HomeMy WebLinkAboutSEWAGE CONSTRUCTION & INSTALLATIONApplicant
Septic tank or
aerobic unit �f
Septic tank or I
aerobic unit
Graylwater
tank
Laundry
waste tank
Other Requirem 'nt
.STATE OF FLORIDA:'
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
I,NSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT SCANNED
Authority:_.Chapter 381, FS
Chapter 10D-6, FAC St. Lueie ChO,
�� �• -�J, �i Permit Number
PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL -------------
Treatment Tank Minimum Draintrench OR Minimum Absorption
Size Bed Size
Grease
gallons interceptor gallons Square Feet e'�-} Square Feet
gallons Dosing tank gallons Square Feet Square Feet
gallons Square Feet Square Feet
gallons Square Feet Square Feet
(a) Installation JmJust be in accord with requirements of chapter 10D-6; FAC.
(b)- "A system cdnstruction 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.,'f
(d) Invert of st46-out for Ato be /2 e" 1 °2y— !C !
benchmark.
-�`
Invert of styb-out for to be
benchmark.
Invert of stub -out for to be
benchmark.
Invert of st bout for to be
benchmark.
f
(e) Fill quality nd quantity: V`f)>.J
EXCAVATION MUST BE CHECKED
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DRAINFIELD INSTALLATION.
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� Other:
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.� c�_�u�t3 vi�rastv�.b�!aJ 1� �vY3UJC41 J.iJ i�HSUrit98.LV4v t:'A.V'i"! t�U^ U—:lAiJd`�ia�,p
�O®i MUST RE GUTTERED PRIOR TO FINAL APPROVAL.
In
System desi and specifications by:Title -
Constructi0 "authorized by: �.. / J %" f.n� �- �'` _ Date
`County Public Health Unit
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Note: Comp eted copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO. 62573
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' HRS-H Form 4016, �,eb 85 (Obsoletes previous editions which may not be used)
(Stock Number.574�-001.4016.0) Page 1 Of 2