HomeMy WebLinkAboutD O H ONSITE SEWAGE TREATMENT AND DISPOSAL CONSTRUCTION PERMITI
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9i STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
'"` APPLICATION FOR CONSTRUCTION PERMIT
[•;] New System
[ ] Repair
APPLICANT:
[ ] Existing System
[ ] Abandonment
PERMIT N0.5-6 S!C- 12576go
DATE PAID:
FEE PAID: 06 jo
RECEIPT #:
[ ] 'Holding Tank [ ] Innovative
[ ] Temporary [ ]
AGENT: L O/� t T G TELEPHONE:
MAILING ADDRESS: `jO0 Y/[/,D/%0 JLdlj! SCANNE®
- -�� vvL11ILY
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY Al PERSON LICENSED
PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPL'ICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
I
PROPERTY INFORMATION
•
LOT:
BLOCK:
SUBDIVISION: PLATTED:
l v�
PROP RTY ID #: 9}% ..Q
)
0 1 O - 66 0 1 ZONING: {f I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE:. /
T'—
CRES WATER SUPPLY: [ xII] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
es
IS SEWER AVAILABLE AS
PER 381.0065, FS? [ Y /�] DISTANCE TO SEWER: FT
PROPERTY ADDRESS:
DIREICTIONS TO PROPERTY:
116A& c eA--elgr
1-7
P
Q�
BUILDING INFORMATION
[�»] RESIDENTIAL [ ] COMMERCIAL ' /
Unit Type of
No. of Building Commercial/Institutional System Design
No Establishment
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
1 S/A4 Id I�AiA( 3
• 2
3
41
[ ] Floor/Equ712!
/'ns [ ] Other (Specify)
SIGNATURE:DATE:
I
DH 4015, 08/09-(Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
I
7 9
STATE OF FLORIDA APPLICATION # AP1363696
DEPARTMENT OF HEALTH PERMIT # 56-SF-1876402
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
•,V �o vim. .
SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1116473
APPLICANT: Darren Reed
CONTRACTOR / AGENT: Dave Golden Homes _
LOT: I BLOCK:
SUBDIVISION: ID# : 1407-313-0020-000-9
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE
REGISTRATION NUMBER AND 'SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: EX ]YES [ ]NO NET USABLE AREA AVAILABLE: 1.04 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 1559.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED'AREA REQUIRED: 563.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: 16d nail in PP W of system. 35" above nail in Rd, S property line extended W.
OF PROPOSED SYSTEM SITE 38.00 [ Ei
/ FT ] [ ABOVE / BELO]] BENCHMARK/REFERENCE POINT
THE MINIMOM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:- FT DITCHES/SWALES: • 86 FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 50 FT POTABLE WATER LINES: 75 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES EX ]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
RnTT. 1PRn7 T.F. TNFARMATTAN CTTF. 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:Lawnwood sand
Munsell #/Color Texture
Depth
10YR 4/1
Sand
0 To 14
1 OYR 5/1
Sand
14 To 17
10YR 5/2
Sand
17 To 25
10YR 6/1
Fine Sand
25 To 33
1 OYR 3/3
Fine Sand
33 To 40
10YR 7/1
Sand
40 To 44
1 OYR 2/1
Spodic Material
44 To 50
7.5YR 4/4
Sand
50 To 72
USDA SOIL SERIES:Lawnwood sand
Munsell #/Color Texture-
Depth
1 OYR 4/1
Sand
0 To 16
1 OYR 5/1
Sand
16 To 33
10YR 6/1
Sand
25 To 35
10YR 3/4
Sand
35. To 44
10YR 7/1
Sand
44 To 52
1 OYR 2/1
Spodic Material
52 To 61
7.5YR 4/3
Sand
61 To 72
OBSERVED WATER TABLE: 66.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 25 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 25.00 INCHES
SOIL TEXT LOADING RATE FOR SYSTEM SIZING: Fine Sand/0.80 DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings.
10YR6/1 stripbing in 10YR5/2 matrix >10% with diffuse boundaries starting at 25" in SB1.
SB1 and SB2I38" below SM.
SITE EVALUATED BY: DATE: 09/25/2018
Ingram, Brian : Environmental Specialist II) (ENVIRONMENTAL HEALTH)
DR 4015, 08/09 (obsoletes previous editions which may not be used) - Incorporated: 64E-6.001, FAC Page: 3 of 4
AP1363696 EID1876402 v 1.0.2