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685 NE 93 St (3)APPLICANT AGENT PROPERTY ADDRESS: S / r ' l 3 LOT: 1 BLOCK E: 5 SUBDIVISIONi. .r CHECKED [X] ITEMS ARE NOT IN COMPLIANCF. WITH STATUTE OR RULE AND MUST BE CORRECTED. CONSTRUCTIO STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPO CONSTRUCTION INSPECTION AND FINA TANK INSTALLATION [01] TANK SIZE [1] [2] [02] TANK MATERIALC3� --u�' [03] OUTLET DEVICE [04] MULTI - CHAMBERED [Y /f] [05] OUTLET FILTER .?/' Jr [06] LEGEND [07] WATERTIGHT_ [08] LEVEL A/ f-4 [09] DEPTH TO LID //j '/ DRAINFIELD INSTALLATION [10] AREA [1]/1 X2S' [2] (5 SOFT [11] DISTRIBUTION BOX HEADER" [12] NUMBER OF DRAINLINES [13] DRAINLINE SEPARATION ,3‘ [14] DRAINLINE SLOPE [15] DEPTH OF COVER /8' ' ' [16] ELEVATION [ABOttet8ELZ7W�BM / • �! [17] SYSTEM LOCATION_ [18] DOSING PUMPS [19] AGGREGATE SIZE S° a [20] AGGREGATE EXCESSIVE FINES [21] AGGREGATE DEPTH / , FILL / EXCAVATION MATERIAL [22] FILL AMOUNT /.' [23] FILL TEXTURE [24] EXCAVATION DEPTH [25] AREA REPLACED [26] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS / REMARKS: 'Page 2), 10/97 (Previous Editions May Be Used) her: 5744- 002- 4016 -4 :o6 - 1205 e TEM VAL � 7 /DISAPPROVED1 A k' r) C FINAL SYSTEM LAPPROVED /DIS PPROVED]: ' �- PERMIT NO.0 1 y - DATE PAID FEE PAID - RECEIPT #- PROPERTY ID #: SETBACKS [27] SURFACE WATER N / 4- FT [28] DITCHES FT [29] PRIVATE WELLS / FT [30] PUBLIC WELLS FT [31] IRRIGATION WELLS 'V /4 FT [32] POTABLE WATER LINES Z i' FT [33] BUILDING FOUNDATION 5 FT [34] PROPERTY LINES / t. FT [35] OTHER FT FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION [40] [41] [42] [43] [44] [45] [46] [47] [48] FINAL SITE GRAD CONTRACTOR OTHER PT 1: Appticanl PT 2: Installer /Contractor PT 3: Building Department PT 4: Health Department 1 ADDITIONAL INFORMATION UNOBSTRUCTED AREA STORMWATER RUNOFF ALARMS MAINTENANCE AGREEMENT BUILDING AREA LOCATION CONFORMS WITH SITE PLAN ABANDONMENT [ [49] TANK PUMPED '� /� q/ [50] TANK CRUSHED & FILLED_/ CHD DATE 5 - /h ^ G' CHD DATE: _ ` - Page 2 of 3