HomeMy WebLinkAboutSewage Application For Construction PermitSTATE 9i FLORIDA PERMIT NO.
., DEPARTMENT OF HEALTH DATE PAID: /
_e. ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: f rrt7
s SYSTEM RECEIPT #:
WmeAPPLICATION FOAr CONSTRUCTION PERMIT �9D�31e�
APPLICATION FOR:
New System [ ] Existing System [ ] Holding Tank [ ] Tnnovative
[,/, Repair [ ] Abandonment [ ]. Temporary [ ]
APPLICANT:
AGENT:s�o i', e'D-� { V `�I l/ S '►�I(i TELEPHONE: -i�Z
MAILING ADDRESS: S P
Clam,.-' 1- FT-,
i
TO BE COMPLETED BY APPLICANT OR APPLICANT'SAUTHORIZED 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 #: I l j " l 33 "dU 30 —Q�-yZONING: AR t I/M OR EQUIVALENT•: [ YIN ]
PROPERTY SIZE: 6Z,. ACRES WATER SUPPLY: >%4::r PRIVATE PUBLIC [ ][=20'00GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.006,5,. FS? [ YIN ] DISTANCE. TO dtVER: FT
PROPERTY ADDRESS: `. t f ? -GYLA V1,V �
DIRECTIONS TO PROPERTY:j &0 ..] N,j
BUILDING INFORMATION 3;< RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial./Institutional System Design
No Establishment, Bedrooms Area Sgft Table 1, 'Chapter 64E-6, PAC
1
2
3
4
[ ] Floor/Equipment Drains
SIGNATURE; lyj�AYV W
[ 1. Other (Specify)
DATE: - i z 2 r
'DR 4015, 0.8/049 :('O)soletes previous editions which may not be used)
Incorporated 64E-6:001, FA.0 Page 1 of•4
STATE OF FLORIDA APPLICATION # AP1733833
DEPARTMENT OF HEALTH
PERMIT # 56-SF-237498.5
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
DOCUMENT # SE1613662
APPLICANT: Hopeton Smith
CONTRACTOR / AGENT: ASHTON SEPTIC TANKS, INC.
LOT: BLOCK:
SUBDIVISION: ID# : 1418-133-0030-000-4
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: 1.02 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 1529.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: PAINTED X NAIL IN PINE TREE W OF PROPERTY.
ELEVATION OF PROPOSED SYSTEM SITE 9.00 [ INCHES / FT ] [ 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: FT NORMALLY WET: [ ]YES [ ]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 95 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 13 FT PROPERTY LINES: 25 FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NOI
10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 RnTT. VRAFTT.F. TNW PMn TTnW RTMW 9
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
10YR 4/2
Fill - Sand
0 To 26
N 2.5/
Fill - Loam
12 To 16
5Y 5/1
Sand
26 To 36
1 OYR 6/1
Sand
36 To 39
5Y 2.511
Sand
36 To 39
10YR 711
Sand
39 To 52
1 OYR 712
Sand
39 To 62
1OYR 6/3
Sand
62 To 72
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
10YR 3/2
Fill - Sand
0 To 17
10YR 511
Sand
17 To 24
1 OYR 211
Sand
17 To 28
1 OYR 4/1
Sand
28 To 34
1 OYR 5/1
Sand
28 To 34
1 OYR 7/1
Sand
34 To 56
1 OYR 5/2
Sand
56 To 57
REFUSAL
Refusal
57 To 72
OBSERVED WATER TABLE: 49.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 39 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES EX ]NO MOTTLING: [X]YES [ ]NO DEPTH: 39.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: 0 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings. 10YR712 stripping in a 10YR711 matrix > 10% with diffuse boundaries starting
at 39" in SB1. SB1 9" below BM. SB2 22" below BM.
SITE EVALUATED BY: DATE: 11/18/2021
Vajany , Matthew (Title: E ronmen pecialist 1) (Florida Department of Health in S
Da 4015, 08/09 (Obsoletes previous editions which y not a used) Incorporated: 64E-6.001, PAC Page 3 of 4
AP1733833 EID2374985 v 1.0.2