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639 NE 97 St (6)CONSTRUCTION PERMIT FO [ 09 New System [ �] [ • /Repair APPLICANT: PROPERTY STREET ADDRESS: 6 LOT: 07 /� 0 BLOCK: c SUBDIVISION: 1� PROPERTY ID #: ado 0 . 7 O 6 g 0 T H E R SPECIFICATIONS BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT • Authority: Chapter 381, FS & 7 ELEVATION. OF PROPOSED SYSTEM SITS [ 0.0 [ I BOTTOM OF DRAINFIELD TO BE [ > 6% [I FILL REQUIRED: [ Gam' f]l INCHES - -D Existing System Abandonment • Chapter 10D -6, FAC Applicant • r Holding Tank ' Temporary /Experimental Other(Specify) AGENT: i j PERMIT # 0g DATE PAID 3-00- FEE PAID $ • �/ a ` RECEIPT #%S CJO 3 p ■ ( 6) 0 4 riLdi 00 [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX_ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY 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. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. SYSTEM DESIG oS ECU AIONS T [ ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ] [GALLONS / GPD) CAPACITY MULTI- CHAMBERED /IN SERIES:( ) N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE KATE [ ] PER 24 HRS NO. OF PUMPS: [ ] O D D [ SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 1 SQUARE FEET SYSTEM Ai A TYPE SYSTEM: [ ] STANDARD [ FILLED • [Mt MOUND I CONFIGURATION: [ CA TRENCH [ %] BED [ N y v F LOCATION OF BENCHMARK: U ll M P C=�� II U � ( k 0 . I f_ %FT] [ABOVE /B BENCHMARK /REFERENCE POINT E CH S /FT] [ABOVE /BO BENCHMARK /REFERENCE POINT Gi 747 07 P C llpr m MUM] M] c7 OR16ginF aflj) 1MAITg l L V 1EN LoU Ref MEM dCMGEO Wen THE TITLE: PvA;JlrU` U ,Nnt v2: DED EMPE3 MEMO [ 4 .EXCAVATION REQUIRED: [ 2- ] INCHES QMIL OCR [1,©no? © gE V� APPROVED BY: ° TITLE: „i EXPIRATION DATE: 6 DH 4016,10/96 (Replaces HRS -H Form 4016 [page 11 which may be used) ;; . R8TALLIED CM ME ©M V TIP Page 1 of 2 (Stock Number: 5744- 001- 4016 -0) CHD INSTRUCTIONS: Pr.'. 1 ♦ t. . . PERMIT NUMBER: Permit tracking number by Coun'tyybiealth Department, • APPLICATION FOR: Check type of permit; if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. a- EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. APPLICANT: SOIL PROFILE INFORMATION SITE 1 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS / �� ' J U/4A1 /� LOT: /Q. L, 3 7 - 7 kOCK: /0 SUBDIVISION: m/404/ �� /O �� // / .- w D PROPERTY SIZE CONFORMS TO SITE PLAN: TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: (p, ELEVATION OF PROPOSED SYSTEM SITE IS SITE SUBJECT TO FREQUENT FLOODING: [ ] YES 10 YEAR FLOOD ELEVATION FOR SITE: e /W 30 Texture Depth SITE EVALUATED BY: DH 4015, 10/96 (Replaces HRS -H Form 4015 (Page 3) whicit may ; e used) (Stock Number: 5744- 003 - 4015 -1) NO FT MSL /NGVD AGENT: pl [ ] NO NET USABLE AREA AVAILABLE: GALLONS PER DAY [RESIDENCES -TABLE 1 GALLONS PER DAY [1500 GPD /ACRE OR SQFT UNOBSTRUCTED AREA REQUIRED: PROPERTY ID #: /1' , ' / q _/ C [ Section /Township /Range /Parcel No. or Tax ID Number] TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. BENCHMARK /REFERENCE POINT LOCATION-:'' r/ ) g lC%rj FL ,w/ 7 / 'INCHES T] [ABOV J o,C /LC= LE /CUTE- /4) — k' yA 2p SOIL PROFILE INFORMATION SITE 2 o 'V ACRES OTHER -TABLE 2] 0 di � P14 SQFT ENCHMARK /REFERENCE POINT THE MINIMUM SETBACK CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING - FEATURES: SURFACE WATER: /U41 FT DITCHES /SWALES: A/Al FT NORMALLY WET? [ ] YES [1 WELLS: PUBLIC: AM FT LIMITED USE: d ol FT PRIVATE: iol FT NON- POTABLE: FT BUILDING � FT PROPERTY LINES: S '�. FT POTABLE WATER LINES: FT N 10 YEAR FLOODING? [ ) YES [/f SITE ELEVATION: 0 • T'6 / FT MSL /NGVD Munsell # /Color Texture Depth /. t 7t, Oft to pL C . 7 /,e to '' I n ` R /2- ,- S/gA/D /o // to 612/1l 5X1Aj7) to 5o // &P/=1 •/ 'v/L J /v/) J /to 1 /1 /1 to /1 /I 11 to /1 /1 /1 - to i1 // // to USDA SOIL SERIES: (JP tM/t/,LJ4,t.1,9 OBSERVED WATER TABLE: AIR INCHES [ABOVE / B LOW] EXI ING GRADE. TYPE. PERCHED / APPARENT] 7 0 . ESTIMATED WET SEASON WATER TABLE ELEVATION: 3 (INCHES [ ABOVE BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: r] YES [WNO MOTTLI INCHES l ] YES [J'3 NO DEPTH: 4�4 INCHES /' D DEPTH OF EXCAVATION: 4{2 INCHES SOIL TEXTURE /LOOYNG RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [y] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: DATE: Page 3 of 3 INSTRUCTIONS: PERMIT NUMBER: APPLICANT: AGENT. LOT. BLOCK, SUBDIVISION: PROPERTY 1L) NUMBER: PROPER1Y SIZE: S1:WAGk i I,:)P. UNO11 I Ri;CTF1) AREA: :vi!NlMtYM SET'-IAC't(S' 5011. PROFILE INFORMATION - FvATER TAM t {: .? EVr (SHEEP 7L.EVATION! BENCHMARK i S:0.) T 1I.I. Permit tracking number I:y County Health Department Property owner's lull name. Property owner': O'i'Ily autl.arized representative Lot. block. and :,e 1v1Sin;. for lot. 27 character number for property (property appraiser ID numhcr or section /township /range /parcel number). Check if property :it ;in. cn :fo rns to submitted she plan. Record net usable arca available - lot area exclusive of all paved areas and :ucpared rn.,d beds within public rights-of-way or easements and exclusive of streaonr, lakes. normuily wct dr.:iriat.,e uitt :h! s, marshes, or other such bodies of ;Eater. Record the estimated sesr::.. ?'.ow for the establishment from .able 1 (residence) or Table 2 (non- resi;iential), Chapter 10D -6. F. • teem d th.: authorized . ;ewage tlos for the lot based on net usable area and water supply ( 1500 gallons per day per acre for private water supplies and 2500 bpd per acre for public water supplies). If autht.: rrcd sew: L... 1luw dues not equal or exceed the estimated sewage flow. the application must be denied. Record the Square ;'. :ci .,r etohs ;ruc.ed area available and the amount required. Unobstructed area must he at it 2 times as ling,: Es. the absorpt.tsn arc : and at least 7j percent of the unobstructed ar.)a must Meet Milli/MOO setbacks in 0 ha,rter ' OI) -b, i'AC:. - .the unobstructed area must be contiguous to the drainficld. BENCIIMAR{: INFORMATION: R: cord the locatic n of the I.cucl :mark. If using a .u:vevor's benchmark record the actual elevation. ;record the elevation of the y. O'..osr.d system site in relation labove or below) to the benchmark. Record minimum setbacks s.hich can be meet to all listed features Actual measurements must be recorded or "NA" for nonapplicahle fca_ i.:s Features on sit. plan or with 75 feet of the applicant lot must be measured. the location of err; public Orin:di . well within 2.00 fact of the applicant's lot must also he verified. 1 INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site c!cva:ion Two soil profile, within the pmpused absorption ar.a to a minimum depth of b feet or refusal are required. Soil identification v.ill use IIS!; v Soil Classification methodology (Slinscll colors and USDA soil textures). Refusals must be clearly c!nenmenred. Provide 1JSDA sod series if ailahle, record "LINK" i1 she series cannot be determined. Record the d.pih of the r.o :creed water table at the time of the evaluation. Mark "perched" or "apparent as appropriate Record the estimated wet season water table elevation based 00 site evaluation, USA soil maps, and his ;orical irforrnat no_ Indicate if there is htin water !able 'vegetation present. Indicate if mottling is present sod depth SUl1. 'il;A ht`R[ Record soil text.::^, or ln. :dine, rote for system si, ing. DEPTH U;' E .CAVATlON. If applicable record depth :1 c .cavation requir :.d. Record ",NA` if not applicable. i)RAINFILI.t) CONFIGURATION: Check dr.infct.: :o li. -�� :.. :ir..t acquired Ifntitei. specify type. ADD! fit)NA,.'. CRITERIA: SITE. 11:1) ICY Record any r ul: ; :cr ErEs ne *tr.ent. to site er it :: allat,or f dosing required. Signature of cynluatcr. ".i Ir. nd date of evaluation Pro cssi+in engineers must seal all documents sai t'i,`2.tt � 'OINT I. sT: Scale: Each block represents 10 feet and 1 inch = 40 feet. Notes: HD IL1C ►i. LOkip rni11 t ,5 oRE CL 33/3e Site Plan submitted by: ( I � / . ��� �C-7� aoczc 7 T aA)-iptege TOR. Not Approved Date „ - / S ',/. Plan Approved By STATE OF FLORIDA - DEPARTMENT OF HEALTH APPLIC \TION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 00 � - OR ALL CHANGES MUST BE APPROVED`BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form) 15 which may be used) (Stock Number: 5744 -002 - 4015 -6) PART II - SITEPLAN County Health Department Page 2 of 4