLIED GRAVITY LOAD 800 Ltt SYMBOL SAFE UPLIFT LOAD 9608 APPLIED UPLIFT LOAD < 400 BEAM COMPOSITE 8F32-ITIB LI L2 118 9 8F32-ITIB L3 7-6" PRECAST 6472 < 800 3508 < 400 81=32-ITIB L4 13'-4" PRECAST 2883 < 800 1321 < 400 8F32-ITIB L5 2'-10" PRECAST 6113 < 800 4460 < 400 8FI6-IB/IT L6 4'-0" PRECAST 6113 1 < 800 3079 < 400 896-I13/7 L7 6'-6" PRECAST 3480 < 800 1880 < 400 8FI6-IB/IT L8 7-6" PRECAST 2661 < 800 1634 < 400 8FI6-IB/IT L9 13'-4" PRECAST 1079 < 800 606 < 400 8FI6-IB/IT LIO 17'-4" IPPEST12ESSED 950 < 800 404 < 400 8FI6-IB/IT LII 24'-0" PRESTRESSED 450 < 800 267 < 400 8FI6-IB/IT I. ALL BOND BEAM REINFORCING SHALL BE CONTINUOUS AROUND ENTIRE HOUSE PERIMETER INCLUDING CHANGES IN BEAM ELEVATION. ALL SPLICES TO BE A MINIMUM OF 48 BAR DIAMETERS 2. CONCRETE FOR COLUMNS AND BEAMS SHALL HAVE 3000 PSI COMPRESSIVE STRENGTH AT 28 DAYS 3. A SINGLE FILLED CELL IS REQUIRED AT EACH SIDE OF EACH OPENING AND AT 4 FEET ON CENTER 4. 4 INCH MINIMUM BEARING IS REQUIRED FOR ALL LINTELS WI -EN FILLED SOLID WITH CONCRETE. LENGTH - OPEN SPAN PLUS 8 INCHES (MINIMUM) ® 7-4• TOP OF BEAM 8' TOP OF BEAM BEAM HEIGHT SCHEDULE 7 0 ft ra fh ,i l S � � ra^bb In 0 m It 0 n n M W Z J 6 0 0 4 U f 4 S N 4