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HomeMy WebLinkAboutSewage4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: APPLICANT: Charlotte Almi PROPERTY ADDRESS: LOT: 7 BLOCK: OSTDS New PROPERTY xD 4: 2215-700-0009-000-8 SUBDIVISION: PERMIT N: APPLICATION a: DATE PAID: FEE PAID: RECEIPT $: DOCUMENT k: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [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 GUtRAHTEE 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 ANDI 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 T [ 900 ] GALLONS / GPD Septic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ IGATLONS @[ ]DOSES PER 24 HRS #Pumps [ D [ 375 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ] I CONFIGURATION: [X] TRENCH [ ] BED [ ] N F .LOCATION OF BENCHMARK: BM West of turnabout @ CL of Rd by NE property comer I ELEVATION OF PROPOSED SYSTEM 9ITE [ 0.00 ][ INCHES FT ][ABOVE BELOW] BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 16.00It INCHE3 FT ][ ABOVE BELOW ]BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [34.001 INCHES EXCAVATION REQUIRED: [ 65.00] INCHES 0 T H E R ie system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of )0 gpd. is licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with 64E-6.013(3)(f), FAC. BY: Brian APPROVED BY: TITLE: son J Ingr= DATE ISSUED: 12/06/2017 DH 4016, 08/09 (Obsoletes all previous editions v _ Incorporated: 64E-6.003, FAC v 1.1.4 AP1317612 TITLE: Master Septic Tank Contractor SE1055975 Page' 1 ,of 3 ] NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a'final order. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings. are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: PPRmiTit56-SF-1806243 BILL DOC1r56-BID-3636474 CONSTRUCTION APPLICATION*..AP1317612 RECEIVED FROM: Kamer Surveyinp. Inc AMOUNT PAID: $ 400.00 PAYMENT FORM: CREDIT CARD PAYMENT DATE: 12/01/2017 MAIL TO: Charlotte Almore FACILITY NAME: PROPERTY LOCATION: 20005 Southern Star House 2 Fort Pierce, FL 34945 Lot: 7 Block: Property ID: 2215-700-0009-000-8 EXPLANATION or DESCRIPTION: QUANTITY 128 - OSTDS Construction System Inspection Research Fee 1 $ -1 - Surcharge (All) 1 $ -1 - OSTDS New Permit Surcharge 1 $ -1 - OSTDS Construction Application and Plan Review,New 1 $ 126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 127 - OSTDS Construction System Inspection 1 $ 133 - OSTDS Construction Reinspection 1 $ FEE 5.00 15.00 100.00 100.00 55.00 75.00 50.00 RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3445463 STATE OF FLORIDA PERMIT No. SF 180 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: 14 3 New System [ 3 Existing System [ ] Holding Tank [ 1 Innovative [ 3 Repair [ 3 Abandonment [ ] Temporary [ 1 APPLICANTt Charlotte Almore AGENTS RARNRR SURVEYING INC TELEPHONB(772) 288 7206 MAILING ADDRESS: 2740 SW MARTIN DOWNS BLVD #333, PALM CITY, PL. 34990 varrsrrwatwwmrwwmmvvamvrrrvmw�rmmmrrrrwmrrwrwrmrvmarwmmurarmavrvtrwwrravuammvrmrmmnmmm TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTRK9 MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUI1ENTATION OF THE DATE THE LOT WAS CRRATZD OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. wswrwswouwvoowsarvawaswwwsrawwwrrawwruayswmmwwwoumwvwwwmrwwromwwsrrrwvrrwvasaawm PROPERTY INFORMATION LOTi 1 BLOCAt N/A SUSDIVISIONs Southern Star Stables PLATTEDS 6/2006 PROPERTY ID # t 2215 700-0009-000-8 ZONING s_ I/M OR EQUIVALENT. [ Y / PROPERTY SIZES 10.96 ACRES WATER SUPPLY. 0_]_PRIVATE PUBLIC [ 36w2000GPD [ 1s20000PD rT IS SEWER AVAILAELB AS PER 361�0065, FS4 [ Y /Zip DISTANCE TO SEWERS Z AFT PROPERTY ADDRESS Southern Star Drive, Fort Pierce F1. 34945 DIRECTIONS TO PROP]IRTY2 04.Ar - ernneYty is at t BUILDING INFORMATION Unit Type of No Eetablisbment [RESIDENTIAL [ 3 COMMRCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Soft Table 1 Chapter 54B-6 PAC 1Kyzfz RESIDENCE 2 3 4 [ ] Floor/Rquipmnant Drains [ 3 Other (SPecify) SIGNATUREs DATES (✓ v DR 401S, 10/97 (Previous Editioae May Be Used) ONLINE VERSION Page i of 4 STATE OF FLORIDA PERMIT #. 6%?' Sic ^ l $O (02 k 3 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PPLICANT: Charlotte Almore AGENTS KARNER SURVEYING INC OT: 7 BLOCKS N/A SUBDIVi8I0N: Southern Star Stables ROPERTY ID #s2215-700-0009-000-8 [Section/Township/Parcel No. or Tax ID Numbar] 0 BE COMPLETED BY ENGINEER, HEALTH DEPARTSmINT. EMPLOYEE, OR OTHER QUALIFI3D PERSON. ENGINNERRS DST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ROPSRTY SIZE CONFORMS TO SITE PLANS L83 YES [ ] NO NET IIBASLE AREA AVAiLA8LEs10.96 A/C` ACRE8/Ac OTAL ESTIMATED SEWAGE FLOW' vJ GALLONS PER DAY {F' SNCES-TABL /OTHER-TABLE23 At.F ,UTHORIZSD SEWAGE FLOWS W GALLONS PER DAY 2500 GPD/ACRE] NOBSTRUCTED AREA AVAILABLB: SQPT UNOBSTRUCTED AREA REQ .,E:1500 - SQFT nNom .wREFaRENce POINT LOCATION: g�o wC > LEVATION OF PROPOSED SYSTEM SITS IS LINQHES/8'ir]i [AgOpEyBELOWj BENCfRGM POINT���E 'HE NINZZ411m? SETBACK WHICH CAN BE MAINTAINED FROM THE P$QPOSED SYSTEM TO THE FOLLOWING S .VRFACE WATER: 2V BT DITCHES/ S:�f� gT NORMALLY WET? [ ] YE9 NO IELLS.: PUBLIC: FT LIMITED USE: PRIVATE: �FP NON -POTABLE: FT 10ILDING FOUNVA / FT PROPERTY LINES: // 7'F POTABLE WATER LINES: FT iITE SUBJECT TO FREQUENT BLOODING: L ] S V1 NO 10 YEAR FLOODING?0 ] YES Y(/) NO .0 YEAR FLOOD ELEVATION.B'OR SITE: - FT NSL/NGVD SITE ELEVATION: PT MSL/NGVD USDA. SOIL SERIES:�Si 'y DBSERVED WATER TABLE: D INCHES [ABOVE / ] EXISTING GRADE. TYPE: ZRCHED / A'P�Z tENT7 ESTIMATED NET SEASON WATER TABLE ELEVATION: INCHES [ABOVE /] EXI8TIN0 GRADE HIGH 'WATER TABLE VEGETATION: L ] YES [%�] NO MOTTLINGt [�] YES L 77K0 DEPTH :' _INCHES SOIL TEXTURE/LOADING RATE FO SYSTEM SIZING: /( - DEPTH OF 3RCAVBTZ0x: �� zmelms WIELD CONFIGURATION: �] TRENCH [ ] mail SITE LVALUATED = 4013,,. 69/00 (obwclwtew prwviouw •macaw which my not be awwd) Incorporated: 64E-8.001. FAC Page 3 of 4 >rOperty Card Page 1 of 5G-SF- IVOW `!3 Michelle Franklin, CFA — Saint Lucie County Property Appraiser —All rights reserved. Property Identification Site Address: TBD Parcel ID: 2215-700-0009- Account #: 168610 Sec/Town/Range: 000-8 15/35S/38E Map ID: 22/15X Zoning: Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description Charlotte Almore SOUTHERN STAR STABLES S/D (PB 53-24) LOT 7 (10.95 Bertrand Laidler Jr AC) (OR 3986-1904; 4029-1582) Michael E Bell II 1200 Tumblin Kling RD Fort Pierce, FL 34982-6952 Current Values Historical Values 3-year Just/Market: $98,600 Assessed: $98,600 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $98,600 2017 $98,600 $98,600 $0 $98,600 2016 $109,500 $98,360 $0 $98,360 2015 $108,800 $89,419 $0 $89,419 Sale History Date Book/Page Sale Code Deed Grantor Price 06-19-2017 4029 / 1582 0111 QC Ahnore Charlotte $100 04-18-2017 3986/1904 0001 WD Rynard John D $119,000 03-05-2012 3368 / 0745 0202 WD Steele,Tracy D $330,000 Primary Building Information Finished Area of this building: 0 SF Gross Area of this building: 0 SF Exterior Data View: Year Built: N/A Primary Wall: Bedrooms: 0 Full Baths: 0 Half Baths: 0 Type Roof Cover: Roof Structure: Frame: Grade: Story Height: No. Units: 0 Interior Data A/C %: 0% Electric: Heated %: N/A% Heat Type: Sprinkled %: 0% Heat Fuel: In7c.4e Total Areas Building Type: Effective Year: 2014 Secondary Wall: Primary Int Wall: Avg Hgt/Floor: 0 Primary Floors: Or Finished/UnderAir 0 Sketch (SF): unavailable Gross Area (SF): 0 for t7�iS(Jla)� Land Size (acres): 10.95 Land Size (SF): 476,982 Total Building Count: 1 Special Features and Yard Items Qty Units Year Bit This information is believed to be correct at this time but it is subject to change and is not warranted. ® Copyright 2017 Saint Lucie County Property Appraiser. All rights reserved. tt0://www.Daslc.ora/RECard/ 1 m /gym 7 8V699OWS TT9GTf Tat V'T•T n E 30 I abed ova 'E00'9-349 :pegezodxooux dam gotq�n suot�ipe snoinesd IIe se4eSosgo) 60/So '9I04 Ha 6LOZ/90/90 :3Mva NOIMVHIdx3 L60Z/901U :aanssl Siva mBT CUBTS allo eionj';Q II'48TTVToadS IeXuemuo=iAu3 :=IM �^ :dH a3AOHddv ,,,�,/� =ogoa=4uoo XuaM otydeS seXsap) :gUMIM 9TAea uai=H :dH SNOIMvaI3IOHdS 'OV3 'U)(£)£LO'9-349 q;Inn eouepj000e ul %ue; to tio6a;eo wnwlulw eql 6ugle;sul jot alglsuodsw sl wa;sAs aq; 6ugle;sul Io;oei;uoo pasueoll at ,pd6 OOL nog pa;ewgso le;o; a uo; '(woarpaq Iad Z) suosied b;10 /auedn000 wnwlxew a q;Inn swoapaq L Io; peZls sl W91SAS at H 3 H M 0 sHHONI [00'S9 1 :aHHIna3H NOIMVAVOxH S3Hoxi [00'17£1 :a3Hin63H ririxa a ri MNIod 3oNHH333H/xHVFHiON3H I MO'I3H HAOHH I Md SUHONI 1I00,91 1 3s OM ariaiami Ha ao NOMMOH a MNIOd 3oHHH333H/xHaNHON3H I MOrize =1I M3 S3HONI lI 00'0 1 HSIs NHMsds assodoud a0 NOIMYA3ri3 I lewoo /gaadad 3N Rq pM to lO @@ Inogewn;;o Isom INS :XavmoN3H do Noxzvooa a N I 1 clue [ 1 Hommu [xl :NoxivHn0I3NOo I 11 aNnox Ixl aaariia 11 auvaxvMs [ 1 :P=SAS &UM v P MSEs V/N S33a HHvaos I 1 H k=SAS Mau plagule10 xazg HHenbs N SL9 1 a 1 sdmndg snH 4Z H3d sasoal 10 SNOTMI 1 xmiovavo xNvM ONxsoa smomw I 1 x [SNoririvo OSZI:xNVM Hri9NIS xMIovdvo NnNlxvxl AXIOvdvo HolazoHSMNI Hswaso smoTIVJ [ 1 N xzxovdvo V/N ado / sxoririvo I 1 v xziovdvo MauogaaS WE / SNOririvO [ 099'6 1 M smoizvoI8Iozas aNv NvisHa waisxs 'XMHHdOHd SIHM 30 MNZWEVIHA3a H03 aHHInbHH ONIMMIKHHd ZvoO'I HO '3MVM3 lwaaas3 HHHMO HMIM 3omwimmoo ➢Ia" MNvoxridav an Magma SON saoa MINH3d SIHM do 3oNvnssI 'ai°A ONv Tum 3avx oxias: ZxNH3a sIHM NI rmsau XVK 6NoIMVOIBxacm Sons 'HOIMvoIudav MINH3d ally x3IaOX OM MHVOIriddv 3HM HHInbuH 'MINHHd SIHS 30 3oNVnSSI HOa SISVH v Sv aHAHHS HOIHN 'SMova Wl-duMVN NI 3OMHO xNV 'SWIM 3o mium OI3IO3ds my Ho3 Hommo3HHd xH°SovasxSvs amixvavna SON S30a N3Ss2Ls do Tmmidv MN31VMHvd3cl 'O'v'a 19-349 HUMavHo aNv " s'a 'S900'I8E NOIMo3S a0 SaHHONvMs aNv sNOIMvoIaxoads HMIM 3ONVclHOOov NI azionHMSNoo as ISDN P MSAS NiaamN ax xvM Ho] 9-000-6000-OOL-96ZZ :q ax 7MH3aoda [H3eNaN 'IHOHVd 'ZONVH '8IH3NMOM 'NOIMo351 :NoislAlasns :xooris L :Mori : ssaucav xMHHdoHd 546b£'1d 'Gould PO=l buIMMN pue asnoq ulelN 'jO Ie;S way;noS SZOOZ UMMid mmmoa : axva 333 :axva 3zva 669L6£4dV:# Noilvoxriddv M90Wds-99:0 xlmaa MaN SUSO .13XUHa wowlV OPOPE43 :zHaOxriadv :Hod MIWH3d NoxzonHzsmoo wmsas zasoasia amw xmw- vzam uo wlss msisxo Hs7VZH ao xammuvasa eaimia $o asvas NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: -# 56-SF-1806241 BILL DOC a.56-BID-3636470 CONSTRUCTION APPLICATIONM AP1317611 RECEIVED FROM: Kerner Survevinq, Inc AMOUNT PAID: $ 400.00 PAYMENT FORM: CREDIT CARD PAYMENT DATE: 12/01/2017 MAIL TO: Charlotte Almore FACILITY NAME: PROPERTY LOCATION: 20005 Southern Star Main House Dr Fort Pierce, FL 34945 7 Lot: Block: Property ID: 2215-700-0009-000-8 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge -1 - OSTDS Construction Application and Plan Review,New 126 - OSTDS Construction Permit (New or Mod, Amendment) 127 - OSTDS Construction System Inspection 133 - OSTDS Construction Reinspection 1 $ 15.00 1 $ 100.00 1 $ 100.00 1 $ 55.00 1 $ 75.00 1 $ 50.00 RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3446459 59-sr. -nyowry/ Todd N. Smith, PE, Inc. 914 20' Place Vero Beach, Fl. 329560 772-559-3699 tape@bellsouth.net November 29, 2017 Brian Ingram St. Lucie County Environmental Health Services 5150 NW Milner Dr. Port St. Lucie, F134983 RE: 20005 Southern Star Dr., Ft. Pierce Dear Mr. Ingram: It is my understanding that the 3 houses on the referenced property is being considered by the Health Dept. as one combined area. The contractor proposes to split the lot flows for each respective house. Whereby, the flows would be 300 gpd for each 3 bedroom house < 2250 sq living area and 400 gpd for the 4 bedroom house < 3300 sq ft living area as per 64E6. We have no objection to this type of analysis and find that it complies with the requirements of 64E-6. Additionally, combining the flow for the main house and house #2 will be 700 gpd and the stand alone flow for house #1 will be 300 gpd. Therefore, one septic system shall serve the main house and house #2 and the other system would be designed to serve the stand alone house #3. Please call me if you have any questions. Sincerely. 0% t, Sul -. . Iii��� .� OF Z*• S�Q:'=;: Todd N. SmithyP ,� Fl. Engineer's L�fiF�B'' �G.` CC: Brian Davis - Brian Davis Septic & Backhoes Services, Inc. .MA (/V �- f��IV>t STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: (4 3 New System [ ] Existing System [ ] Bolding Tank I 3 Repair [ 1 Abandonment [ ] Temporary Wi,IP 5s170.01 PERMIT NO..F JAPjeZVj DATE PAID: FEE PAID: RECEIPT ps [ 7 I ] Innovative APPLICANTS Charlotte Almore AGENTS KARNBR SURVEYING INC TELEPHONE(772) 288 7206 MAILING ADDRESS:.2740 SW MARTIN DOWNS BLVD #333 PALM CITY PL. 34990 ....... a..ur. r trot... r..m.m... " I..tram.am.mrrmuarrmrmrmmramraormmrarrvrvmmrmvmrm...ry TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.109(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE TES LOT WAS CREATED OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. ar...r000uuvor.r..¢r uru.md¢ammaru urro aeaaavmn.¢mrrrmrrvr...............m..mr. PROPERTY INFORMATION LOT: 1 BLOCKS N/A SUBDIVISION: Southern Star Stables PLATTED: 6/2006 PROPERTY ID 1!: 2215-700-0009-000-8 ZONING: -,&;;L— I/M OR EQUIVALENT! [ Y PROPERTY SIZE: 10.96 ACRES WATER SUPPLY: I/3 PRIVATE PUBLIC I 3<r2000GPD I )>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS7 I Y / N1 DISTANCE TO SRWBR: PROPERTY ADDRE98: Southern Star Drive, Fort Pierce, F1. 34945 DIRECTIONS TO PROPERTY: star - orooerty is at t BUILDING INFORMATION Unit Type of No Establisbment 1 RESIDENCE AAA44-, 2 14c, U 4Zr 3 i^W� 4 [ ] Floor/Equipment Drains SIGNATURES (A RESIDENTIAL [ 7 COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Scift Table 1 Chapter 64E-6 FAC �— N LZ 3 ) 3 Other (Specify) -�7 __... DATE: G � DB 4015, 10/97 (Previous Editions May Be Used) ONLINE VERSION Page 1 of 4 ENCHMARE/REFERENCE POINT LOCATION: ��'m aC t0 r LEVATI00 OF PROPOSED SYSTEM SITE I STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT #. 5,6 -51" 'To � Zq% PPLICANT: Charlotte Almore AGENT: KARNER SURVEYING INC OT: 7 BLOCKt N/A SUBDIVISION: Southern Star Stables Ron= ID #:2215.700-0009-000-8 [Section/TOwnahip/Parcel NO. or Tax ID Number] 0 BE COMPLETED BY ENGINEER, HEALTH DEPARTMMNT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGnOMRS UST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL RACE PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. �1411PM4- ROPSRTY SIZE CONFORMS TO SITE PLANS L41 YES L I NO NET USABLE LD.96 A/C ACRES OTAL ESTIMATED SEWAGE FLOWS 7f.��GALLONS PER DAY RE, �GPDFO!ISOO [ /OTEER-TABL827 t �G UT80RIZED SEWAGE BLOWS w GALLONS PER DAY GPD/ACREI NQBSTRUCTED AREA AVAILABLE: - SQPT UNOBSTRUCTED AREA REQUXREDv- 3/,� SQFT le=A�4f) -HZ 24nmm SETBACK WHICH'CAN BE MAINTAINED FROM THE POSED SYSTEM TO THE FOLLOWING FEATURES ,URFACE WATER: d4 FT DITCHES/ QPJRLEB: ./ 4'- FT N�'�Y WET? I 7 YES L NO (ELLS: PUBLIC: FT LIMITED USE: iI- FT PRIVATE: On PT NON-POTABLE:'A FT IUILDIN6 FOUNOATI0N3: / L P'P PROPERTY LINES; �FT POTABLE WATER LINES: c U FT SITE SUBJECT TO FREQUENT FLOODING: [ ] �/J NO 10 YEAR FLOODING? YES vh NO .0 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/HGVD TO TO TO OBSERVED WATER TABLE: 2 z- INCHES [ABOVE ESTXb90EDD NET SEASON WATER TABLE ELEVATION:_ HIGH WATER TABLE VEGETATION: 17 YES I/w NO SOIL TZ=VRZ/LQADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGORATION:. [�7 '�' mll ` [ 7 /BED fii� /3AS.,,i1 cam. SITE EVALUATED BY Se EXISTING GRADE. TYPE: �HED / 7 INCHES [ABOVE /L jSL0 EXISTING GRADE rT/LING: [A -YES 17 NO DEPTH; INCHES n DEPTH OS EXCi\VATSOt:: � � INCHZ9 VH 4015, 09/09 (lmeolrrtet pr*viow .dit►onr. which Gay not be erred) Incorporated: 84H-8.009. FAC Page 3 Of 4