2446 SEM RD DOH SEWER TRMT Y
APPLICATION #:AP1159835
STATE OF FLORIDA
DEPARTMENT OF HEALTH PERMIT #:16-SJ-1560206
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #:F1978486
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:10/06/2014
FEE PAID:235.00
RECEIPT #:16-PID-2547543
APPLICANT: Rex Williams(Signature Homes& Development inc.)
AGENT:
PROPERTY ADDRESS: 2446 Seminole Rd Atlantic Beach, FL 32233
LOT: 2 BLOCK: na
SUBDIVISION: Section Land ID#: 168354-0100
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION SETBACKS
[ 1 [01] TANK SIZE [1] 1200.00 [2] 750.00 [ ] [27] SURFACE WATER 75 FT
[ ] [02] TANK MATERIAL Concrete [ ] [28] DITCHES NA FT
[ ] [03] OUTLET DEVICE M [ ] [29] PRIVATE WELLS
160 FT
[ 1 [04] MULTI-CHAMBERED [ Y N ] [ ] [30] PUBLIC WELLS
NA FT
[ ] [05] OUTLET FILTER Polylok PL-68 [ ] [31] IRRIGATION WELLS NA FT
[ ] [06] LEGEND 1. 16-063-12DC4 2. 16-063-07SC4 [ ] [32] POTABLE WATER 49 FT
[ ] [07] WATERTIGHT [ ] [33] BUILDING FOUNDATIONS 16 FT
[ ] [08] LEVEL [
] [09] DEPTH TO LID ] [34] PROPERTY LINES 10 FT
[ [
DRAINFIELD INSTALLATION ] [35] OTHER NA FTFILLED / MOUND SYSTEM
[ ] [10] AREA [1] 630 [2] NA SQFT [ ] [36] DRAINFIELD COVER
[ l [11] DISTRIBUTION BOX X [ ] [37] SHOULDERS
[ ] [12] NUMBER OF DRAINLINES TGG 2. [ ] [38] SLOPES
[ ] [13] DRAINLINE SEPARATIONJ„� [ ] [39] STABILIZATION /j/[ ] [14] DRAINLINE SLOPE
( ] [15] DEPTH OF COVER ADDITIONAL INFORMATION
[ ] [16] ELEVATION [ ABOVE / BELOW ]BM 64.004 [ ] [40] UNOBSTRUCTED AREA
[ ] [17] SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF
[ ] [18] DOSING PUMPS j 1,00 [ ] [42] ALARMS
[ ) [19] AGGREGATE SIZE { t/;3(� �/� [ ] [43] MAINTENANCE AGREEMENT
[ ] [20] AGGREGATE EXCESSIVE FINES ( , [ ] [44] BUILDING AREA
[ ] [21] AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN
FILL / EXCAVATION MATERIAL [ ] [46] FINAL SITE GRADING
[ ] [22] FILL AMOUNT [ l [47] CONTRACTOR Billy J Fuller(Moore"s Sand&
[ ] [23] FILL TEXTURE [ ] [48] OTHER PTI MPRDS (9 pipes-2 tier)
[ ] [24] EXCAVATION DEPTH ABANDONMENT
[ ] [25] AREA REPLACED [ ] [49] TANK PUMPED 12/04/2014
[ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED 12/04/2014
Comments: Comments are on page 2.
CONSTRUCTION [ APPROVED / DISAPPROVED Duval CHD DATE: 12/04/2014
] :
Environmental Specialist II V I 'g(DCHD-Environmental Health 8
FINAL SYSTEM [ APPRO'JED / DISAPPROVED ] ; Duval CHD DATE: 12/04/2014
nvironmenta pecaa ist i wig nwronmenta Health 8
(Explanation of Violations on following page)
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
EH Database v 1.0.1 EID1660206
APPLICATION #:AP1159835
STATE OF FLORIDA PERMIT #:16-SJ-1560206
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT #:F1978486
CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:10/06/2014
FEE PAID:235.00
RECEIPT #:16-PID-2547543
Violation Number Comment
Comments
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons(2 per bedroom), for a total estimated flow of 460
gpd.#12-7 Trench,#18-1 1/3 hp Myers,210 LF 9 Bundle PTI
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
F11 MAabas, v 1.0.1 AP'1'159835 EID1560206