HomeMy WebLinkAboutSewage Application For Construction Permit11 L-
STATE OF FLORIDA
' DEPARTMENT OF HEALTH
' ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
WE APPLICATION FOR CONSTRUCTION PERMIT
PERMIT NO�t-, ZAI �•. ? -i
DATE PAID:
FEE PAID: rst
RECEIPT #:"j� ;f^''•a-
APPLICATION FOR:
[>J New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair ^[ ]. Abandonment [ ] Temporary [ J
APPLICANT: i`C, cat TvJV1C...i �;�►`; v�cu .3J Z`�'� Lam. l I �::; : H _ �V �" 1
AGENT: �5 I tyj—ti <zTELEPHONE:��Z�Z�� �� C
MAILING ADDRESS: Z3G S ��04 ?i 6--c6 Ft 3 q C( �
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: PLATTED:
PROPERTY ID #: 1q(: % -311 - ctjc C,CG -, ZONING: A 6 I/M OR EQUIVALENT: [ Y /(-1
PROPERTY SIZE: I ACRES WATER SUPPLY: PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /(I`,] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: �`�j ( �� E
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
2
3 Y
4
[ ] Floor/ gui,pme rain.,
SIGNATURE: -
DH 4015, 08/09 (Obsoletes(p3
Incorporated 64E-6.001, FAC
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tt So uT(! -� i a-!> k tz-4"t —,a
[ ] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
—-zzc, )-
Other (Specify)
, DATE:
ious editions which may not be used)
Page 1 of 4
STATE OF
DEPARTMENTLDA OFIHEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Ron Raymond
CONTRACTOR / AGENT: Ashton
LOT:
BLOCK:
APPLICATION # AP1758088
PERMIT # 56-SF-2411354
DOCUMENT # SE1618224
SUBDIVISION: ID# : 1407-341-0005-000-5
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: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.95 ACRES
TOTAL ESTIMATED SEWAGE FLOW
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
1425.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
1250.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: NAIL IN TP S OF PROPERTY
ELEVATION OF PROPOSED SYSTEM SITE 20.00 [ INCHES / FT I [ ABOVE / BELOW) BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: 35 FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 135 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 10 FT PROPERTY LINES: 17 FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE:
rs -^-MA mr nwr crmti_ 1
[ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
10YR 6/1
Sand
0 To 24
10YR 7/1
Sand
2 To 24
10YR 2/1
Spodic Material
24 To 34
10YR 3/3
• Sand
34 To 48
10YR 3/1
Sand
48 To 60
REFUSAL
Refusal
60 To 72
;OIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
7.5YR 4/3
Organic Soil
0 To 9
10YR 5/1
Sand
9 To 24
10YR 6/1
Sand
12 To 24
10YR 7/1
Sand
24 To 34
1OYR 2/1
Spodic Material
34 To 44
10YR 4/3
Sand
44 To 52
10YR 4/2
Sand
52 To 57
10YR 2/1
Spodic Material
57 To 58
REFUSAL
Refusal
58 To 72
OBSERVED WATER TABLE: 24.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE:
ESTIMATED WET SEASON WATER TABLE ELEVATION: 2 INCHES [ ABOVE / BELOW )
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED
r REMARKS/ADDITIONAL CRITERIA
[ PERCHED / APPARENT ]
EXISTING GRADE
DEPTH. 2.00 INCHES
Sand/0.60 DEPTH OF EXCAVATION
[ ] OTHER (SPECIFY)
WSWT determined using USDA WSS and soil borings. 10YR7/1 stripping in a 10YR6/1 matrix > 10% with diffuse boundaries starting
at 2" in SB1. SBi 20" below BM. S132 10" below BM.
SITE EVALUATED BY:
Vajanyi, Matthew (Title:
DH 4015, 08/09 (Obsoletes previous editions which
on ent ecialist 1) (Florida Department of Health In S
not a used) Incorporated: 64E-6.001, FAC
AP1758088 EID2411354
INCHES
DATE: 11 /19/2021
Page 3 of 4
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