HomeMy WebLinkAboutApplication For ConstructionSTATE W FLORIDA PEibilT 40.
:bXPARndENT OF H=Tk"
DATE; 4TD:
j,ONSITE, SEWAGE TREAU�EMT AHS.;t D1,S)POSlia� FEE , PAID
WE
.SYSTEM RE6:1, T, #:
APPLICATION FOR CONST1aUCT10M P)HIRMIT
APPLICATION FOR:
I I New System Existing:Sijrsbm-'�I'l I I Holding tink Innovative
Repair Abandonment Temipurary., w] CERTIFICATION
.APPLICANT: SAVANNA CONCIFRGE
AGENT: ALL,COUNTY SEPTIC AND PLUMBING
TELEPHONE,: 3404040
MAILING ADDRESS: 4875 BALD CYPRESS TRL FORT' PIERCE Fl, 34951
'TO .BE COMPLETED BY APPLICANT OR APPLIC'ANTIS AUTHORIZED MENT. SY*STEMS MUST BE CONSTRUCTED
,BY A PERSON LICENSED PURSUANT To 4 a q.:L b 5 (,.1) (M) Olt �j 8 1). 5!j
2, FLORIDA -STATUTES. IT IS THE
APPLICANT'$ RESPONSIBILITY TO PROVID3k DoCIMM
MATZO?' OF THE DATE, :THE LOT WAS CREATED OR
PLATTED, (MM/DD/YY) IF REQUESTING COMSIDr-WOUXON 01v "MMUMS1 GM kDiMlllik
PROVISIONS.
PROPERTY INFORMATION
LOT: 12
BLOCK: 2 SUBDIVISION: RFPLf,,TOF PALM (;/LRDENs PLATTED: 1950
PROPERTY ID #: 3403-802-0024-000-2 ZONING: RES 04'MEWIVALENT: I No El
PROPERTY SIZE: .18 ACRES WATER SUPPLY: I V 1 YFMOM TE
IS SEWER AVAILABLE AS PER 381.0065, FS? C Tq0
PROPERTY ADDRESS: 360BARRACLOIJGHFORT .PIElt,('1 Fl..
'DIRECTIONS To PROPERTY: SEE MAPQUEST
mnsialb:, [ ]<''2
P606PD I 1>2000GPE
DXSTANC,E TO SEWER: NA FT
BUILDING INFORMATION RESIDENTIAL CORMWMC IAL
Unit Type of No. of Bu` 61di,Klg Colmnexc -4.l:Ll/I'
,m$ Arl'a S,- n6titutional.-System Design
No Establishment Bedroo
Ch
64E-6, VAC
SF 4 1476 1,10C GPI D FLOW, 1955
955
2
3
4,
FlOcr/Equipment Drains I I Other (Specif-y)
SIGNATURE:
4z�
DR 4015, 08/109 ' (Obsoletes previous editionz; whi,::�h mny not be used)
Incorporated 64E-6.001, FAC
DATE -r 3/26/21
Page 1 of 4-
STATE OF; FLORII=� i.
5. DEPARTMENT OF $i'jLjlSj PERMIT #
ONSITE SEWAGE '!'I.21 a';kTTtes.F3-j AjjD 133:S%j jSAj, SYSTEN
EXISTING SYSTEM AN: D P21'AYR-VIALUATION
.moo %WME
APPLICANT: SAVANNA CONCIERGE
AGENT ED: ALL COUIVTYi `.iLI'TIC ��i�1) P1 U1VII31NG
_�- --
T: 12 szocx: 2SUBDI'v: REPLA.1. 0 PALM GARDENS ID#: 3403-802-M24-0(
TO BE COMPLETED BY FLORIDA REGISTER) EAiGT�7i E1�, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR
OTHER CERTIFIED PERSON _ SIGN • AND I Si:AL ALL DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS.
COMPLETE. TANK CERTIFICATION 'BELL w I c)R. UOTE III? REJYaA Um3 WHY THE TANKS CANNOT BE CERTIFIED .
EXISTING TANK INFORMATION
[900 j GALLONS SEPTIC TANK ErJ LEGFNI. »r.�v.�D; [N Ell,
NA MATERIAL: CON
I I GALLONS SEPTIC' TANK El LEGEND: -- MATER3':AL:
I I GALLONS GREASE INTERCEPTol., LLGZkUj : _ BAFFLED: [ YIN ]
[300 } GALLONS DOSING TANK MATERIAL:
-- LEGEND: NA MATERIAL: CON # PUMPS : [
I CERTIFY THAT THE LISTED TATHE VOLUMES VOLUMES SPECIFIED AS+DET
DEFECTS OR LEAKS, AND,HAVE A
SIGNATURE OF LICENSED
EXISTING DRAINFIELD
Ks WERE :s' >;n oiu 3 / 26 / 21 BY ALL COUNTY SEPTIC .
RM.gNED BYI J)IP.,iFtdSlO]NS HAVE
[$QLIDS DEFLECTION DEVIC'F �J ARE FREE of OBSERVABLE
J INSTALLED.
ALL COUNTY SEPTIC AND PLUMBING 3/26/21
PtR i BUSINESS ,�TA� DATE
[30O I SQUARE BEET PRIMARY DRA� NF II?.LD SYS7."FR No. OF TRT$ATCHES
I I SQUARE FEET I ]
DIMENSIONS: 15 X20
TYPE OF SYSTEM: [ ✓]. STANDARD:`; - -- SYSTEM4 No. QF TRIiNCHES I J
[ j I°3LLR"D
DIMENSIONS: g
I J. MOUND [ ]
CONFIGURATION: [ I TRENCH • .[ /1. IIACD IV] 25 E,) 36 CHAMBERS
DESIGN: I ✓l; 'HEADER �' ;I ]� D-BOX I. I GRAVITY,SYSTm [ ✓ ]
ELEVATION OF BOTTOM! OF DRAINFIELD 'GRADE
DOSED SYSTEM
14 RELATION TO EXIST•NG 4
INCHES [BELOW Ell
SYSTEM FAILURE AND REPAIR INFORi IRTIO!I
[1955 ] SYSTEM INSTALI,ATIolt DATz
[300 WAGISTYPE OF WASTE [ ✓j DOMESTIC [ j COMMERCIAL
] GPD ESTYMIITED SE'' i3'I�OFU BASED
ON C I METERED WATER
[ ✓ ] TABLE 1, 64E-6,
SITE I I DRAINAGE STRUC7C' I L I I.00L I I PATIO
/ DECK
CONDITIONS: [ ] SLOPING:;PROPERTy cal BACK •
[ ] PARKING -
NATURE OF [ J HYDRAULIC OVERLOAD C I SOILS [
] M41NTENANCE FAILURE: [ ] DRAINAGE /RUN a0iy F l I J Ii.OGTS
[ WATER
I I SYSTEM DAMAGE
J TABLE
[ ✓ ] CERTIFICATION
FAILURE I I SEWAGE ON GROum , C I IANR I ] D iBOX/>f1EADER
SYMPTOM: [ j PLUMBING
I I DRAINFIELD
,HACKUl� :: feel CERTfFICATIW
REMARKS/ADDITIONAL CRITERIACER�TIFIC;AifIO11 PUIZPOSE.i ONLY
SUBMITTED BY: o�
�- TITTER/LICENs�PRES 61509 DATE:3/26/21
DH 9015, 08/09 (Obsolet' previous t�c1:i bons w�laich m�,� note used)
Incorporated 64E-6.001, FAC
Page 4 of 4
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