810 NE 95 St (10)Installer
Other findings'
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Applicant Permit Number �� it 7r
P II STEM INSTALLATION INSPECTION AND FINAL. ENSTAtLLATI APPROVAL
Tanks watertight: Yes
Proper tank legend: Yes ApP No
No
Proper tank outlet device: Yes/ –" No Manhole or marker to grade: Yes No
Dralnfi ®Id Trench Absorption Bed
lath Width Length width Length,, 9 feet x/0 feet = ' ft
feet feet II feet feet Length feetx feet= ft
9 a
feet feet �/ ��� feet feet Proper No. drainlines: Yes No
feet feet feet feet Proper pipe separation: Yes No
Total = ft Total = ft Distribution box level: Yes No
Systems located as permitted: Yes a' No
Systems including plumbing stub -outs installed at proper elevation: Yes No
Average depth to drainpipe invert from finished grade: inches Maximum depth -2Y Inches
Average depth of drainfield gravel: inches Minimum depth of gravel _1Z inches
Proper gravel size: Yes No
Sackfill or fill material as required: (Quality) Yes / No (Quantity) Yes No
Inspected by .rte i�, .i' Date
�' PART III - FINAL NSTALLATION APPROVAL
Date- "2 ,7 r 'e Approved by:
AN APPROVED INSTALLATION DOES NOT G ARA EE PERFORMANCE
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used)
(Stock Number: 5744-002-4016-4)
Tank Manufacturer 4
Tank material Tank evel: Yes No
Tank size gallons — gallons `� gallons
Gravel is suitable quality: Yes ° No
OUNTY PUBLIC HEALTH UNIT
Page 2 of 2