HomeMy WebLinkAboutApplication For Construction Permite
RECEI', uL 2917
STATE OF FLORIDA PERMIT NO. 02Q�i,�
DEPARTMENT OF HEALTH DATE PAID
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
osrsTDT #e •(r
SYSII
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR: / Existing SHolding Tank [ ]/I ovat'vei
[ ] New System [ /] [ ] g
[ ] Repair [ ] Abandonment [ ] Temporary [.-
APPLICANT: Tirio►v It S CIA Art Y
AGENT: � �'i��� � � � L TELEPHONE: 0) (a
MAILING ADDRESS:
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
pLpTT�TMM/D/YY)IFIREQUESTINGPROVIDE
CONSIDERATIIONAOFOSTATUTORYDATE
GRANDFATHER PROVILOT WAS SIONS.TED OR
PLATTED
PROPERTY INFORMATION > /�
LOT: 3—:-� BLOCK:
°JZ SUBDIVISION: /��/ �Ji'1/� PLATTED:
` PROPERTY ID #: l3D�, l/D �O�D�^UVZONING: I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE:_ ACRES WATER SUPPLY: ;-�,e PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
�
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /('NJ] DISTANCE TO SEWER: -ALtt—FT
PROPERTY ADDRESS:
DIRECTIONS TO PROPERTY: S-
BUILDING INFORMATION
Unit Type of
No Establishment
2
3
4
[ ] Floor/E/gAuAipment Drain,
1"
SIGNATURE:
(>cl-RESIDENTIAL [ ] COMMERCIAL,
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 11 Chapter 64E-6, FAC
W
3 2jbg no dw, JdJ e
ZS
[ ] Other (Specify)
DATE:407-
D11 4015, 08/ 9 (Obsoletes previous editions which may not be used) page 1 of 4
incoroorat 64E-6.001, FAC
RECU- �u
APPLICATION #:R►P1173216
STATE OF FLORIDA PERMIT #:56-SF-02045
DEPARTMENT OF HEALTH DOCUMENT #:F1984164
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
•+nwTemorrrmTnm TN:RPECTION AND FINAL APPROVAL DATE PAID:
FEE PAID:
RECEIPT #:
APPLICANT: Travis C Carter
AGENT: Jason Hams (AII About Septic Services, Inc)
PROPERTY ADDRESS: 6306 Coquina Ave Fort Pierce, FL 34951
LOT: 314 BLOCK: 92
SUBDIVISION: Lakewood Park xv#: 1301-60"107-000-3
CBECIO:D [%] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED -
TANK INSTALLATION
( ]
[01]
TANK SIZE [1] 1050.00 121
[ ]
( ]
1023
TANK MATERIAL Concrete
[ ]
j ]
103]
OUTLET DEVICE
i ]
[]
[041
MOLTI-CEAMSERED L Y
[ ]
(05]
OUTLET FILTER Polylok.PL-68
L ]
[ ]
[061
LEGEND 1. Unknown 2.
[ ]
[ ]
(071
WATERTIGHT
I 3
( I
cool
LEVEL
t ]
[ ]
1091
DEPTH TO LID
[ ]
DRATNPIELD INSTALLATION
[ ]
I103
AREA 113 510 [2]SQFT
i ]
[ ]
111]
DISTRIBUTION BOX HEADER X
L ]
j ]
[121
NUMBER OF DRAINLINES 1. 5.00 2.
L ]
[ ]
[131
DRAINLINE SEPARATION
[ ]
[ ]
(14]
DRAINLINE SLOPE
j ]
115]
DEPTH OF COVER
( I
[16]
ELEVATION [ ABOVE / BELDw ]BM 30.00
L ]
[ ]
E171
SYSTEM LOCATION
[ ]
[ ]
1181
DOSING Pt7ta+S
[ ]
j ]
1191
AGGREGATE SIZE
[ ]
L ]
[201
AGGREGATE EXCESSIVE FINES
L ]
j ]
[211
AGGREGATE DEPTH
i ]
t ]
SETBACKS
1273
SURSACS 10-M
81
FT
1291
DITCHES
10
PT
1293
PRIVATE 'WELLS
78
FT
c303
PUBLIC WELLS
FT
[31]
IRRIGATION WELLS
FT
E321
POTABLE WATER
5
FT
[33]
BUILDING FOUNDATIONS
10
FT
1341
PROPERTY LINES
20
FT
[351
OTHER
FT
FUSED / MOUND SYSTEM
1361
DRAINFIELD COVER
1373
SHOULDERS
1381
SLOPES
[391
STABILIZATION
ADDITIONAL INFORMATION
140] UNOBSTRUCTED AREA
j413 STORMWATER RUNOFF
E42) ALARMS
1431 MAINTENANCE AGREEMENT
L443 BUILDING AREA
(45] LOCATION CONFORMS WITH SITE PLAN
[46] FINAL SITE GRADING
PILL / EXCAVATION MATERIAL
I ]
[47]
CONTRACTOR Jason Harris (All About Sept
i l
L22] FILL AMOUNT
t ]
[491
OTHER MINERAL AGGREGATE
( 7
221 PILL TEXTURE
I 1
1243 EXCAVATION DEPTH
ASANDOMIENT
t ]
1251 AREA REPLACED
( 7
1493
TANK PUMPED
I ]
j263 REPLACEMENT MATERIAL
[ ]
(SO]
TANK CRUSHED a FILLED
Comments: Commonts are on gage 2.
CONSTRUCTION [ APPROVED / DISAPPROVED ]:
FINAL SYSTEM i APPROVED / DISAPPROVED ];
juplauatioe of Violations on £olloriug Page)
5t. Lucie cHD DATE: 01/22/2015
it: LUCID County}
St. Lucie CHD DATE: 01/22/2015
DR 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 642-6.003, PAC Page 2 of 3
EN Databaso v 1.0.1 AP117321S EID343811
J
tZECE{.�0 C61 �''' J.
2017 PERMIT #..56-SF-02045
APPLICATIoN #: AN 173216
STATE OF FLORIDA DATE PAID:
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CCNSTRUC;'1`1V1V YFittinit act:�.trs n:
`' ,, z,•�` • DOCUMENT # : PR961548
osms #:00-0316-N
CONSTRUCTION PERMIT FOR: OSTDS Repair
APPLICANT: Travis C Carter
PROPERTY ADDRESS: 8306 Coquina Ave Fort Pierce, FL 34951
LOT: 3/4 BLOCK: 92 smmmsxoN: Lakewood Park
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAR ID NUMBER]
PROPERTY ID #: 1301.608-0107-000-3
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
391.0065, F.S., AND CHAPTER 648-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITS OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPHW OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T E 1,050 ] GALLONS / GPD Septic CAPACITY
A { 0 ] GALLONS / GPD CAPACITY
N I 0 7 GALLONS GREASI; INTERCEPTOR CAPACITY IMLv.V= CAPACITY SINGLE TAN8:1250 GALLONS]
A [ ] GALLONS DOSING TANK CAPACITY I ]GALLONS 0E ]DOSES.PER 24 ERS 0—ps I
D t Soo I SQUARE FEET SYSTEM
R I 0 ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [NJ STANDARD I ] FILLED II MOUND I I
I CONFIGURATION: [ ] TRENCH 1XI BED I I
N
F LOCATION OF BENCHMARK: top oftank
I ELEVATION of PROPOSED SYSTEM SSTE E 3.00 It FT ]t ABOVE BELOW POINT
INCHES
E BOTTOM OE DRAINFIELD TO BE [ 33.00 1 irs—me-a-s-T FT I[ABOVE iBELOW BENCHMRRK/REFERENCE POINT
L
D
0
T
R
E
R
5. REQUIRED: 10.00] INCHES EXCAVATION REQUIRED: I ] INCHG:f
ie system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow
300 gpd.
le licensed contractor installing the system is responsible for installing the minimum category Of tank in accordance with
64E-6.013(3)(0. FAG.
SPECIFICATIONS BY: aso Harris / TITLE. Septic Tank Contractor
APPROVED BY: k A TITLE: Env. Sup 11 St. Luoie COD
victor =ae
DATE ISSUED: 01122/2015 EXPIRATION RATE: 04/22/2015
DR 4016, 08/09 (Obsclatea all Previous editions which may not be used)
Page 1 of 3
Incarpasated: 64E-6.003, PAC
y 1.1,, APL173216 S6948563 (A�
Stl
E
Site
QSTQ$
Date•
Reviewer.;,;
6-JOLinty Heifth Departure
rim,eptal Health Division
Approved for Construction
3s All Pre%46US NO Pkfhs for
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