801 NE 97 St (6)CONSTRUCTION PERMIT FOR:
[ -]New System [;'] Existing System [! -f Holding Tank [% ] Temporary /Experimental
[",,] Repair [ ] Abandonment [ /T %Other(Specify)
APPLICANT:
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID #:
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF C:EiAPTER 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. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICi SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY TEE PERMIT A ?PLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIGN AND SPECIFICATIONS
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK: SUBDIVISION:
AGENT:
T [ ]•[GALLONS /, GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBE:lED /IN SERIES:[ ]
A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBE:2ED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ <'] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK:
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
] (INCHES /FT] [ABOVE /BELOW] BENCHMARKL /REFERENCE POINT
] (INCHES /FT] [ABOVE /BELOW] BENCHMARX/REFERENCE POINT
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 'J INCHES
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
3
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
TITLE: CPHU
EXPIRATION DATE:
Page 1 of 2
APPLICANT: A
STATE OF FLORIDA PERMIT 1
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM .
SITE EVALUATION AND SYSTEM S ECI CAT ONS
AGENT zi '''p 1 /�
r H "/ i4 Kes? ✓4' jt:o
al4 14. re .
LOT: 13 BLOCK:
PROPERTY ID #:
7-3
/I - 3o6 - ® /Y- a se °.
PROPERTY SIZE CONFORMS TO SITE PLAN: [ ]
TOTAL ESTIMATED SEWAGE FLOW: a o O
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE: .100
BENCHMARK /REFERENCE POINT LOCATION: 1/.
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color
1 •
USDA SOIL SERIES:
Texture Depth
.9AJ c7. to
to
to
to
to
to
to
to
SITE EVALUATED BY ! 44 i N+ ,,
SUBDIVISION:
04 ►A. J/lorP
" / !.• - f f o o dr(
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 003 - 4015 -1)
SOIL PROFILE INFORMATION SITE 2
of‘a6 76
(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.
YES (7J NO NET USABLE AREA AVAILABLE: ACRES
GALLONS PER DAY (RESIDENCES -TABLE 1 / OTHER-TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: 5 SQFT
ter__
ELEVATION OF PROPOSED SYSTEM SITE IS CH /FTJ (ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: ;)77 FT DITCHES /SWALES: ,J /h- FT NORMALLY WET? ( ] YES [e] NO
WELLS: PUBLIC: 4 FT LIMITED USE: DIA, FT PRIVATE: A)11- FT NON - POTABLE* ,diet. FT
BUILDING FOUNDATIONS: 75. FT PROPERTY LINES: ?S. FT POTABLE WATER LINES: ;P/O FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES ( ] NO 10 YEAR FLOODING? [ ] YES [ ] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD. SITE ELEVATION: / P ^ #,FT MSL /NGVD
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
0 to
to
to
to
to
to
to
to •
to_2A__
OBSERVED WATER TABLE: 7, HES /[ABOVE / �� XISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
i
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION:� INCHES
DRAINFIELD CONFIGURATION: ( ] TRENCH [ ''J BED [ ] OTHER (SPECIFY)
`r REMARKS /ADDITIONAL CRITERIA: J n .7 1 JMssfa) s'y17�2i
DATE: -5=3-99
Page 3 of 3
APPLICATION FOR:
[A/1 New System
[y Repair
APPLICANT:
AGENT:
MAILING ADDRESS:
/al !4Oie14
i
p-i p Pe rPoe
LOT: 1:5 BLOCK:
PROPERTY ID #:
/ /- - aster.
PROPERTY SIZE: D 1a ACRES [Sqft/43560]
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY: X /7
2
3
4
BUILDING INFORMATION
Unit Type of
No Establishment
1 KQS10J 1 41
APPLICANT'S SIGNATURE:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
([ [A.] Abandonment [/V] Other(Specify)
Existing System
Z4-r ,
lab 9 Al, w. 7k
, - (L3- Gv
[/'� Garbage Grinders /Disposals
[ ] Ultra -low Volume Flush Toilets
A4 e
/l it
73
SUBDIVISION:
go) N, P. 97 V.
] RESIDENTIAL
No. of
Bedrooms
/
Holding Tank
33/ (
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED 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]
HRS-H Form 4015, Mar 92 (Obsotetes previous editions which may not be used)
(Stock Number: 5744- 001-4015-1)
DATE OF 9s y
1 o • S'�D�p SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
PROPERTY WATER SUPPLY: [
j °op
9s
Spas /Hot Tubs
[ ] COMMERCIAL
Building # Persons Business Activity
Area Sqft Served For Commercial Only
] Other (Specify)
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
Temporary /Experimental
TELEPHONE: 7 y, 61 y o,
] PRIVATE [. ) PUBLIC
[Floor /Equipment Drains
DATE:
Page l of 3 1