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ar F STATE OF FLORIDA PERMIT NO.
DEPARTMENT.Or,'HEALTH DATE. PAID:
v� ONSITE SEWAGE 'TREATMENT AND DISPOSAL FED PAID:
SYSh;EIKI RECEIPT 4k:
APPLICAtION FOR CONSTRUCTION PERMIT
ARP�LICATION� FOR:
I�%t] New System L ] Existing System [ ] Ho o vatzve
C ' ] Repair { ] Abandonment [ ] T , poraz
APPLICANT: .1 .
AmBPT-
MAILING ADDRESS: x
,TO BE COMPLETED HY APPLICANT �OR'APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A'PERSON LICENSED PURSUANT To 489. 105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS: THE
APPLICANTS RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/Y.y) IF REQUESTING CONSIDERATION OF STATUTORY 'GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT BLOCK: '�--" SUBDIVISION i _/��� D / • �.7n h7•Q'LATTED k
&ROPERTY ID 4k: ZONING: I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE:. 34..ACRE9 WATER SUPPLY: [ ] PRIVATE PUBLIC 1 ]<=2000GPD [ 1>20009PD
IS SEWER AYAILABLE•AS PER 381.0065, FS? [ jY j N ]
PROPERTY ADDRESS: H 4Z(
C.
DIRECTIONS TO PROPE'/1 ORTY:/hq S,�/)%� )_5 PH, i7P]
-.'BUILDING INFORMATION
DISTANCE TO SEWER: 'FT
C 7(J RESIDENTIAL v [ ] COMMERCIAL
'Unit. Type of No. of Building Commaroial/Institutional 9yskam Dosign
No Establiskament Bedrooms Area .S £ Table X, Chapter 64E-6 PAC
2
1.
i
L, ] Floor/Equipment. Drains [ ] Other (Specify)
SIGNATURE: 'K DATE:� '
"-DH 4015, 00/09 '(Obsoletes previous adItions which may not b:e used)'
IncorpO.tated 64E-6.001, PAC :Page 1 of 4
T STATE OI' rLORIDi1 PERMIT 1k.
1,DEPARTMENT'OF HEATTH
ONSTTA 'SEWAG� TLXP,.TMGNT AND DISPOSAL SYSTEIK
on SITt EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT i AGENT: K
LOT i! BLOCK: SUBDIVISION: .$. /�^ /
_ /il�PiS O/�,Cc7d[�1�Oc�
PROPERTY ID 4i: -I• [.S'ectioiVTown'shin/Purccl No. or Tax ID Number
r "UAL'i'I1. 1J1:PARTMENT EMPLOYEE, OR
7
PROPERTY SIZE CONFORMS TO SITE PLAN:, v � YES [ ] NO NET USABLE AREA AVAILABLE: .,.35 ACRES
TOTAL ESTIMATED SEWAGE ,FLOW: On r� ` GALLONS PER .DAY ''� [ RESIDENCES -TABLE I/OTtIER-TABLE 2. 7
1.
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY ' [ 1500 OPD/ACIIG OIL 2500 OPD/ACRE : ]
UNOBSTRUCTED AREA AVAILABLE: /�Q gQg��T}} [ UNOBSTRUCTED AREA. RlEQUIRED: SQFT
BENCHMARK/REFEREIQCE �46
POINT LOCATION: (/ ] DAU Z• (� i b / 1IAQ j.
ELEVATION OF PROPOSED SYSTEM SITE TS [INCHES/FP I [ABOVE/BELOW'] BENCHMARIS/REITRiNCE POINT
i
THE JM=Nlmum SETBA C NHICH CAN BE 'MAINTAINED FROM THE P OPOSED SYSTEM TO THE £OLLOWING'FEATURES
SER S'CE WATERPUBLIC:
FT DITCHESI9WALEg: �__FT NORMFILLY WET? [ [ YES NO
WELL3i PUBLIC DQ FT .LIMITED USE:. )pa FT PAIVAT) : 7,� FT NON -POTABLE: FT
YiUILDING FOTJNDAh.'IONS.Q FT PROPERTY LINE3:FT 'POTABLE WATER LINES FT
SI'TP,.'(SUB.=CT TO FREQUENT FLOODING: [ ] . YES PO 10 YEAR FLOODING? [ ] YES 'I ] NO
10 XPiAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MS-I,/IQGVD
TO
USDA SOIL SERIE9:
OBSERVED wATER TABLE: INCHES [ABOVE./BBLOW '] EXISTING
ESTIMATED WET SEASON WATER TAHIX ELEVATION: 'INCI-ICS
HIG$,T"TATER :TABLE ,VL GETATION: [ '] YES [N NO MOTTLING: I
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DI
DRAdNV=, LD CONFIGURATION: .[ J TRENCH
REMARKS/Ai)nTTTrnan'T� ro T,i,nvTr . [ [ '1 / 1 • I ] OTHER
SITE EVALUATED ,
D8 4015, 12/11 (Obeoletea psevioue
i
Ili
which may not bn uaea) Incorporated:
TO
TO
LADE., TYPE: [ PERCHED /APPARENT
[.ABOVE/BELOW '] EXIS!TIN& GRADE
'YES [ ] NO DEPTm- ••* INCHES
'H2OF EXCAVATION1 'INCHES
FAC
Ic
ATE
' Page 4 of A
fah r
tll;�'1i1�Vir#iih1 • 'M•
WIG*
APPI.ICANTi AGDNT:A
LOT,0� BLOCK -."-�-�9U;bna9ION
PROPERTY ID
PROPERTY SIZE CONFORMS TO SITE P YE9 I ] NO NE- II9AB
TOTAL• ESTIMATED SEWAGE FLOW: Od' GALLONS PER DAY IIIAUTHORIZED ;SEWAGE .BLOW: .GALLONS PER DAY C1
UNOBSTRUCTED AREA 'AVAILABLE: ^_ Q 'SOFT UNOBSTRUCTE
I
BENCkMARK/REFERENCE POINT.LOCATI013.: Lc
Ti.1',1'VATI0N OFMOPOSED STSTEM SITE B-EWYL IiNCFIE97FT 7 IABOvE
bo
THE; ;MINIMUM SETBA { WHICH CAN BE MAINTAIXElD FROM THE P OPOSED
SURFACE WATER:_ -FT DITCHE3I9WAZE9:.�FT
'WELLS r' PUBLIC: �' OO. FT :LIMITED VSE:_/4['_FT PRIVATE:
"BIII;GbING FOUNDATIONS: f Q FT PROPERTY -LINES:^F
SITE an CT TO FREQUENT FLOODING: [ ] YES jPQ NO :1
10 7UR, FLOOD.. ELEVATION MR Si'.CE: nT IML/'NGVD Si
. TO
'To
'TO
TO
TO
USDA SOIL .SERIES:
SOIL
. PERMIT It.
ID Number ]
VIAL_ COMPLETE-ALL..ITEMS.
.AVA L.ABLD:. ,3t:LACRES
S-TAELIiI/OTHERTAD4E2 ]
,ICE Olt 2500 C;PD/ACRE : ] '
REQUIRED: ' SOFT
'STEM TO THE FOLLOWING. FEATURES
NORMALLY VET? I '[ YES A NO
. Z 'FT NON-POTAHLD: c5() FT
POTABLE WATER LINES.:
YEAR FLOODING? I ] YES '.[ ] NO
li:LEVATION: FT M3L/NGVL)'
2
OB94LVED, WATER TABLE: .INCHES [ABOVE/BBLOW 7 EXISTING GRADE_ TYPE:[PERCHED /APPARENT ]
E9Tn'%T5D VIEW SEAkIr' 'riee,TER' T.ABL'E''=91U.Lw: INCHES' I.ADOVE/BELOW .] 3iXISTING GRADE
HIGIi�;. 6iA.TEA. TABLE VE(MTATION: I I YES - , [A NO MOTTLING: I I TES. I I NO DEPTH: INCHES
SOIL TEXTU9E/LOADING RATE FOR SYSTEM SIZING: DF�PTS OF EXCAVATION: �' INCHES
DR�IELD CONFIGURATION: I J TRENCH I I BED) 17 OTHER`I(SPECIyy) i
RE /.AnnTTTntaa7,` ro•rn.mor>:. .i � '
TF EVALUATED.'' - I DATE; (�
CH 40161„12111 (Obeoletae Previous editions rhich may not be used) Incorporated: 04E•0.001, FAC Page 9 of A
i : psi: •
I,:
STATE.OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
,APPLICANT:
CONTRACTOR / AGENT:
LOT: 277
Inc
APPLICATION # AP1478536
'PERMIT #,56-SF-2055078
DOCUMNT.# SE1274136
PROPERTY BIZE CONFORMS. TO SITE .PLAN: i[X]YES [. ]NO NEZI USABLE AREA,AVAILABLE:' 6,34 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [RE§IDENCES=TABL81 / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 849.98 :GALLONS PER .DAY [ 1500 GPD/ACRE OR, 2500 OPD/ACRE j.
UNOBSTRUCTED AREA AVAILABLE: 1510.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1600.00 `'sQPT
BENCEMMM/•REFERENCE POINT LOCATION: Sfte.BM,•. orange . paint triangle,:CLOf. rd� centerof property,..
..ELEVATION OF PROPOSED. :SYSTEM SITE 15.00f17I7CNES / FP ] .[.ABOVE /.BELOW ]:BENCHMARK/REFERENCE POINT.
THEMINIMUMWATER:
SETBACK WHICH LIMITED 9E:MAINTAINED �M TWALES: PROPOSED TO ,THE FOLLOWING FEATURES,
SURFACE WATER: FT DITCHES/SWALES: 15 FP NORMALLY WET: [ ]YES ',[X]NO
PRIVATE: FT NON -POTABLE: 90 'PT
.BUILDING FOUNDATIONS: • 5 FT PROPERTY.LINES: 5 77 I POTABLE WATER LINES: "5 FT
SITE SUBJECT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR. SITE:
SOIL.PROFILR INFORMATION SITE i
[ :]YES '[X]NO
FT [ MSL / NGVD j SITE
USDA SOIL-SERIESi"
Munsell #/Color
Texture
Depth.
I OYR 411 `
Loamy Fine Sand
0 T67
1OYR 5/2
Loamy Fine'Sand
7 To 11
1OYR 511
-'FneSand-
11To28.
1OYR 5/8
CMN/PRM.RF '
25'To 32
1OYR 6/2
Flne;Sand
.. 28 To 32
10YR 4A
Fine Sandy Loom
32 To 46
I OYR 6/2
Loamy Flne,Sand
46 To 57
1OYR 6/1
Sandy Clsy Loam
J57.To 72
QMTT. 9Rn£TT.Tt.
10 YEAR FLOODING? '.I ] YES [ X ] NO]
ATION: FT ,[ MSL / NGVD
MRMATTM 'RITA 2
USDA SOIL SERIES:
Munsell #/Color
I
Texture
Depth
10YR 411
Loamy Fine Sand
O To
1OYR 6/2
�.
Loamy Fine Sand -
8 To12
1 OYR 5/1
[
Fill
12 To, 30.
1 OYR 518
[
CMN/P.RM RF
25 To 33
10YR 6/1
f
Fine Sand
30 To 34
10YR 4/4
1.
Sandy Clay Loam
34 To 44
1OYR 5/2
[
Loamy Fine Sand
44 To 58
1OYR 5/1
}
Sandy Clay Loam
5B To 72
OBSERVED WATER TABLE: 63,00 INCHES [ ABOVE / BELOW ] •EXISTING G�ADE TYPE: [ PERCHED / APPARENT]
ESTIMATED .WET SEASON WATER TABLE ELEVATION: 25.. INCHES [.ABOVE / BELOW] EXISTING GRADE
HIGH WATER TABLE VEGETATION:. [ ]YES 1[X]NO .MOTTLING: '[X]YES [ :]NO DEPTH: 25.00. INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF .EXCAVATION: 46 INCHES
DRAINFIELD,CONFIGURATION: IX] TRENCH [ ] BED 'I I OTHER (SPECIFY)
REMARKS/ADDITIONAL.CRITERIA —^
WSWT determined using LSAD WSS.and loll borings.
10YR518 CMN PROM RF"mottling in".10YR51..and 10YRS12 matrix>2% starling at 25".In S81.
SB1' 15"abova BM. SB211" ebovo SM.
SITE 'EVALUATED BY: = DATE: .04/2112020.
Ingram, Bdan le: EhGironmental Speclellet II) (ENVIRONMENTAL�HEALTH)
Da 4015, 08/09 (Obaoletes previous -editions w ch may not be need) Incorporated: 614E-6. 001, ;FAC Page 3 of 4
AP1478636 E102055078 v 1.0.2
STATE OF FLORIDA
DEPARTMENT OF, HEALTH
I ... 0a ON,SITE SEWAGE TREATMENT AND DISPOSAL
APPLICATION FOR CONSTRUCTION PERMIT
J,pypy,ICATION•FOR:
Wv New System L ] Existing System [ ] Holding Tank
L'•] .Repair �� L 7 Ab nd nment, / L ]A Temporary
APPLICANT: x
PERMIT PAID.
v-VOID..
DATE• PAID:
FEE PAID:
.RECEIPT 47;
C*—
[ ] Innovative
[ ]
AGPNT: / I-TDLEPHUNE / IXD
KuLnQG ADDRt S9: x \ ( � ,.
I. .
TO BE .COMPLETED SY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MOST BE CONSTRUCTED
BY A'PERB¢N LICENSED PURSUANT TO 489.1d5(3)(m) OR 4B9.552, FLORIDA STATUTES. ,-IT IS TIM
APPLICANT1B RESPONSIBILITY TO PROVIDE DOCUMENTATION OF 'THE DATE'TBE LOT WAS CREATED OR
PLATTED (MK/DD/7Y) IF. REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVI9YONS.-
PROPERTY INFORMATION
LOT: BLOCK: 9UBDMSION:
PROPERTY iD (i:
I;
ZONING.: I I/M,OR EQUIVALENT: I Y/ N]
•PROPER TY SIGE:[J ACRES WATER SUPPLY: .f. ]. PRIVATE
:PTTBI�CC J�r]<-2QD0GPD ?
3>2000ePD
IS SEWER AVAILABLE-A.S.PER.381.0065, FS?
[ Y'/ N ]
DISTANCE TO SEWER:
FT
PROPERTY
/J/.(1.�J n l r _
_ _ I] A,5 .. / A
aI Sil^i
ADDRESS:
DIRECTIONS TO PRC
BUILDING INFORMATION F
Unit . Type of
No Establisbment I
.1 R
2
�3
b
[ X, RE 9IDENTTAL
No. of Building
Bednooms Area SCrft
_ '7
V C '] COMMERCIAL '
Commercia' Chapterl/Institutional System Design
Table 1,•.64E-6,FAC
i
j
(9DPf]i firl I
X �n I
9I DATE:
DH 4015, 08/09 (Obsoletea Previous editions which may not be used)'
Incorporated 64E-6.001,. FAC
Page 1 of 4
61
PROPERTY ADDRESS: 1807 Hazelwood Dr Fort Pierce, FL34982
LOT: 27 BLOCK: SUBDIVISION: Estate Of LOngWood
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID N: 2433-502-0027-000-2
. ]OA TAX' ID''NUMBERI
SYSTEM MUST BE 'CONSTRUCTED ;IN ACCORDANCE :WITH SPECIFICATIONS AND STANDARDS OF SECTION
a
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT ,APPROVAL 'OF SYSTEM DOES NOT GUARANTEE
'SATISFACTORY PERFORMANCE FOR ANY. SPECIFIC PERIODOF 'TIME. 1 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 SBDtic new CAPACITY I
A [ ] GALLONS / GPD N/A CAPACITYI
N I ] GALLONS GREASE INTERCEPTOR 'CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY '[ ]GALLONS @I ]DOSES PER-24 SHE #Pumps [ ]
D [ 600 ] SQUARE FEET Dralnfleld new SYSTEM,
R [ ] SQUARE .FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [X] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: site BM, orange paint triangle, CL oftd, center of prop
I ELEVATION OF PROPOSED SYSTEM SITE 115.00It INCHES FT ][C
E BOTTOM OF DRAINFIELD TO BE [ 14.00 ] I INCHES FT ] b ABOV
L
D FILL REQUIRED: [17.001 INCHES EXCAVATION REQUIRED: t 46,
The system is sized ,for 4 bedrooms with a maximum occupancy of 8 persons (2 per b:
0 400 gpd.
T
H
E
R
BELOW.] BENCHMARK/REFERENCE POINT
BELOW]BENCHMARK/REFERENCE POINT
INCHES
7), fora total estimated flow of
SPECIFICATIONS
BY: Brian J IngrqLM
I
TITLE: Environmental Specialist
Ix
APPROVED BY:
TITTLE: Environmental Specialist Ix
St. Lucie CED
Brian J In am
DATE ISSUED:
04/22/2020
EXPIRATION DATE:
10/22/2021
DH 4016, 08109
lobs oletes all previous
editions which may not be used)
Incorporated:
64E-6.003, PAC.
Page I of 3
v 1.1.4
M478536
SE1274136