HomeMy WebLinkAboutSewage1�
STATE OF FLORIDA
DEPARTMENT OF HEALTH
P ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #.
APPLICANT: Francisco & Peggy Perez AGENT: Alexander J. Piazza PSM, Inc.
LOT: na BLOCK: na SUBDIVISION:
PROPERTY ID # : 2310-412-0002-000-7 [ Tax ID Number
na
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: 5.00 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 767 GALLONS PER DAY [RESIDENCES -TABLE VOTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1200 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS34 [INCHES/FT ] [ABOVE/BELOW'] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:100 FT DITCHES/SWALES:15 FT NORMALLY WET? [ [ YES [✓] NO
WELLS: PUBLIC:200 FT LIMITED USE:100 FT PRIVATE:75 FT NON—POTABLE:100 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? [ ] YES 1�/] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION : FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE:40+ INCHES [BELOW q EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES ABOVE BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [.�'] TRENCH [ ]
REMARKS/ADDITIONAL CRITERIA:
BED
DEPTH OF EXCAVATION: INCHES
[ ] OTHER (SPECIFY)
igi a ysigne
,, D,:I =Una 811at2d,_er A01a4z2za7E0000016581 EE3C9600001981,—AlexanderAIQvander J Piazza
am
SITE EVALUATED BY: Dte:2019.01.3116.04:1645'00' DATE: 1-31-19
DH 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
Unit Type of No. of
No Establishment Bedrooms
1 RESIDENCE 4
2
3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL°
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
New System [ ] Existing System [ ] Holding Tank
[ ] Repair [ ] Abandonment [ ] Temporary
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
[ ] Innovative
[ l
APPLICANT: Francisco & Peggy Perez
AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE: 772-340-7770
MAILING ADDRESS: 619 SW Biltmore Street, Port St. Lucie, Florida 34983
TO BE COMPLETED BY 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
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT: na BLOCK: na SUBDIVISION: na PLATTED: na
PROPERTY ID #: 2310-412-0002-000-7 ZONING: R I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 5.00 ACRES WATER SUPPLY: [,/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER;.- FT
PROPERTY ADDRESS: Orange Avenue, Fort Pierce, FL
DIRECTIONS TO PROPERTY: SEE MAP
BUILDING INFORMATION [v/] RESIDENTIAL [ ] COMMERCIAL
Building Commercial/Institutional System Design
Area Sqft Table 1, Chapter 64E-6, FAC
3,783
4
[ ] Floor/Equipment Drains Other (Specify) GARBAGE GRINDERS / DISPOSALS
t Diaihllysia dby Alex &,J Pia
Alexander J Piazza DN.
N r—US, filie d owA07417E0W0016581EP3C96000019a1,cn=Alexan&rJ
SIGNATURE: j Dec 2019.01.3116A0:33-0S'W DATE: 1-31-19
DH 4015, 08/09 (Obsoletes previous editi6ns which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
s
STHATE OF FLORIDA
•
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Francisco & Peggy Perez .
PROPERTY ADDRESS: TBD Orange Ave Fort Pierce, FL 34945
LOT: BLOCK: SUBDIVISION:
PROPERTY ID # : 2310-412-0002-000-7
PERMIT #: 56-SF-1 927626
APPLICATION #:AP1400084
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT # : PR1207524
[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 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 [ 1,350 ] GALLONS / GPD Septic new CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ j GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 834 ] SQUARE FEET Drainfleld new SYSTEM "
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ j STANDARD A ] FILLED [X] MOUND. [ ]
I CONFIGURATION: [ ] TRENCH [X] BED [ ]
N
F LOCATION OF ,BENCHMARK: orange painted nail in fence post S of system
I ELEVATION OF PROPOSED SYSTEM SITE [ 10.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 6.00 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L ,
D
O
T
H
E
R
:=Lr, xsQaxxED: [GL.UU] INCHES EXCAVATION REQIIIRED: [ ] INCHES
f00
he system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
,
SPECIFICATIONS BY: Brian J Ingr TITLE: Environmental Specialist II
c APPROVED BY: it— r^"^ —TITLE: Environmental Specialist II St. Lucie CHD
Brian J Ingr
io
DATE ISSUED: 03/18/2019 EXPIRATION DATE: 09/18/2020
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1400084 . SE1157285
NOTICE OF RIGHTS
�� O
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 Js 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.
� C
AW
HEALTH
PAYING ON:
-RECEIVED FROM:
PAYMENT FORM:
St. Lucie'County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
#: 56-SF-1927626 BILL ooc #:56-BID-4087241 CONSTRUCTION APPLICATION #: AP1400084
Alexander J. Piazza PSM, Inc AMOUNT PAID: $ 515.00
CHECK 156 PAYMENT DATE: 02/26/2019
MAIL TO:, Francisco & Peggy Perez
FACILITY NAME:
PROPERTY LOCATION:
TBD Orange Ave
Fort Pierce, FL 34945'
Lot:
Block:
Property ID: 2310-412-0002-000-7
EXPLANATION or DESCRIPTION:
128 - OSTDS Construction System Inspection Research Fee
-1 - Surcharge (All)
-1 - OSTDS New Permit Surcharge
-1 - OSTDS Construction Application and Plan Review,New
123 - OSTDS Construction Site Evaluation
126 - OSTDS Construction Permit (New or Mod, Amendment)
127 - OSTDS Construction System Inspection
133 - OSTDS Construction Reinspection
QUANTITY
FEE
1
$
5.00
1
$
15.00
1
$
100.00
1
$
100.00
1
$
115.00
1
$
55..00
1
$
75.00
1
$
50.00
RECEIVED BY: MontanezNM
AUDIT CONTROL -NO. 56-PID-3865206
Q, STATE OF FLORIDA
`j DEPARTMENT OF HEALTH
= ONSITE SEWAGE TREATMENT AND DISPOSAL
�.� SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
New System [ ] Existing System [ ] Holding Tank
( ] Repair [ ] Abandonment [ ] Temporary
APPLICANT:
Francisco &
Perez
PERMIT NO. 5f -� a,(Qa�
DATE PAID:
FEE PAID: 11V 0
RECEIPT #: wa::5, 0
[ ] Innovative
AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE: 772-340-7770
MAILING ADDRESS: 619 SW Biltmore Street, Port St: Lucie, Florida 34983
TO BE COMPLETED BY 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
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT: na BLOCK: na SUBDIVISION:
na
PLATTED: na
PROPERTY ID #: 2310-412-0002-000-7 ZONING: R I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 5.00 ACRES WATER SUPPLY: [�/] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0.065, FS? [ No ]• DISTANCE TO SEWER: FT
PROPERTY ADDRESS: Orange Avenue, Fort Pierce,FL
DIRECTIONS TO PROPERTY: SEE MAP
BUILDING INFORMATION
Unit Type, of
No Establishment
1 RESIDENCE
2 V—m I b oy C
3 5,—Vow-
4
[✓] RESIDENTIAL [ ] COMMERCIAL -
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
4 3,783
0 3 DO
] Floor/Equipment Drains [ ,/ ] Other (Specify) GARBAGE GRINDERS / DISPOSALS
DiSiWly sipcd by Alcxund"j rime
Alexander J Piazza ON:n=US,o-Umlfliuia,nu=AnIa27LOgXN1G5811i17C96000IYBI.rn=Aleandcl
SIGNATURE: P,*—
t)ule:2U19.n1A MA4ll.05-W DATE: 1-31-19
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1=of 4
0
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Francisco & Peggy Perez
CONTRACTOR / AGENT: Alexander J. Piazza PSM. Inc
LOT: BLOCK:
SUBDIVISION: ID# : 2310-412-0002-000-7
APPLICATION # AP1400084
PERMIT # 56-SF-1927626
DOCUMENT # SE1157285
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE
REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 5.02 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 12549.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 1 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1250.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Orange painted nail in fence post S Of
ELEVATION OF PROPOSED SYSTEM SITE 10.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM.THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: .15 FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 40 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SATT. PRAFTT.F. TWrnRMnmrnN eTTF 9
USDA SOIL SERIES:Riviera fine sand
Munsell #/Color Texture
Depth
10YR 5/1
Fine Sand
0 To 13
1 OYR 5/3
Fine Sand
13 To 26
1OYR 5/2.
Fine Sand
20 To 26
10YR 7/4
Sand
26 To 41
10YR 5/2
Sandy Clay Loam
41 To 57
1 OYR 512
Loamy Sand
57 To 72
USDA SOIL SERIES:Riviera fine sand
Munsell #/Color Texture
Depth
10YR 4/1
Sand
0 To 14
1 OYR 5/2
Sand
14 To 24
1 OYR 5/1
Sand
21 To 29
10YR 7/4
Sand
29 To 40
1 OYR 5/2
Sandy Clay Loam
40 To 55
10YR 5/2
Loamy Sand
55 To 72
OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE /BELOW ] EXISTING GRADE TYPE: ( PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 20 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 20.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES
,DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY)
r REMARKS/ADDITIONAL CRITERIA
VT determined using USDA WSS and soil borings.
t5/2 stripping in 10YR5/3 matrix >10% w/ diffuse boundaries starting at 20" in Sal.
10" below BM. S62 9" below BM.
SITE EVALUATED BY:
Ingram, Brian (TitlelEnvironmental Specialist II) (ENVIRONMENTAL HEALTH)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
AP1400084 EID1927626
DATE: 03/05/2019
Page 3 of 4
v 1.0.2
STATE OF FLORIDA
'Y DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #. �G�SF' iy27CoZ�G
APPLICANT: Francisco & Peggy Perez AGENT: Alexander J. Piazza PSM, Inc.
LOT: na BLOCK: na SUBDIVISION: na
PROPERTY ID # : 2310-412-0002-000-7 [ Tax ID Number
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE;OR OTHER QUALIFIED PERSON. ENGINEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: 5.00 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 767 GALLONS PER DAY [RESIDENCES -TABLE I/OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE,OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1200 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS34 [INCHES/FT ] [ABOVE/BELOW'] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:100 FT . DITCHES/SWALES:15 FT NORMALLY WET? [ [ YES [✓] NO
WELLS: PUBLIC: 200 FT LIMITED USE: 100 FT PRIVATE: 75 FT NON —POTABLE: 100 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES:. FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? ( ] YES [,/] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE -INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE
DEPTH
TO
TO
TO
TO
TO
mn
TO
TO
TO
USDA SOIL SERIES:
bul-L PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
mn
TO
TO
TO
TO
Tn
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE:40+ INCHES [BELOW r] EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [,ABOVE/BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ [ YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
7RAINFIELD CONFIGURATION: [./] TRENCH [ ] BED ( ] OTHER (SPECIFY)
-2EMARKS/ADDITIONAL CRITERIA:
uignal1111,"I'A.......
..—
Alexander J Piazza DN;rUS.o UnafiBated.oU=A014DE0000016581EE3C9600001981.,n=Nezander
SITE EVALUATED BY: 1P1a�
Date zo,9.o,31,6oa:,6-asroo DATE: 1-31-19
)H 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
5_&.- 5F_ /9 2 7CoZ co
APPLICANT'S NAME:
LEGAL DESCRIPTION:
Francisco & Peggy Perez
2310-41 2-0002-000-7
r
IN
Z certify that there are no potable private wells within 75 feet of the available area for the
proposed septic system, that there are no non -potable wells within 50 feet of the available area
for the proposed septic system,. that there are no wells within 25 feet of a pesticide -treated
building foundation; that there are no public wells that serve less than 25 people or less than-
15 homes or businesses within 100 feet of the proposed septic system, that there are no public
wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of
the proposed septic system, that the water line from the water meter or well to the structure is
at least t•0 feet from the available area for the proposed septic system unless the plans show
the line to be double sleeved,. that there is not a gravity sewer line, low pressure sewer line or
vacuum sewage line in a -public easement or right-of-way that abuts the property, that there
are no lakes, streams, wetlands, or surface water within 75 feet of the available area for the
proposed septic system unless the property was created prior to 1972, that the septic system is
proposed on the side of the lot farthest from surface water, that all private wells, septic
systems and surface .water on adjacent or contiguous land within 75 feet of the applicant's lot
are shown on the site plan, that all public wells within 200 feet -of the applicant's lot are
shown on the site plan, and that the location of building or residences, swimming pools,
recorded easements, paved areas or driveways, sidewalks, the general slope of the property,
filled areas, drainage features, and surface waters such as lakes, ponds, streams, canals, or
wetlands are shown on the applicants lot.
The natural grade elevation in the area of the. proposed septic system and the benchmark must
be shown on the site plan. Please. locate the benchmark within 200 feet of the proposed septic
system.
NOTE: MUST BE CERTIFIED BY A FLORIDA
REGISTERED SURVEYOR OR ENGINEER.
DgIPollysigned by IL, W. ml Plaaa
Alexander J Piazza °"` '�'�'
ou=AQ142dE DI65BIEF3C9600001981,
Al
CERTIFIED BY. Date 2019D73116.U256-05W
FLORIDA PROFESSIONAL NO.: 6330
DATE: 01 /31 /19 16D NO.: 17-3366
dots/ro rms/septics/Sep ti cAppp Page207
APPLICANT'S NATME: Francisco &Peggy Perez
LEGAL DESCRIPTION: 2310-41,2-0002-000-7
I certify that there are no potable private wells within 75 feet of the available area for the
proposed septic system, that there are no non -potable wells within 50 feet of the available area
for the proposed septic system,. that there are no wells within 25 feet of a pesticide -treated
building foundation; that there are no public wells that serve less than 25 people or less than-
15 homes or businesses within.100 feet of the proposed septic system, that there are no public
wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of
the proposed septic system, that the water line from the water meter or well to the structure is
at least 10 feet.from the available area for the proposed septic system unless the plans show
the line to be double sleeved,. that there is not a gravity sewer line, low pressure sewer line or
vacuum sewage line in a public easement or right-of-way that abuts the property, that there
are no lakes, streams, wetlands, or surface water within 75 feet of the available area for the
proposed septic system unless the property was created prior to 1972, that the septic system is
proposed on the. side of the lot farthest from surface water, that all private wells, septic
systems and surface water on adjacent or contiguous land within 75 feet of the applicant's lot
are shown on the site plan, that all public wells within 200 feet of the applicant's lot are
shown on the site plan, and that the location of building or residences, swimming pools,
recorded easements, paved areas or driveways, sidewalks, the general slope of the property,
filled areas, drainage features, and surface waters such as lakes, ponds, streams, canals, or
wetlands are shown on the applicants lot.
The natural grade elevation in the area of the. proposed septic system and. the benchmark must
be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic
system.
NOTE: MUST BE CERTIFIED BY A FLORIDA
REGISTERED SURVEYOR OR ENGINEER.
( D111ft1 19i dbyAlexaedel7—
Alexander J Piazzakou=AVI4]7E000OO1I6581EE3C9680001981,
CERTIFIED BY:
!,f .'Date 1201901.31 16.03L"5'00'
FLORIDA PROFESSIONAL NO.: 6330
DATE: 01 /31 /19 JOB NO.' 17-3366
does/forms/sep tics/SepticAppp Page207