HomeMy WebLinkAboutAPPLICATION FOR CONSTRUCTION PERMITJ
STATE OF. FLORIDA N . `` • PERMIT ,#
DEPARTMENT OF HEALTH.'AND REHABILITATIVE SERVICES DATE PAID A17b77
ONSITE.:SEWAGE'DISPOSAL SYSTEM FEE PAID $
,Q -,APPLICATION FOR CONSTRUCTION PERMIT RECEIPT
Authority: - -Chp t i ix,.i33ES6,, FS a Chapter j10 6,, . PAC
WE
BY
APPLLCATIN FOR: ,',S
.lu*
�Jxx,j .'Itew ystem • .": ['' ]:`::Existing. System (, ] Holding. Tank:. [. : ] Temporary/Experiment8l • -
''[ ].Reps r '[.•] Abandonment [ ] Other(Specify).
PLICArr<r ; Bruce Neal TELEPHONE:561-461-7631
AGENT• .
��:�s;: &' Eklund Inc:
MAILING RESS;
abasso . FL 32970
x 420 W PO, Bo 1 .,
-. .:�:�=till , , ,°, ,.,,., _..�. .. • .-�:r,.;.:.. ;
r —1-------
:TO',:BE'vCO ETED.rBY-APPLICANT•.,:OR .APPLICANT.'S AUTHORIZED, AGENT. . ATTACH BUILDING PLAN AND .TO -SCALE •
SITE; PLAN SOWING.;PERTINENT,.FEATURES.,REQUIRED BY CHAPTER.lOD-6,.FLORIDA ADMINISTRATIVE CODE.
------___________________________________________________________________
PROPERTY Ii FORMATION JIT LOT..IS-NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR.DEED]
See at ed legal description
LOT: BLOCK: SUBDIVISION: 7�k` . DATE OF
SUBDIVISION:
PROPERTY I#,:8/,36%39;.;;(.443-0001-000�2) [Section/.Township/Range/Parcel.No.] ZONING:
BROP.ERTY'SIZE:20.86 �: ACRES'[Sgft/43560] PROPERTY.WATER SUPPLY: [.Cc] PRIVATE. [ ] PUBLIC
PROPERTY S REET ADDidSS.: 12151 Williams Rd., Pt. St. Lucie, F.h 34988
D� RECTI--NS ITO.• PROPERTY:,. ; Fran US` Highway 1, take, 712 (White'.
City Rd.) West to McCarty' Rd. ,
go.'.South•;on.MeCarty,approximately 1.3 miles to Williams Rd:Site is at SW corner of
Williams' d•McCarty.
BUILDING II,ORMATION'
[xX],RESIDENTIAL [ ] COMMERCIAL
e
Uz
it Type..
Qf .., ,.,.
No." of
Building
# Persons
Business Activity
No
'".'Esta�lishment
Bedrooms
Area Saft
Served
For Commercial Only
i:�
_Res
en ce
5
3421
5
'
l 1
[ Y
Garbs
] , g
, , •.., .w. ,.:
l' Grinder:/Disposal'
' -
��
Spas/Hot
•.
Tubs `�-
"-Pool
(N ] Floor/Equipment Drains.
Ultra .
ow . Volume, . Flu ., T.
Other ( Specify)
,
'
�.
XR June ' 26, 1997 f
-AP
LICANT.. S
�.
IGNA TURE :.
. ,
DATE:
ti•.-. _
i j x`•< John r
�Q
HRSiH"'Form
4015,
3S
iMar 92• (Obsoletes previous a s� � � >, fibt be used)
n.
(Stock
Number:
t44-001=4015-1)
�`;,,, ti`• • r "
Page 1 of 3
o� STATE OF FLORIDA PERMIT #
DEPARTMENT OF,HEALTH AND REHABILITATIVE SERVICES DATE PAID 7
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT #
fi Authority: Chapter 381, FS & Chapter 1OD-6, FAC
STRUCTIO PERMIT FOR:
]_ New Sy litem [ ] Existing System
] Repair''l [ ] Abandonment
iPPLICANT:
rR PERTY S
ADDRESS:
( J Holding Tank [ ] Temporary/Experimental
[ ] Other(Specify)
AGENT:�/I���1 � •n��
11! l 1��1�1G inA7)
SOT.: BLOCK: SUBDIVISION:
)ROPERTY ID #: (SECTION/TOWNSHIP/RANGE/PARCEL NUMBER]
b [OR TAX ID NUMBER] Ij
I __ -----------------------------------------------------------------
°_--------- ------------------------------------------------
;YSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER IOD-6, FAC
ZEPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
;Xl(IRE ONE EAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
?ERF•ORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
3ASIS FOR I SUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
4O TFICATI0 S MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
3Y
C
a
V
K
D
R
A
I
N
F
I
E
L
STEM DESIGN AND SPECIFICATIONS
( ] GALLON / GPD] SEPTIC' T YAEROBIC UNIT CAPACITY <MUL'I'I-CHAMBER /IN SERIES:[ ]
[ ] [GALLONS / GPD] CAPACITY I=OiIA9IBERED/IN SERIES:[ ]
[ ]' GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
0
T
H
E
R
SPl
AP;
DA'
HRS
(St
[ ]
GALLONS PER DOSE DOSING TANK
CAPACITY DOSE -RATE [ ] PER 24 HRS
NO. OF PUMPS: ( ]
[ 776 ];SQUARE
FEET PRIMARY DRAINFIELD
SYSTEM
( ]
SQUARE FEET
SYSTEM
TYPE SYS
EM: , [ ] STANDARD
[ ] FILLED
[yam] MOUND [ ]
CONFIGU
TION: [ ] TRENCH
BED
�`�"?= (c
�'C t �� !-f�'l,� I.�': s•�,� , j ter,
So; �S t-! /did
�_
LOCATION
OF BENCHMARK: 5"
_
OF PROPOSED SYSTEM SITE~ [
C' ] INCHE$)FT] [ABOVE/'16'1�EN ELOW •rCHMARQREFERENCE
POINT
ELEVATIO1
f
DRAINFIELD TO BE [ 2
] NCHE$j/FT]
ABOVE/]r'BENCHMARK/REFERENCE POINT
BOTTOM 0
FILL REQ
IRED.: [ rC ] INCHES EXCAVATION
REQUIRED: [,� ] INCHES
Rmf ^ P 1 r-
CIFICATI(
'NS BY:
TITLE:
ROVED BY•
r
TITLE:AA
CPHU
E ISSUEDI
47-
EXPIRATION DATE: A
/
which
may not be used)
Page 1 of 2
H Form 4016,'Mar
92 (Obsoletes previous editions
ck Number:
744-001-4016-0)
rin
. . .... [NETS
. ..
2
OF:'FLORIDA �STATi PERMIT
`4< ..'OF �IHEALTH.� Alb -REHAB ILXTATIVE SEhVICES.
' :.,.OHSITE-.:,SEWAG9 .;'DISPOSAL'SYSTEM•.-.
ITE"EVALUATIONAND §YSTEM`SP9CIFICATION9'.'
ME_
AGENT:
/0
vlv\
7.
SUBDIVISION:.'
PROPERTYI,11D (Section/Township/Range/Parcel No. or.Tax'ID Number].
-- ------------------------------------------ ��m --------- ----------
UNOB
Munsel
ill= S
hiTED BYsE.ENGINEERe.,HEALTH,,,.WIT:EMPLOY.EE,,.QR*,,OTHER;QVALIIFIED PERSON.- ENGINEER.'S-,.-MUST
q STRATION-..,,.NUMBER,IAND,- SIGN:. AN,-SMAY-EACH,42AGE. OF- SUBMITTAL. COMPLETE ALL ITEMS;:*
---- 77 --- --- - SIZE CONFORMS TO SITE PLAN: YES --------- NO --
NET USABLE AREA AVAILABLES ACRES
(
IMATED.SEWAGE..'FLOW, GALLONS ,PER ,DAY J _RESIDENCES7TABLE_l /-,QTHER-!-TABLE:2.j
qz7
P,,'SEWAGE,n 5GALLONS. PER DAY,_.�'�[1500. GPD/ACRE OR. 250O`.`.r;PD/ACRE]
,e*4c>
TED...AREA;AV
UNOBSTRUCTED..AREA_REQUIRED: SQFT
S ,v .51 NrP.
NEFERENC9, POINT. LOCATION: Or- xu
SYSTEM S;TE,.,.,IS VINCH rJ,/FT]..,:,[AB.OVE/(BEI.,OW). BENCHMARK RE.FEREN. E.:,P.OINT
UM':SETBACK;:,-WHIC . H'-.CAN,*,BE..'MAINTAINED,FROM.THEPROPOSED-SYSTEM * 20`rTHE FOLLOWI FEATURES,I'.
ATER: 1040 FT DITCHEg/SWALES: JQQ FT. NORMALLY -WET? jlj.YES _.:
. .FT PRIVATE FT FT
T% LIMITED,
-FT
FT. T' V WATER DINES' �6UkDAti _ROPERTY.LIN,ES :,.,POTABLE
LOOD ELEVATION FOR f 7SITE :: MNGVD0,...!,-p%TEFT:, MSL NGVD,. ELEVATIONV
ILE'-..'INFORMATION', SITE i S61L'PROFILE INFORMATION SITE:2
#I'Cdlok Textikre Depth
to
Z, to
L to
to
Tl -to-
V- _eA
i to
lr. Mbl
to
T. CVlDTl*Q-
S R , - i
ERVUED WATER-,:TA-1
TIMATEP WET SEA
GH.WAT3R TABLE;,'
Munsell #/Color, Texture Depth
to
to
to
to
to
to.,
to
to
to
USDA.SOIL SERIES:
jj�ISTING GRADETYPE
INCHES [ABOVE el- _jrPERCHED / : APPARENT]
BELO' i.
6lb-powpo. E 3Wj ., EX I STINGGRADE. ,
)N_9aTEA2 TABLE. ELEVATION:. INCHES ABOVE BE
3GETATION: YES* NO MOTTLING; ].'YES DEPTH: INCHES
j,
4GFLATE,FORSYSTEM', S 21 A AADEPTHEXCAVATION, INCHES
....... OTHER(SPECIFY)
CRI�TE
:a
t -A
t7
V
SITE
E
Y
TED BY DA E:
J j
40 92;�'(0bki*efiS`-.' may` 6 used) Page: 3 ',of 3
PRt�H; 'eviour. I t�iwhUCS
Form 4015,,�Mar Pr
'(Stock 4 0 44,1 _0
........ colpa 2 9 8 5.. 02