HomeMy WebLinkAboutDEPT OF HEALTH SEWAGE TREATMENT AND DISPOSAL APPLICATION 4-24-18i
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FLORIDA
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STATE OF
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OF HEALTH
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ONSITE SEWAGE TREATMENT AND
DISPOSAL
FEE PAID:
SYSTEM
RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLI T�OIF6R
[)(] New Syst [ ]
Existing System
[ ] Holding Tank [ ] Innovative
[ ] epair [ ]
Abandonment
[ ] Temporary
[ ]
,
APPLI T
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AGENT:, !% _ Iif''%Q
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TELEPHONE:I ✓-�"'� C�2L
MAILI IG ADDRESS: Ct-P 1 (� 1 V U � � � U-<WD � -A33 �a
TO BEIICOMPLETED: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
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PLATT (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY,GRANDFATHER PROVISIONS.
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PROPE CITY INFORMATION
LOT: BLOCK: SUBDIVISION: PLATTED:
22 � C7
PROPERTY ID #: J — % - U60' G0ZONING: A - I/M OR EQUIVALENT: [ Y /�I�i/1
PROPE Y SIZE: "" �� AC SS FTATER SUPPLY: [ PRIVATE PUBLIG-�— ]<=2000GPD [ ]>2000GPD
IS SE R AVAILABLE AS PER.381.0065, FS? [ Y /G DISTANCE TO'SEWER. /VA FT
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PROPER Y ADDRESS : 81 0 S GfY2 LTO IJ r-P Por I S l W tl 9-i F1-- S
DIRECT IS TO PROPERTY:
BUIL
Unit
No
III 1
i
2
3
I
4
INFORMATION
Pe of
tablishment
nq t4
I RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area,Sgft Table 1, Chapter 64E-6, FAC
[ oor/Equip e t Drains [ ] Other (Specify)
SIGNAT (/fj DATE:
DH 4018 08/09 (Obsoletes previous editions which may not be used)
Incorpo ated 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
APPLICATION # AP1342818
PERMIT # 56-SF-1844684-
DOCUMENT #.SE1079965
APPLICANT: Eric Graff
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CONTRACTOR / AGENT: Cherie Howington
(LOT: BLOCK:
SUBDIVI9,pN: ID#: 3229-111-0001-000-0
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TO BE CO LETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR. OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE
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REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS-
PROPERTY SIZE CONFORMS TO SITE PLAN: (%]YES [ ]NO NET USABLE AREA AVAILABLE; 287•87 ACRES
TED SEWAGE FLOW: 400, GALLONS PER DAY [ ET / OTHER -TABLE Z
TOTAL ESTI RESIDENCES=TABL]
(AUTHORIZED SEWAGE FLOW: 431804.99 GALLONS PER DAY IF 1500 GPI/ACREOR 2500 GPD/ACRE
UNOBSTRUCT D AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT'
BENCHMARK/REFERENCE POINT LOCATION: SE Corner Of well pad
ELEVATION PROPOSED SYSTEM SITE 11.00 [ INCHES / FT ] [ ABOVE J BELOW ] BENCHMARK/REFERENCE POINT
ITHE MINI SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE .FOLLOWING FEATURES
ISURFACE WATER: 100 FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO
(WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE': 75 FT NON -POTABLE: FT
BUILDING F 7NDATIONS; 5 FT PROPERTY LINES: 100 FT POTABLE WATER LINES: 5 FT
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BITE SUBJE T TO FREQUENT FLOODING?
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'10 YEAR FLOID ELEVATION FOR SITE:
�.nr7• nnnrTr[.'tTwrrnntuamrnwT cTmt.' 't
[ ]YES IX]NO 10 YEAR FLOODING? [ ]YES IX]NO)
FT [ MSL / NGVD ] 'SITE ELEVATION: _ FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 2
USDA SOIL IIRIES:Pople
Munsell #/Color
sand
Texture
Depth
1 OYR 4/2 11
Sand
0 To 3
1 OYR 5/2 I
_
Sand
3 To 10
REFUSAL III
Hard Rock
10 To 72 _
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BSERVED WA'
(EISTIMATED W1
$IGH WATER
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SOIL TEXTUI
DRAINFIELD I
USDA SOIL SERIES':.Pople
Munsell #/Color
sand
Texture
Depth
1 OYR 4/2
Sand
0 To 4
10YR 5/2
Sand
4 To 2:1
10YR 612
Sand
6 To 21
1 OYR 7/2
Sand
21 To 39
HOLE CAVING
Refusal
39 To 71
TABLE: 3.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / "APPARENT
SEASON WATER TABLE ELEVATION: 6 INCHES I ABOVE / BELOW ] EXISTING GRADE
►BLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [, ]NO DEPTH: 6.00 INCHES
'LOADING RATE FOR SYSTEM. SIZING': Sand/0.60 DEPTH OF EXCAVATION:
FIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY)
DDITIONAL CRITERIA
VSWT determ(,ed using. USDA WSS and soil borings.
0YR6/2 strippi g In 10YR512 matrix.>10% with diffuse boundaries starting at 6" In SB2.
Bb i 11"elow M. SB214" below$M. Hard rock located below the majority of the drainfleld;area:
INCHES
CTE EVALUATEb BY:
DATE: 06/01/2018
Ingram, Brian (Title nv(ronmental Specialist 11) (ENVIRONMENTAL HEALTH)
1 403.5, 08/09'(Obsoletes previous editions whicIr.ay not be used) Incorporated( 64E-6:.001, FAC Page 3 of 4
AP1342818 EID1844684 v 1.0.2