HomeMy WebLinkAboutSEWAGESTATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
4
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
N�u6 Authority: Chapter 381, FS
Chapter 1 OD-6, FAC
SCANNED
Applicant. ti� /� <'� : �- �, ? Permit Number.
,' 1 'y
1E COUNTY
---------------PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL---------------
Treatment Tank Minimum Draintrench
OR Minimum Absorption
Size
Bed Size
a
Septic tank or Grease
aerobic unit. ran gallons interceptor gallons Square Feet
•=I Square Feet
Septic tank or
aerobic unit gallons Dosing tank gallons Square Feet
Square Feet
Graywater
tank gallons Square Feet
Square Feet
Laundry
waste tank gallons Square Feet
Square Feet
Other Requirements:
(a) Installation must be in accord with requirements of chapter 10D-6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.
(c) Final installation inspection and approval is required before the system is covered.
(d) Invert of stub -out for-�,�.� to be 1w ��re G/i roc
benchmark.
Invert of stub -out for to be
benchmark.
Invert of stub -out for to be
benchmark.
Invert of stub -out for to be
benchmark.
(e) Fill quality and quantity: A - _�� x 197 `= 51
EXCAVATION MUST BE CHECK'
BY THIS DEPARTMENT PRIOR TO
DRAINFIELD INSTALLATION
(f) Other: IF AREA OF DRAINFIELD IS SUBJECT TO SATURATION FROM
ROOF DRAINAGE, ROOF MUST BE GUTTERED PRIOR TO
FINAL
�f
System design and specifications by:.l
Title)
��•
Construction authorized. -by: :,,'� 1'=: 'r�.� _ ,
Date - 7- `7 J
ST o LUCIE County Public Health Unit
Note: Completed copies -of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO. SQUARE MILE_ 61_1
HRS-H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-001.4016-0) ` Page 1 Of 2