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Apri127, 2020
Jared Modine
3101 Matthews Road
Fort Pierce, FL 34945
RE: Modification to a. Single Family Residence - No Bedroom,Addition
Application Document Number: AP1481183
Centrax Permit Number: 56-SF-2058661
3101 Matthews Road
Fort Pierce, FL 34946
Lot:5 Block: 5 Subdivision: McHurlen Farms
Dear Applicant,
This will acknowledge receipt of a floor plan and site plan on 04/27/2020 for the use of the existing
onsite sewage.treatment and disposal system located on the above referenced property.
Ran Deeantis
Governor
swN A. Maio.., No
State Surgeon General
This office has reviewed and verified the floor plan and site plan you submitted, for the proposed
remodeling addition or modification to your.single-family home. Based on the, information you provided,
the Health Department concludes:
1. the proposed remodeling addition or modification is not adding -a bedroom; and
2. it does not appear to cover any part of the existing system or encroach on the required setback
or unobstructed area.
3. No existing system inspection or evaluation and assessment, or modification, replacement, or
upgrade authorization is required.
Because an inspection or evaluation of the existing septic system was not conducted, the Department
cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use.
You may request a voluntary inspection and assessment of your system from a licensed septic tank
contractor or plumber, or person certified under section 381.0101, Florida Statute's.
If you have any questions, please call our office at (772) 873-4931.
Sincerely, A,
Brian Ingram
Environmental Specialist II
Department of Health in St. Lucie County
Fladdn Yaparba"d of Hamm www.Rodd~*4m
in St Lucie County • 5150 NW Milner Drive • Port Saint Lucie, Florida TVVITTER:HeailhyFLA
34983 FACEBOOKFLDeparhnentofHealth
PHONE: (772) 8734931 YOUTUBE: Sdoh
St, Lucie County Health Department
HEALTH5150 NW Milner Or Port Saint Lucie, FL 34983.
PAYING ON: #:56-SF2058661 1311-Looc#:56-BID4644605 CONSTRUCTION APPLICATION #.APi481183
RECEIVED FROM: Jared Modine AMOUNT PAID: $ 35.00
PAYMENT FORM: CREDIT CARD 417204 PAYMENT DATE: 04/27/2020
MAIL TO: Judy Mauro
FACILITY NAME: _
PROPERTY LOCATION:
3101 Matthews Rd
Fort Pierce; FL 34945
Lot:
5
5
Block: _
Properly ID: 2320-501-0081-000-8
EXPLANATION or,DESCRIPTION: QUANTITY FEE
139 - OSTDS Application Approval Existing, No Insp 1 $ 35.00
RECEIVED BY: WhiilhamJL AUDIT CONTROL NO. 56-PID-4364778
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEDGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
PERMIT
DATE PAID:
FEE PAID:
RECEIPT #: _.
APPLICATION FOR:
[ ] New System [" ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ✓ ] Plan Review
APPLICANT: Judy Mauro
AGENT: Jared Modine TELEPHONE:772-519-0558
MAILING ADDRESS: 3101 Matthews Road Fort Pierce,. FL 34945
TO BE COMPLETED BY APPLICANT OR APPLICANTS AUTRORIZEDAGENT.. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489..105(3)(m) OR 489._862, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (1ST/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT: 5
BLOCK: 5 SUBDIVISION:
MCNurlen Farms
PLATTED;
PROPERTY ID
#: 2320=50.1-0081-000/8
ZONING:
I/M OR EQUIVALENT: [
No ]
PROPERTY SIZE: 19.03 ACRES WATER SUPPLY: [ v] PRIVATE PUBLIC [ po=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER.381.,0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 3101 Matthews Road FortPiece, FL 34945
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION [✓]
Unit Type of
No Establishment
1 Residential
2
3
4
[ J Floor/Equipment Drains
SIGNATURE.: Jared Modine
[ J COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6., FAC
3 7166 N:1 &-OWL
[ ] Other (Specify)
Digitally signed by Jared Modine
Date: 2020.04.0615.15:22-04'00' DATE:
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
incorporated 64E-6.001, FAC _ Page 1 of 4
suwuvh Z I •
RIGHT SIDE ELEVATION
\ir
LEFT SIDE ELEVATION
REAR -ELEVATION
FDOH in St. Lucie County
Environmental Health
Septic System. Appears Adequate
For Proposed ConstructiOn%VF-P, Ya&,/
This Approval Does Not Guarantee
Perfo ance of the em
Reviewer: -
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