HomeMy WebLinkAboutSUBMITTED PAPPERS8s'3eO-13 ,IaweS A. m rDy i i i
STATE OF FLORIDA irveyc
`DEPARTMENT OF HEALTH AND REHa1BHdTATIVE SERVIC E
Li�lt Pierce, FP da
APPLICATION FOR SEPTIC TANK PERMIT R96211985
`fNft INSPECTION FORM
Authority:
BY Chapter381,fij:36WI1 JE COUNTY
St. Lucie County Chapter loD—s,FWEALTH UNIT
DATE— 3/'b'S Permit Number
osFzo
Name of Appli ant
Mailing Address of Applicant
To Be Install At: (Glw Street Address)• L
Lot No. yR_ Block No. 3 Subdivision L • rat let Book
Size of Lot: 330 r By 12-%n• No. Living Units No. Bedrooms.
Type of Business No. Tollets — No: Wash Basins
Total Square Feet In Bulidinit
'Note: Attach Site Location Map and Other Supportive Documents
E INFORMATION
l; 'r
No. People —
No. Employees
4A
of Applicant
Distance to Sanitary Sewer
Distance to Stream, Lake, Canal /
Distance to Public Water Supply A
��i� %S
Distance to Private Wallisl
Rainfall Data:
Is Area Subject to Flooding J
Does Site have Good Natural Drainage?
Which Way Does Lot Drain ?.Ir3
�
Any Perimeter Ditches? '100T Depth of Ditches
Is there Standing Water In Ditches? .—Aid D pth of Water i Ditches
Distance to Nearest Residence (North4dgl-- East South—West ) Are Buildings
In this Area on: Septic Tanks Sand Flit gr�
` Other
Any Known Dralnfield Failures this Area —Alb a/G
SOIL PROFILE
AND PERCOLATION DATA
se
ar
`Water Table At
Tia�t�Pen At
mchas
Inches
d•J
ii x°
Clay \ At
�A
Inches
=
a
Muck
Inches
1u-
haw
Other Ate!
SollClassifiration:
,
_ =
'� 4
Percolation Rate:
INSTALLATION
SPECIFICATIONS
Septic Tank Capacity:
Drain Tile (Linear Ft.):.
`
Dosing Tank Capacity:
Sand Filter Size: (Sq.FL)
Grease Trap Cipwiry:
Absorbtion Bad Size: (Sq•Ft.)
Perforated Pipe: (Linear Ft.)
Lateral Dreinfieid Size: (Sq.Ft.)
�O
Other Specifications:
RECOMMENDATION:' Approval
LEI
Disapproval
Date Processed
A
!
County Health Department
! HNAL IN51fE(A ION VAIA
Date and Time of Inspection - Type of Tank(Concrate, Fiberglass, Etc.) M..
Size Tank Installed Drainfleld Size No. Tile Feet
Dosing Tank,Size Grease Trap Size Sand Filter Size
Who Made lristallatlon
RECOMMENDATION: Approval Disapproval
HRS—H FORM e015. Aug 78(RsPlaara floe-4=1 Signature of Sanitarian
SEPTIC'TANK CONSTRUCTION PERMIT '
1111Instolktllon must bo In accurd with •cquhements of Clupler
100•6, Florida Adminlstrgtlyu toile.
(b) Final mspeclion requlrw. t helwn work Is covered.
(c) Permit void If nbl usrd minin one year.
(d) Approved InsWllatlon duos not guaranla performance.
' (e) Other
f . &&a rn I—Qf'� t1�w�fA �•��
. _' • .. E'S-Sao
SOIL PROFILE AND PERCOLATION DATA
PERC HOLE fl
WATER TABLE @INCHES
HARD PAN @ — INCHES
CLAY @ — INCHES
MUCK @ _ INCHES
OTHER @ INCHES
SOIL CLASSIFICATION`CSP
PERCOLATION RATE /, O
PERC HOLE f2
g.6 �eri„
WATER TABLE @ SO.q INCHES
4-7 Mau
HARD PAN @ — INCHES
CLAY @ INCHES
MUCK @ , INCHES
OTHER @ — INCHES
_
SOIL CLASSIFICATION7:-Sy
PERCOLATION RATE /. D
PERC HOLE f3
WATER TABLE @_INCHES
-
HARD PAN @ — INCHES
CLAY @ =INCHES
MUCK @ INCHES
OTHER @ INCHES
SOIL CLASSIFICATION �SP
PERCOLATION -RATE A
- JAdES A. KIRBY@ III'
REGISTERED LAND SURVEYOR 02391 .
1919 ORANGE AVENUE
FORT PIERCE, FL 33450
464-9621
� 1
I � I
i
i . 1 40
1
r i �Ui i
i
j
NOTICE: OWNER/BUILDERS
OWNER/BUILDERS OF ONE OR TWO-FAMILY UNIT DWELLINGS, OR COMMER-
CIAL BUILDINGS UNDER $25,000.00 IN VALUE, ARE EXEMPT FROM THE
REGULATIONS AS SET FORTH IN FLORIDA STATUTES 489 WHEN BUILDING
FOR THEIR OWN USE AND OCCUPANCY ONLY.
THE SALE OR LEASE, OR OFFERING FOR SALE OR LEASE, OF SAID
STRUCTURE IS A CRIMINAL VIOLATION PUNISHABLE AS A MISDEMEANOR
OF THE SECOND DEGREE.
IN ADDITION, IF THE OWNER/BUILDER DOES SELL OR LEASE THE DWELL-
ING, HE MAY SUBJECT HIMSELF TO A CIVIL LAW SUIT.
I HEREBY ACKNOWLEDGE THAT I HAVE READ AND U DERSTAND THE ABOVE
NOTICE ON THE _2 8 DAY OF , 19 :05-
OWNER/BUILDER
OOZ ? 1C) (40
ARCHITECTS AND/OR ENGINEERS AFFIDAVIT
Southern Standard Building Code as adopted by the St. Lucie County Board
of County Commissioners - Section 105.6E
The plans submitted for Mr. Kim Bessemer, Tilton Road, St. Lucie County, FL.,
conform to the requirements of this Code as to strength, stresses, strains,
load and stability.
I further agree to submit to the Building Official on the completion of
the structure, a certification that the structure has been erected in
accordance with the requirements of this Code.
Wayne U. Sines, Jr.
Professional Engineer 1i178
l
C)
LO
-__
1•:i
:JU
L)
-
J
�
_
C