HD_Permit_Burlwood.pdf

PERMIT # : 57- SG- 2967269

STATE OF FLORIDA

DEPARTMENT OF HEALTH DATE PAID:

ONSITE SEWAGE TREATMENT AND DISPOSAL pgg p

SYSTEM

RECEIPT # :

DOCUMENT # : PR2139269

CONSTRUCTION PERMIT FOR: OSTDS Repair

APPLICANT : Rebekah Spivey

PROPERTY ADDRESS : 2721 Burlwood Dr Milton, FL 32583

LOT: 2 BLOCK: B SUBDIVISION: BurlOaks

[ SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]

PROPERTY ID # : 02- 1S- 28- 0448- 00B00- 0020

[ OR TAX ID NUMBER]

SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION

381.0065, F.S., AND CHAPTER 64E- 6, F.A.C. DEPARTMENT 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.

ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.

SYSTEM DESIGN AND SPECIFICATIONS

T [ 1,050 ] GALLONS / GPD Existina SeDtic Tank CAPACITY

A [ O ] GALLONS / GPD CAPACITY

N [ O ] GALLONS GREASE INTERCEPTOR CAPACITY [ MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]

K [ ] GALLONS DOSING TANK CAPACITY [ ] GALLONS @ [ ] DOSES PER 24 HRS # Pumps [ ]

D [ 462 ] SQUARE FEET Drainfield SYSTEM

R [ 0 ] SQUARE FEET SYSTEM

A TYPE SYSTEM: [ ] STANDARD [ x] FILLED [ ] MOUND [ ]

I CONFIGURATION: [ X] TRENCH [ ] BED [ ]

N

F LOCATION OF BENCHMARK: Nail with metal cap and orange tape in 4 x 4 of privacy fence

I ELEVATION OF PROPOSED SYSTEM SITE [ 24.00 ] [ | INCHES FT ] [ ABOVE BELOWbBENCHMARK/ REFERENCE POINT

E BOTTOM OF DRAINFIELD TO BE [ 26.00 ) [ INCHES FT ] [ A3OVE BELOWhBENCHMARK/ REFERENCE POINT

D FILL REQUIRED: [ i6.00] INCHES EXCAVATION REQUIRED: [ 0.00 ] INCHES

The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow Of O 300 gpd. Repair the existing certified 1050 gallon septic tank system by the installation Of 462 sq. ft. Of new drainfield.

T Maintain all setbacks in accordance with FAC 62- 6. Above must be completed prior to Final Inspe ction & Approval. A

H re- inspection fee will be charged for additional inspections. Mound system specifications due to slope. Additional fill will be required due to slope. Sod stabilization highly recommended. Remove O horizon prior to installation of drainfield. RemOve E and properly dispose of existing drainfield and spoils encountered during repair.

R

SPECIFICATIONS BY: Charles F Oker TITLE:

Private Site Evaluator

APPROVED BY: L- n cy TITLE: Environmental Supervisor II Santa ROsa CHD Dana L Grissom

DATE ISSUED: 08/ 09/ 2024 EXPIRATION DATE : 11/ 07/ 2024

DEP 4015, 06- 21- 2022 (Obsoletes previous editions which may not be used)

Incorporated 62- 6.004, FAC Page 1 of 3 v 1 .1. 4 m118520 s2204960

PEEIMIT NO. ) / / > 2.

STATE OF FIoRIDA DATE PAID:

DEPARTMENT OF ENVIROledENTAL PROTECTION FEE PAID:

ONSITE SEWAGE TREATMENT AND DISPOSAL RECEXPT 4:

SYSTEM (OSTDS)

APPLICATION FOR CONSTRUCTION PERMIT

APPLICATIOtt FOR:

[ ] New System [ ] Existing System [ } Holding Tank [ ] Innovative [ )() Repair [ ] Abandonment [ } Temporary

APPLICANT: 6 A. EMAIL: agmag.com

AGsNT: New Horizons Environmental Solutions, LLC TELEPacem: (850)- 572- 9383 amILING ADDRESS: 2707 Larkin Street Pensacola FL, 32514

TO BE CCtfPLETED BT APPLICANT OR APPLICANT's AUTHORIZED AGEglT. SYSTENS MUST BE CONSTitoCTED BY A PE3tS(BI LICENSED PURSUANT TO 489.105(3) (a) OR 489.552, Fmoma STATUTES. IT IS THE APPLICANT's RESPONSIBILITT TO PROVIDE DOCUMENTATIORI OF TEE DATE THE LOT NAS CREA OR PLATIED Gaf/ DD/ YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.

PROPERTI INEURMATION OSTDS REMEDIATION PLAN? [ Y

Im: 2 m: 3 SUmDIvIsraer: off Oaks PLAmD: / f A9

PROPERTY ID # : () () - (b8OO- (j )ZONING I/ M OR EQUIVALENT: Y

PROPERTE SIEE: (). ACRES WATER SUPPLT: [ ] PRIVATE PUBLIC [ ] < r2000GPD I ] > 2000GPD

IS SEWER AVAILABLE AS PER 381.0065 , FS? [ Y DISTANCE TO SEEER: NA ri'

PitOPERTT ADDRESS: (J f~ dOOd D M - - w, nsas DIRECTIOttS TO PROPERTY u na ( 96 M 4 on AMA

BUILDING INFORMATION [ X3 RESIDENTIAL [ I Craemor- IAL

Unit Type of No. of Building Commercial/ Institutional System Design N Establi t Bedrooms Area Sqft Table I t Chapter 62- 6, FAC

6FR ? 5 13% fP LA .

[ ] Floor/ t 'ns I ] Other (ilpecify)

SIGNATURE:

DATE ()))/

DEP 4015, 06- 21- 2022 (Obsoletes previous editions which may not be used) Incorporated 62- 6.004, FAC

- - - - - - - - aERAT- - - .. . - - - - - .g

[ I S+ S

M W o o o O o O n

O a _.

O

O SITE SunaGF. TRFATEEIPf END DISPOSaL SYSTEM EEZsTZuG SrSTEM as m mEFAZR mm aFFLICaMT: Rebekah Spivey m / aGEmT: Zeb Watts Septic & Underground, inc . _ wT: 2 EZacE: B somDZv: Burloaks IDe:

2721 BurtwOOd Dr MIftOn FL 32583

To Ez Er FrmTna amGISTEmED EmGZmEER, n a. . - EMrzorEE, SzFTIC TauE cCmErnaCTaR OR 02EER CERTIFIED PERStEI. SIGN aMD SEAL ALL SUINEXTTED DOCtEIEATS. CCBiPIETE ATA APPr.TMW ITEMS.

ccMFLETE TauE (2AtTZFZCRTICII EELOII OR EDTE ZN amsanza NEr THE Tanuts CanuOT E15 CERTIFIED.

EZZSTING TaME INNtEGIRTZ(N

(1050 ] T.7 SEPTIC TaME/ T Mit: af Ma garagp BaFREED: [ TQ [ ] T.T W SEPTIC TaME/ IEGEAD: anaemaraT. EaFFIED: [ Yd ED [ @ T.TNA f I aRE Ma TaT.

[ T.TM T T : MatERZaL: ___ # PERSS: [ ] Z CERTZFE TERT THE LZSTED TIMIES EintE PtEEPED a 6/ 21/ 24 Er Zab watts Septic , EEgE THE TEE.UIES SPECIFIED as r o - - BY TE rintTC cam ] , aRE FEEE OF CESERWaBIE

, AM) EEUE A [ | SOLZDS Day2CE OUTEST FILTER DEVICE ] ZEBear.m.

asp watts heptic a Underground, g/ 2134

SIGmattutE OF LZCEASED CCAEERECTUR BUBINESS ERIE DATE

IMtaZHFIEED ZEEt3IMETZ ER

[ ] BERT Pomany MaTArPZELD STSTEM ED. oF TRANCHES [ ] D EMATMR: E [ ] STSTEM ED. OF TEEECBES [ ] D E TTPE OF SEETEN: Mr5 [ FILZED [ { MOUND [ ( COMFIGEntaTZm: [ BED I I DESIGN: [ D- EOE ! I GRAVITY STSTEM I DOEED STSTEM ELEVATION OF BOTT(3E OF ma gELarg go EgrgTING ZNCAES [ ABOUE / BEZaIII

STSTsar raTTM aMD sEmaZR OIt

[ ] SYSTEM 2EB917.T.a9Z0AI DATE OF EaSTE [ DCEAISTIC TaT. I ] GPD EST SENaGE FIGN (N I WaTER TIMILE 1, 645- 6, FAC

SITE Ma POOL Farro Pa 03uDITZ(aiS: I SZapZmG

ERTUEE OF j C Og| gtLQaD | SOILS EIaZIP maur r Thama F a / R05 Orr ROOTS WaTER TaBIB [

I Ama ON commn TaME D BOE/ armarwn MaTanPIEED : I I prmay

"= = / aDDITZ(zian Tank has bottom, no baffle, no iilter. 8B"Lx5Wz4B* D septicayatern performance.

SUInEXTTED Er:

TTTLE/ LICIDISE DETE: DE 4015, 08/ 09 ((2ssolates previous editions which may not used) Zncorporated 64E- 6.001, Fac

STATE OF FICRIDA PERMIT #

DEPAR25AENT OF ENVIRONMENTAL PROTECTION

ONSITE SENAGE TREA55AENT AND DISPOSAL SYSTEM

EEISTING SYSTEM AND SYSTEM REPAIR EVALUATION

APPLICANT:

- t- A NT LOT: BICCK: SUBDIV IDi:

TO BE COMPLETED BY FICRIDA REGISTERED ENGINEER, DEPARTMENT EMPLOIEE , SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCOMENTS. COMPLETE ALL APPLICABLE ITEMS.

COMPLETE TANK CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED.

EEISTING INR2GAATION

[ ] GALLO IC TANK/ GPD ATU LEGEND: MATERIAL: BAFFLED: [ Y / N] [ ] GALLONS SEPTIC GPD ATU LEGEND: MATERIAL: BAFFLED: [ Y / N] [ ] GALIGNS GREASE INTER LEGEND: MA :

[ ] GALLONS DOSING TANK : MATERIAL: # BUMPS: [ ]

I CERTIFY THAT THE LISTED TANKS WERE BY

, HAVE THE VOLUMES SPECIFIED AS DETERMI [ DIMENSIONS / FILL LEGEND ] , ARE FREE OF OBSERVABLE DEFECTS OR LEAKS, AND HAVE A LI DS DEFLECTION DEVICE / OUTLET DEVICE ] INSTALLED.

SIGNATORE OF LICENSEd CONTRACTOR BUSINESS NAME

EXISTING DRAINFIELD INFORMATION

I 340 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM No. OF TRENCHES [ 3 ] DIMENSIONS: X [ ] SQUARE FEET

, SYSTEM No. OF TRENCHES [ ] DIMENSIONS: Z EYPE OF SYSTEM: ] STANDARD (d ] FILLED [ ] MOUND [ ] "ONFIGDRATION: TRENCH [ ] BED [ ] 3RSIGN: ] HEADER [ ] D- BOX [ ] GRAVITY SYSTEM ] DOSED SYSTEM ELEVATION OF OF DRAINFIELD IN RELATION TO NATURAL GRADE INCHES [ ABOVE

BYSTEM FAILURE AND REPAIR IN2URMATION

] SYSTEM INSTALLATION DATE TYPE OF WASTE [ ] DCMESTIC [ ] CCMMERCIAL T ] GPD ESTIMATED SENAGE FIow BASED ON [ ] METERED WATER [ ] TABLE I, 62- 6, FAC

ITE [ ] DRAINAGE STRUCTURES { ] POOL [ ] PATIO / DECK [ I PARKING UNDITIONS: [ ] SLOPING PROPERTY [ ]

ATURE OF [ ] HIDRAULIC OVERLOAD [ )(] SOILS [ ] MAINTENANCE [ ] SYSTEM DAMAGE AILURE: [ ] DRAINAGE / RUN OFF [ ] ROOTS [ ] WATER TABLE [ (] * d 5ydeW AILURE [ ] SENAGE ON GROUND [ ] TANK [ ] D BOX/ [ MIEID YMPTCM: [ ] PLUMBING BACKUP [ ]

EMARES/ ADDITIONAL CRITERIA

EMITTED BY:

TITLE/ LICENSE - o o DATE: 7of y

EP 4015, 06- 21- 2022 (Obsoletes previous editions which may not be used) scorporated 62- 6.004, FAC

STATE OF FLORIDA PERMIT 4.

DEPAR'1NENT OF ENVIRONMENTAL PROTECTION

ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM

SITE EVALUATION AND SYSTEM SPECIFICATIONS

APPLICANT: e5f AGERT

LOT: BICCE SUBDIVISION:

PROPERTY ID # : 62- / SQ B- 0 - 6()(3 00 - (X9 b [ Section/ Township/ Parcel No. or Tax ID Nmber]

TO BE COMPLETED BT EttGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS NUST PRDVIDE REGISTRATION NOMEER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. CCBiPLETE ALL ITEMS.

PROPERTY SIEE CONFORMS TO SITE PLAN: IES [ ) N0 NET USABLE AREA AVAILABLE: B TOTAL ESTIMATED SEEAGE FI4W:

4 Oh GALIGNS PER DAY OTHER] AUTHORIEED SEEAGE FLON: i M 5 GALLoNS PER DAY [ 1soo GPD/ ACRE 1 UNOBSTRUCTED ABEA AVAILABLE: f G[ L SQFT UNOBSTRUCTED AREA REQUIRED SQFT

BENCHMARE/ REFERENCE POINT LOCATION: a ed 00 A E tn afe ELEVATION OF PROPOSED SYSTEM SITE IS / FT [ ABOVE POINT

THE BENINUM WEICH CAN BE MAINTAINED FRCN THE PROPOSED SYSTEM TO THE FOLWEING FEATURES SURFACE WATER: ET DITCBES/ fT) FT NORMRI.LY WET? [ ] TES d] NO NELLS: PUBLIC: FT LIMITED USE: NA ET PRITikTE: A/ A FT Nest- POTABLE: A/ 4 FT EUIICING FOUNDATIONS: FT PROPERTY LINES (fl.5ft") ET POTABLE WATER LINES: A9/ 7% FT

SITE SUBJECT TO FREQUENT FLOODING: [ ] YES Ed NO 10 YEAR FICODING? ] TES [ h NO 10 IEAR FLOOD ELEVATICEI FOR SITE: FT MSL/ NGVD SITE ELBVATION: A/ A FT MSL/ MGVD

SOIL PROFII2 INFORMATION SITE 1 SOIL PROFILE IN.BMATION SITE 2

nEarSELL # / cDICR TExTURE DEern MouSELL # / cOIoR TEEToaE DEPN

JoW RtS / 5 3 TO 7 / 6 st R/ 3 Li ( / 2 b ot .SY M- t L5 7 TO / d ')E < / t M g TO / < 2,5p / ./ 4 (5 / L TOt/ 2.W 4 / / 5 . / 5 TOt6 5)A 5 / s Re fer owfpm r) 2057' M st a Ne Aw ow/ Ae / A tory

USDA SOIL * * a / / (/ r) USDA SOIL MNRTWa : a H / ' menVED WATER INCHES [ ABOVE EEISTING GRADE. TYPE: [ PERCHED ESTIMATED NET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE EEISTING GRADE HIGE WATER TABLE VEGETATION: [ ] TES NO WSWT Indicator: YES [ ] NO DEPTH INCBES

SOIL TEETURE/ IoADING RATE EOR SYSTEM SIEING: M / ) .(,5 DEPTs Or EECAVATIcN: 4 A INCEES DRAINFIELD CCEgFIGURATION: TRENCE [ ] [ I (SPECIFY) . REMARES/ ADDITIONAL CRITERIA: mff mph (, / / / f n/ / / , fa; v (), () horth ( n e Mea . \ ) e ex Mh al R aul TAdhif 'lf.2 an.3

EITE EVALUATED BY:

DATE: thf

> EP 4015, 06- 21- 2022 (Obsoletea previous editions which may not be used) Encorporated: 62- 6.004, FAC

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