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STATE OF FLORIDA PERMIT # . 56.5F- [ 79 Ho 9b
DEPARTMENT OF HEALTH
G .n: ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
'a
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: CHRISTOPHER AND MELISSA HUTCHINGS AGENT: GROUP ONE CONSTRUCTION
LOT: 31/30 BLOCK: 6 SUBDIVISION: INDIAN RIVER ESTATES UNIT TWO
PROPERTY ID # : 3402-602-0074-000-0 1 I 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: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: 0.674 ACRES
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [ RESIDENCES -TABLE 1/OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
BENCHMARK/REFERENCE POINT LOCATION: (SITE BENCHMARK TWO) SEE SURVEY
ELEVATION OF PROPOSED SYSTEM SITE IS 0.2 [FT ] [ABOVE ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:75 FT
DITCHES/SWALES:15 FT
NORMALLY WET?
[ I YES (
] NO
WELLS: PUBLIC:200 FT
LIMITED USE:100 FT PRIVATE:75
FT NON—POTABLE:50
FT
BUILDING FOUNDATIONS:5
FT PROPERTY LINES:10 FT
POTABLE WATER
LINES:10
FT
SITE SUBJECT TO FREQUENT
FLOODING: [ ] YES [ ] NO 10
YEAR FLOODING?
] YES
] NO
10 YEAR FLOOD ELEVATION
FOR SITE: FT MSL/NGVD SITE ELEVATION:
FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE DEPTH
4
USDA SOIL SERIES:
TO
TO
TO
TO
TO
TO
TO
TO
mn
SOIL PROFILE INFORMATION SITE 2
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 I ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
�°' PEg8%288//2'017
DR 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
Page 3 of 4
5F STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND
SITE EVALUATION AND SYSTEM
DISPOSAL SYSTEM
SPECIFICATIONS
PERMIT #.5G'51C-199909&,
APPLICANT: CHRISTOPHER AND MELISSA HUTCHINGS —AGENT: GROUP ONE CONSTRUCTION
LOT: 31/30 BLOCK: 6
SUBDIVISION: INDIAN RIVER ESTATES UNIT TWO
PROPERTY ID # : 3402-602-0074-000-0 1 [ 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:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
IV]
YES [ ] NO NET USABLE AREA AVAILABLE: 0.674 ACRES
_GALLONS PER DAY [ RESIDENCES -TABLE VOTHER-TABLE 2 ]
_GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
_SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
BENCHMARK/REFERENCE POINT LOCATION: (SITE BENCHMARK TWO) SEE SURVEY
ELEVATION OF PROPOSED SYSTEM SITE IS 0.2 [Fr ] [ABOVE ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:75 FT DITCHES/SWALES:15 FT NORMALLY WET? [ I YES [ ] NO
WELLS: PUBLIC:200 FT LIMITED USE:100 FT PRIVATE:75 FT NON-POTABLE:50 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES:10 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO 10 YEAR FLOODING? ] YES ] ] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE
USDA SOIL SERIES:
DEPTH
TO
TO
TO
TO
TO
TO
TO
mn
MUNSELL #/COLOR
USDA SOIL SERIES:
TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
OBSERVED WATER TABLE: INCHES [ABOVE/BELOW r] EXISTING GRADE. TYPE:[ PERCHED /APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ j YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ j TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
PATE: 08/28/2017
DE 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 Of 4
dr
STATE OF FLORIDA
R' DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #. Slt S,C �7Q�{09G
APPLICANT: CHRISTOPHER AND MELISSA HUTCHINGS AGENT: GROUP ONE CONSTRUCTION
LOT: 31/30 BLOCK: 6 SUBDIVISION: INDIAN RIVER ESTATES UNIT TWO
PROPERTY ID # : 3402-602-0074-000-0
I 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: IV]
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
YES [ ] NO NET USABLE AREA AVAILABLE: 0.674
_GALLONS PER DAY [ RESIDENCES -TABLE VOTHER-TABLE 2
_GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE
SQFT UNOBSTRUCTED AREA REQUIRED:
ACRES
SQFT
BENCHMARK/REFERENCE POINT LOCATION: (SITE BENCHMARK TWO) SEE SURVEY
ELEVATION OF PROPOSED SYSTEM SITE IS 0.2 [Fr ] [ABOVE ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:75 FT DITCHES/SWALES:15 FT NORMALLY WET? [ I YES [ ] NO
WELLS: PUBLIC:200 FT LIMITED USE:100 FT PRIVATE:75 FT NON-POTABLE:50 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES:10 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO 10 YEAR FLOODING? ] YES I ] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
MUNSELL #/COLOR
USDA SOIL SERIES:
TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
OBSERVED WATER TABLE: INCHES [ABOVE/BELOW r] 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: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ I BED ] ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
PATE: 08/28/2017
DR 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 Of 4
STATE OF FLORIDA
a DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT 7 9 c/D 46
APPLICANT: CHRISTOPHER AND MELISSA HUTCHINGS AGENT: GROUP ONE. CONSTRUCTION
LOT: 31/30 BLOCK: 6
SUBDIVISION: INDIAN RIVER ESTATES UNIT TWO
PROPERTY ID # : 3402-602-0074-000-0 [ 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:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
[✓] YES [ ] NO NET USABLE AREA AVAILABLE: 0.674
GALLONS PER DAY [ RESIDENCES -TABLE 1/OTHER-TABLE 2
GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE
SQFT UNOBSTRUCTED AREA REQUIRED:
ACRES
]
]
SQFT
BENCHMARK/REFERENCE POINT LOCATION: (SITE BENCHMARK TWO) SEE SURVEY
ELEVATION OF PROPOSED SYSTEM SITE IS 0.2 [Fr ] [ABOVE ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:75 FT DITCHES/SWALES:15 FT NORMALLY WET? [ ] YES [ ] NO
WELLS: PUBLIC:200 FT LIMITED USE:100 FT PRIVATE:75 FT NON-POTABLE:50 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES:10 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO 10 YEAR FLOODING? [ ] YES [ ] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE/BELOW f] 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:
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
DEPTH OF EXCAVATION:
[ ] OTHER (SPECIFY)
DATE: 08/28/2017
INCHES
DH 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4