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1050 NE 91 Terr (3)ROPERTY ID #: PPLICANT: GENT: L Y 1Ca �Ce.l 1 o s z - �-e c �e nC A- . ( C OT:2 1 _ ‘I BLOCK: N�Fa 0 BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST ROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ROPERTY SIZE CONFORMS TO SITE PLAN: t-54 YES [ ] NO NET USABLE AREA AVAILABLE: 0./g ACRES 3TAL ESTIMATED SEWAGE FLOW: ?c )C) GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] JTHORIZED SEWAGE FLOW: 1j 7 3 GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] VOBSTRUCTED AREA AVAILABLE: 5 ( SQFT UNOBSTRUCTED AREA REQUIRED: 6 G0 SQFT 19 I / LEVATION OF PROPOSED SYSTEM SITE IS '3 (5 [INCHES /FT] [ABOVE ENCHMARK /REFERENCE POINT LOCATION: 3E MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE JRFACE WATER: A iI) FT DITCHES /SWALES: _ ELLS: PUBLIC: _ FT LIMITED USE: -- FT JILDING FOUNDATIONS: _S FT PROPERTY LINES: )IL PROFILE INFORMATION SITE 1 4unsell # /Color Texture N JSDA SOIL SERIES: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS :TE EVALUATED BY:,/ Depth to___ to to _to to to to to [ ] YES 1 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3] which may be used) :ock Numhar 57dd_flfi'3_df115_11 Oc ° NO )IL TEXTURE /LOADING RATE FOR SYSTEM SIZING: tAINFIELD CONFIGURATION: [ ] TRENCH [�} BED :MARKS /ADDITIONAL CRITERIA: /9-l! PERMIT 1 SUBDIVISION: {.-)��er` E e [Section/Township/Range/Pa il e1 No. or Tax ID N ar / umber] o+ , � - ELO FERENCE POINT PROPOSED SYSTEM TO THE FOLLOWING FEATURES: FT NORMALLY WET? � YES [ J NO RIVATE: -- FT NON- POTAL -- FT NON - POTABLE: FT FT POTABLE WATER LINES: /0 FT (TE SUBJECT TO FREQUENT FLOODING: [ ] YES [7} NO 10 YEAR FLOODING? [ ] YES /N NO ) YEAR FLOOD ELEVATION FOR SITE: - FT MSL /NGVD SITE ELEVATION: /ID I FT MSL/NGVD SOIL PROFILE INFORMATION SITE 2 Mu sell # /Color Texture Depth YQ� , 444tisfr lZ o 7� / l to to to USDA SOIL SERIES: to. t o to t o :SERVED WATER TABLE: 4 ( INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] >TIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE. :GH WATER TABLE VEGETATION: MOTTLING: [ ] YES pi-NO DEPTH: DEPTH OF EXCAVATION: INCHES ] OTHER (SPECK) -� � /V ffk1/772 f .'c INCHES DATE: // Page;3 of 3 lotes: ;ite Plan Submitted by 'Ian Approved STATE OF FLORIDA 'DEPARTMENT OF HEALTIcl AND fibiti(BligoiTATIVESERVIF, APPLICATION FOR ONSITE SEWA SYSTEM CONSTRUCTION PERMIT Permit Application Number ( Iir PART II - SITE PLAN-•-- r ■ anwo multam■/■ // /m.ilmammu / ommo ■minim / / / //1//■ ornolimmoimm■■ ommi ■■ % _ `� ■ . . ■... ..■...■■........■■.■ 1■......■■■....■■...■.►.. ■ ■■.. ■...�... ■...■ • ■ ......... ■. ■■ .• •U,/.0 ■. ...u..... ■■■.■■■.■■■■■■■■■ ■■...■■■....■.. ■■■....■..... ■■r grin ■...■■..■11....■ ■....7.. ■ ■■■■■ ■.■.■■■ ■.. u. ■■■■..■■■..■■■.■■■ ■ ■.....■u ...i.. ■■�A . ■■ ■■... ■■ ■■.■■■.■■■■■. ■UUU,UIUI ..0 ■.U. ....U,......■ .■. ■...■■■■......■..... ■./.......■■... ...... o ..... .................iM........M... ........i+ ■..■ ■.■■■....■■■■■..■■■■■■.■■■■.■■■■■....■■■■. 5.■■■ 7..■ ■.. ■ ■ ■..;..■ ■...■ ■...;.■ ■■ ■.■ ■■ .. ■...■ ■ ■.■ . .. .■.■...■■■■■■■■■.■■.■■■■.■■■.■■...■.■..►■..■■■.■.■■........■ _.R ■.....■ ■ ■. ■..... ■ ■■.... .. ■ .. ■■ ■.■.■. 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R..■■■.■■■;.. ■..■/...■■ ■ ■.. ■ ■ ■. ■/ ■■■R. ■/lAs .7Nt■ ■'..■■./1nomma..7/ ■. ■ ■ma .111ir•r�. .A ,M u1 AAA AU ■A7P.u....:._./7u..■ ■1■.■■d�7 POOR: INAMI;�AMMOA.asa, s:.....WAA,MAAr ./_ /1�aWO • M__ UA WM o i Not Approved Date / / ^16F T� County Public Unit r�•Uq— vy.....�y rya- .'^r.'ISa1TC ^ ...'- n �.. rVwv+.fl t' ii .,r w. ... .. ��. �.•.. -t.a rte... -.. �� +�• -_-.. '�...+......+nT • APPLICATION FOR: NI New System [NI] Repair APPLICANT: V n !� \ ( F � \ n L � - � --Z - C (P f D3 AGENT: MAILING ADDRESS: V• 1, TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIEED'AGENT. ATTACH BUILDING /PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT. 1. -J �BLOCK: SUBDIVISION: PROPERTY ID , #:t PROPERTY SIZE:- k) ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [(.] PUBLIC PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit No 1 2 3 4 [t8] (N fJ Type of Establishment 4._.)1; . `t _ !! STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC [N ] Existing System [N] Abandonment [N] Other(Specify) Garbage Grinders /Disposals Ultra -low Volume Flush Toilets //lA APPLICANT'S SIGNATURE: t '7 `o c3') l l O te 9 ( pc \ rtT o V )) (-) [X] RESIDENTIAL No. of Building Bedrooms Area Sqft [ N ] Holding Tank [N [ ] COMMERCIAL PERMIT # DATE PAID FEE PAID $ RECEIPT # J • U d (9 7 * (-15' Temporary /Experimental TELEPHONE: LA `_ 1 n ID i *310 R". LDucr ECV- [ Section /Township /Range P*rcel No.] ZONING: DATE OF SUBDIVISION: 1jJ # Persons Business Activity Served For Commercial Only (NI Spas /Hot Tubs [N] Floor /Equipment Drains [W] Other (Specify) DATE: t \- \9 -D . Dana 1 of 1 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CON J STRUCTION PERMIT F.OR: New System [01/ Existing System olding Tank i'4 Temporary /Experimental [u ] Repair Abandonment j/l/Other(Specify) APPLICANT: / y 1 f} IGZ c 6 3 L()Pe7 �Fh(� � �� I �C� r- ] PROPERTY STREET ADDRESS: A / /z_ /a .sue A✓� q / 1 LOT:' VV BLOCK: �- SUBDIVISION: ` ' , r' 1 G- C.�J ,__c PROPERTY ID #: SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -6, F REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMI EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HAS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTOR PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SU MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIGN AND SPE IkICATIONS T ,(2o U ] 1G GP SEPTIC TANI ROBIC UN A [ ] [GALLONS / GPD) N [ ] GALLONS GREASE INTERCEPTOR CAPACITY K [ ] GALLONS PER DOSE DOSING TANK CAPACITY L SQUARE FEET PRIMARY DRAINFIELD SYST D R [ [ A TYPE SYSTEM: I CONFIGURATION: F LOCATION OF BENCHMARK: V:5.77 3.7 F'. : /Od1- Q ( €43.4 c I ELEVATION OF PROPOSED SYSTEM SITE [3C. ] [INCHES /FT] [ABOV ENCE-POZ E BOTTOM OF DRAINFIELD TO BE [ /'+ INCHES /FT] [ABO BENCHMA REFERENCE SYSTEM [ ] STANDARD [ ] FILLED [ ] MOUND [ ] TRENCH [j BED [ ] D FILL REQUIRED: [ - --)- INCNE, EXCAVATION REQUIRED: 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED> /_ HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Numb r: 5744 -001- 4016 -01 PERMIT # O �j / DATE PAID 1/- / 8 — 7 FEE PAID $ RECEIPT # [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] TITLE: FTC MULTI- CHAMBERED /IN SERIES:[ CAPACi MULTI- CHAMBERED /IN SERIES:[ [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLON DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ INCHES TITLE: J EXPIRATION DATE:2_ Page 1 of