HomeMy WebLinkAboutSewage Application For Construction PermitSTATE OF FLORIDA
'- DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPI,Z6ATION FOR:
PERMIT NO. 'S -1 b $l
DATE PAID: Ni T.3, Q
FEE PAID:
RECEIPT #:
[ ] New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: ANIJA e&a!z
AGENT: mu. m4 actil-re r TELEPHONE: Z&M-'IW
MAILING ADDRESS: /2%�QI s, Dlxie p7wy, , a 331a
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: t b
BLOCK: 50
SUBDIVISION:
r• PIERCIE SRORES
PLATTED:
PROPERTY
ID #: l "y3(o b D3
OG2'y r ��O %
ZONING: RS -4
I/M OR EQUIVALENT: [ Y / N ]
PROPERTY
SIZE: ACRES
WATER SUPPLY:
[ ] PRIVATE PUBLIC [ ]<=2000GPD [ ✓1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS?[ Y /0 DISTANCETOSEWER: ? FT
PROPERTY ADDRESS: 23D+ A-CW 16 5a) FAW &Ub • , ROAM I UU GYIAISON WO, 51, XJ42
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL
Unit Type of
No Establishment
1-S1W64f rfrm%a
2
3
4
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
� 3o`�Z. �IUCLUIiE5 Y6QeNEs � ��t�A�E�
[ ] Floor/Equipment Dra�ns//,,� /Y Other (Specify)
/L�/'/M`%0WFAa,
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Darren & Anna Casey
CONTRACTOR / AGENT: WilliarnArthur- Architect
LOT: 13 BLOCK: 30
SUBDIVISION: ID# : 1436-603-0024-000-7
APPLICATION # AP1583200
PERMIT # 56-SF-1370381
DOCUMENT # SE1503455
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: 0.32 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 799.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 1 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 887.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Site BM, NiD, E side of Rd, near NW property corner
ELEVATION OF PROPOSED SYSTEM SITE 8.00 [I INCHES I/ FT ] [ ABOVE /I BELOW I] 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
[X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE:
FT NON -POTABLE:
50 FT
BUILDING FOUNDATIONS: 5 FT
PROPERTY LINES: 5 FT
POTABLE WATER LINES:
27 FT
SITE SUBJECT TO FREQUENT FLOODING?
[ ]YES [X]NO
10 YEAR FLOODING? [ ]YES
[X]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
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
1 OYR 4/2
Fill - Sand
0 To 7
1 OYR 6/3
Sand
7 To 23
1 OYR 4/1
Sand
23 To 27
1 OYR 4/3
Fine Sand
25 To 36
1 OYR 5/2
Fine Sand
29 To 41
1 OYR 6/2
Fine. Sand
41 To 57
10YR 7/3
Sand
57 To 72
USDA SOIL SERIES:
Munsell #/Color
Texture
Depth
1 OYR 4/3
Fill - Loamy Sand
0 To 8
1OYR 5/3
Sand
8 To 31
1 OYR 6/2
Sand
30 To 44
10YR 4/3
Sand
44 To 51
10YR 6/2
Sand
51 To 66
1 OYR 7/2
Sand
66 To 72
OBSERVED WATER TABLE: 63.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 29 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 29.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [X ] TRENCH [
r- REMARKS/ADDITIONAL CRITERIA
Fine Sand/0.80 DEPTH OF EXCAVATION:
] BED [ ] OTHER (SPECIFY)
WSWT determined using USDA WSS and soil borings.
10YR5/2 stripping in 10YR4/3 matrix >10% with diffuse boundaries starting at 29" in SB1.
SB1 and SB2 8" below BM. 17
SITE EVALUATED BY:
Ingram, Brian ( le: Environmental Specialist 111) (ENVIRONMENTAL HEALTH)
DH 4015, 08/09 (Obsoletes previous editions w ich may not be used) Incorporated: 64E-6.001, FAC
AP1583200 EID1370381
INCHES
DATE: 03/31 /2021
Page 3 of 4
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