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HomeMy WebLinkAboutHealth Department Septic Approval i ' PERMIT #;56-SF-1741002 y APPLICATION #:AP1276646 STATE OF FLORIDA DATE PAID: DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: e DOCUMENT #: PR1051116 CONSTRUCTION PERMIT FOR: OSTDS New -APPLICANT: Demetrio Garcia PROPERTY ADDRESS: 4735 Selvitz Rd Fort Pierce, FL 34981 LOT: 1/2/3 BLOCK: SUBDIVISION: Model Land Company PROPERTY ID #: 3406-501-0004-000-1 [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 j" 1,200 ] 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 [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 767 ] SQUARE FEET Drainafield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [x] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: Site BM fnd bolt near front of property(elev 17.95') I ELEVATION OF PROPOSED SYSTEM SITE [ 17.00 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 15.00 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT -L D FILL REQUIRED: [ 16.001 INCHES EXCAVATION REQUIRED: [ ] INCHES The system is sized for 5 bedrooms with a maximum occupancy of 10 persons(2 per bedroom),for a total estimated flow of =O 460 gpd. T The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with H s.64E-6.013(3)(0, FAC. E R SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II APPROVED BY: , TLE: Environmental Specialist II St. Lucie CHD Brian J lngr06 DATE ISSUED: 02/27/2017 EXPIRATION DATE: 08/27/2018 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 AP1276646 SE1024470 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 HKTH PAYING ON: PERMIT#•56-SF-1741002 13ILLDOC#:56-BID-3349000 CONSTRUCTION APPLICATION#:AP1276646 RECEIVED FROM: Alexander J. Piazza PSM, Inc AMOUNT PAID: $515.00 PAYMENT FORM: CHECK 3701 PAYMENT DATE: 02/17/2017 MAIL TO: Demetrio Garcia FACILITY NAME : PROPERTY LOCATION: 4735 Selvitz Rd Fort Pierce, FL 34981 1/2/3 Lot: Block: Property ID: 3406-501-0004-000-1 EXPLANATION or DESCRIPTION: QUANTITY FEE -1 - OSTDS Construction Application and Plan Review,New 1 $ 100.00 123- OSTDS Construction Site Evaluation 1 $ 115.00 126- OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127- OSTDS Construction System Inspection 1 $ 75.00 128- OSTDS Construction System Inspection Research Fee 1 $ 5.00 .133- OSTDS Construction Reinspection 1 $ 50.00 -1 -Surcharge (All) 1 $ 15.00 -1 - OSTDS New Permit Surcharge 1 $ 100.00 RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-3186578 STATE OF FLORIDA PERMIT N0. DEPARTMENT OF HEALTH DATE PAID: oZ ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: $� SYSTEM RECEIPT #: l q35 q � ( APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ l Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ l Abandonment [ ] Temporary APPLICANT: Demetrio Garcia � SBVS � � bwg.6 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: 1/2/3 BLOCK: - SUBDIVISION: Model Land Company PLATTED: PROPERTY ID #: 3406-501-0004-000-1 ZONING: R I/M OR EQUIVALENT: [ NO ] PROPERTY SIZE: 4.617 ACRES WATER SUPPLY: [ ,(] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: - FT PROPERTY ADDRESS: 4735 Selvitz Road,Fort Pierce DIRECTIONS TO PROPERTY: SEE MAP • BUILDING INFORMATION [ ✓ ] RESIDENTIAL COMMERCIAL[ ] Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 RESIDENCE 5 2,783 2 3 4 [ ] Floor/Equipment -Drains Ly1] `Other (Specify) GARBAGE GRINDERS/DISPOSALS SIGNATURE: / '! �- i`y r �_^,.-7 DATE: 1-13-2017 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 1 STATE OF FLORIDA APPLICATION # AP1276646 Y DEPARTMENT OF HEALTH 56-SF-1741002 PERMIT # ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM 4 SITE EVALUATION AND SYSTEM SPECIFICATION DOCUMENT # SE1024470 APPLICANT: Demetrio Garcia CONTRACTOR / AGENT: Alexander J. Piazza PSM, Inc LOT: 1/2/3 BLOCK: SUBDIVISION: Model Land Company ID#: 3406-501-0004-000-1 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: 4.62 ACRES TOTAL ESTIMATED SEWAGE FLOW: 460 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: 6929.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1250.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1150.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM fnd bolt near front of property(elev 17.95') ELEVATION OF PROPOSED SYSTEM SITE 17.00 [ 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: FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON-POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 22 FT POTABLE WATER LINES: 45 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES EX]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 SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Tantile sand USDA SOIL SERIES:Tantile sand Munsell#/Color Texture Depth Munsell#/Color Texture Depth 1 OYR 5/2 Sand 0 To 8 1 OYR 4/2 Fine Sand 0 To 10 1 OYR 3/2 Sand 8 To 19 1 OYR 3/2 Fine Sand 10 To 21 1 OYR 4/1 Sand 19 To 22 1 OYR 4/1 Sand 21 To 25 1 OYR 5/1 Sand 22 To 33 1 OYR 5/1 Sand 25 To 37 1 OYR 6/1 Fine Sand 33 To 44 1 OYR 6/1 Sand 37 To 44 1 OYR 2/1 Fine Sand 44 To 49 5YR 2.5/1 Spodic Material 44 To 62 5YR 2.512 Spodic Material 49 To 63 7.5YR 3/3 Sand 62 To 72 7.5YR 3/2 Fine Sand 63 To 72 OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 26 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 26.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR6/1 stripping in 10YR5/1 matrix,>10%with diffuse boundaries starting at 26"in SB1. S81 17"above BM.SB1 18"above BM. SITE EVALUATED BY: DATE: 02/24/2017 Ingram,Bria Tltle:Environmental Specialist II)(ENVIRONMENTAL HEALTH) DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1276646 EID1741002 v 1.0.2 1 o� STATE OF FLORIDA PERMIT DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: Demetrio Garcia AGENT: Alexander J.Piazza PSM,Inc. LOT: 1/2/3 BLOCK: - SUBDIVISION: Model Land Company PROPERTY ID #: 3406-501-0004-000-1 [Tax ID Number 7 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: 4.617 ACRES TOTAL ESTIMATED SEWAGE FLOW: 833 GALLONS PER DAY [RESIDENCES-TABLE 1/OTHER-TABLE2 ] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1250 SQFT UNOBSTRUCTED AREA REQUIRED: 1250 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? [ I YES I✓] NO WELLS: PUBLIC: 200 FT LIMITED USE: 100 FT PRIVATE: 75 FT NON-POTA13LE: 100 FT BUILDING FOUNDATIONS: S FT PROPERTY LINES: 10 FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ 1 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 SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE DEPTH MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: USDA SOIL SERIES: OBSERVED WATER TABLE: 40+ INCHES [BELOW T7 EXISTING GRADE. TYPE: [PERCHED/APPARENT ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES ABOVE BELOW ] EXISTING GRAD]. HIGH WATER TABLE VEGETATION: ' [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHE; SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHE; DRAINFIELD CONFIGURATION: [V(] TRENCH [ ] BED ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: i.�. d., � :.--�� _ � DATE: 1-13-2017 w y Ds 4015, 12/11 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001,FAC Page 3 of APPLICA.I'NT'S NA.IME: Demetrio Garcia 17q/06P- LEGAL DESCRIPTION: S 1/2 of Lots 1,2 and 3, Model Land Company, Plat book 4, page 34 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 CERTIFIED BY: % REGISTERED SURVEYOR OR ENGINEER. FLORIDA PROFESSIONAL PTO.: DATt: 01/13/17 1"JOB NO.: 1 2689 dots/Con-ns/septics/SepticApppPage207 � " t _ r , r-i I _ C:�eriaway Rd _ �� I i Property Card ; Page 1 of Michelle Franklin, CFA--Saint Lucie County Property Appraiser--All rights reserved. Property Identification Site Address:4735 Parcel ID:3406-501-0004- Account#:40085 Sec/Town/Range: SELVITZ RD 000-1 06/36S/40E Map ID:34/06N Zoning:AR-1 Use Type:0000 Jurisdiction:Saint Lucie County Ownership Legal Description Demetrio Garcia MODEL LAND CO'S S/D OF 6-36-40 N 220 FT OF S 1/2 OF 697 NW Archer Ave LOTS 11 2 AND 3-LESS E 50 FT OF LOT I-IN NE 1/4-AND Port St Lucie,FL 34983 LESS RD R/W AS IN OR 3357-2824(4.62 AC)(OR 3660-769) Current Values Historical Values 3-year Just/Market: $113,800 Assessed: $83,490 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $83,490 2016 $113,800 $83,490 $0 $83,490 2015 $75,900 $75,900 $0 $75,900 2014 $75,900 $75,900 $0 $75,900 Sale History Date Book/Page Sale Code Deed Grantor Price 07-25-2014 3660/0769 0001 WD Kuro,Nellie R $90,000 06-01-1979 0311/2696 XX00 CV $86,000 05-01-1972 0202/1987 XX00 CV $45,000 Primary Building Information Finished Area of this building:0 SF Gross Area of this building:0 SF Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built:N/A Frame: Grade: Effective Year:2014 Primary Wall: Story Height: No.Units:0 Secondary Wall: Interior Data Bedrooms:0 A/C%:0% Electric: Primary Int Wall: Full Baths:0 Heated%:N/A% Heat Type: Avg Hgt/Floor:0 Half Baths:0 Sprinkled%:0% Heat Fuel: Primary Floors: Total Areas j 3, t a<�' " �`;✓ Finished/Under Air 0 r (SF): t ' Gross Area(SF): 0 Land Size(acres): 4.62 Land Size(SF): 201,247 Total Building Count: 1 Special Features and Yard Items Type Qty Units Year Blt 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. ttp://www.paslc.org/RECard/ 2/17/2017 i APPLICATION #:AP1276646 } r STATE OF FLORIDA PERMIT #:56-SF-1741002 DEPARTMENT OF HEALTH DOCUMENT #:FI 1264205 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM 10/04/2017 CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID: -hoop • FEE PAID:140.00 RECEIVED RECEIPT #:56-PI D-3403153 APPLICANT: Demetfi0 Garcia CFO a A?Q19 AGENT: Ralph Chapin Permitting_Departrnenr PROPERTY ADDRESS: 4735 Selvitz Rd Fort Pierce FL 34981 St Lucie Cokmtv LOT: 1/2/3 BLOCK: SUBDIVISION: Model Land Company ID#: 3406-501-0004-000-1 CHECKED [XI ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [1] 1250.00 [2] [ ] 127] SURFACE WATER FT [ ] [02] TANK MATERIAL Concrete [ ] [281 DITCHES 100+ FT [ ] [031 OUTLET DEVICE [ ] (291 PRIVATE WELLS 75 FT [ ] [04] MULTI-CHAMBERED [ Y N ] [ ] [301 PUBLIC WELLS FT [ ] [051 OUTLET FILTER Polylok PL-68 [ ] 1311 IRRIGATION WELLS FT [ ] [061 LEGEND 1. 28-015-16DC3 2. [ ] [321 POTABLE WATER 55 FT [ ] [07] . WATERTIGHT [ ] [331 BUILDING FOUNDATIONS 8 FT [ ] [081 LEVEL [ ] [34] PROPERTY LINES 33 FT [ ] [091 DEPTH TO LID [ ] 135] OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ ] 1101 AREA [1] 812 [2] SQFT [ ] [361 DRAINFIELD COVER [ ] 111] DISTRIBUTION BOX HEADER X [ ] [371 SHOULDERS [ ] [12] NUMBER OF DRAINLINES 'I. 5.00 2. [ ] [381 SLOPES [ ] [13] DRAINLINE SEPARATION [ ] [39] STABILIZATION 02/05/2019 [ ] [141 DRAINLINE SLOPE [ ] [151 DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / BELOW ]BM 22.00 [ ] [401 UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION [ ] [411 STORMWATER RUNOFF [ ] [181 DOSING PUMPS [ ] [42] ALARMS [ ] [19] AGGREGATE SIZE [ ] [43) MAINTENANCE AGREEMENT [ ] [20] AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA [ ] [211 AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL [ ] [46] FINAL SITE GRADING [ ] [22] FILL AMOUNT [ ] [47] CONTRACTOR Ernesto Gamez(SEPTIC EN [ ] [231 FILL TEXTURE [ ] [481 OTHER INFILTRATOR EQ36(Single Chambe [ ] [24] EXCAVATION DEPTH ABANDONMENT [ ] [25] AREA REPLACED [ ] [49] TANK PUMPED [ ] [261 REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED Comments: Comments are on page 2. lei CONSTRUCTION [ APPROVED / St. Lucie CHD DATE: 05/30/2018 DISAPPROVED ]' Enviro ental Supervisor I=May(Floridartment of Healt FINAL SYSTEM [ APpROVED / DISAPPROVED ]: Lucie CHU DATE: 02/05/2019 Environmental Specialist II Bri J Ingram(ENVIRONMENTAL HEALTH) (Explanation of Violations on following page) DE 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 AP1276646 EID1741002 1 APPLICATION #:14P1276646 ? r t STATE OF FLORIDA PERT #:56-SF-1741002 MI DEPARTMENT OF HEALTH DOCUMENT #:F 11264205 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:10/04/2017 •� VMS FEE PAID:140.00 RECEIPT #:56-PID-3403153 Violation Number Comment Comments The system is sized for 5 bedrooms with a maximum occupancy of 10 persons(2 per bedroom),for a total estimated flow of 460 gpd. New ST and DF installed 5x 6.6 chambers long. Infiltrator EQ36 Quickcut chambers used. No violations observed,system ok to cover. Contractor notified onsite. Needs final for filled system and final site grading. Final system approved.Contractor and building department emailed final approval. i i DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 2 of 3 Incorporated: 64E-6.003, FAC EH Database v 1,0.1 AP1276646 HAD 1741002 r76 15-GO 35 IE APPLICATION #:-AP1276646 STATE OF FLORIDA PERMIT #:56-SF-1741002 DEPARTMENT OF HEALTH DOCUMENT #.:F11264205 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM ',y 5 CONSTRUCTION INSPECTION AND FINAL APPROVAL DATE PAID:10/04/2017 ter` ' FEE PAID•140•00 RECEIPT #:56-PID-3403153 APPLICANT: Demetri0 Garcia AGENT: Ralph Chapin PROPERTY ADDRESS: 4735 Selvitz Rd Fort Pierce, FL 34981 LOT: 1/213 BLOCK: SUBDIVISION: Model Land Company ID#: 3406-501-0004-000-1 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [1] 1250iOO [2] [ ] [27] SURFACE WATER FT [ ] [02] TANK MATERIAL Concrete [ ] [28] DITCHES 10Qt FT [ ] [03] OUTLET DEVICE [ ] [2'9] PRIVATE WELLS 75 FT [ ] .[04] MULTI-CHAMBERED [L_Yj N ] [ ] [301' PUBLIC WELLS FT [ ] [05] OUTLET' FILTER Polylok PL-68 [ ] [31] IRRIGATION WELLS FT [ ] [06] LEGEND 1. 28-015-16DC3 2, [ ] [32] POTABLE WATER 55 FT [ ] [07] . WATERTIGHT [ ] [33] BUILDING FOUNDATIONS 8 FT [ J [08] LEVEL [ ] [34] PROPERTY LINES 33 FT [ ] [0'91 DEPTH TO LTD [ ] [351 OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM [ ] [1'0] AREA [1] 812 [2] SQFT [ ] [361 DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX, HEADER X [ ] [37] SHOULDERS [ ] [12] NUMBER OF DRAINLINES 1, 5.00 2. [ ] [38] SLOPES [ ] [13] DRAINLINE SEPARATION [ ] [391 STABILIZATION 02/05/2019 [ ] [141 DRAINLINE SLOPE [ ] [15] DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / BELOW ]BM 22,00 [ ] [40] UNOBSTRUCTED AREA [ ] [17] SYSTEM LOCATION [ ] (41] STORMWATER RUNOFF L ] [la] DOSING PUMPS [ ] [42] ALARMS [ ] [19] AGGREGATE SIZE [ ] [431 MAINTENANCE AGREEMENT [ ] [20] AGGREGATE EXCESSIVE FINES [ ] [44] BUILDING AREA [ ] [211 AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL [ ] [4.6) FINAL SITE GRADING [ ] [22] FILL AMOUNT [ ] [4,71 CONTRACTOR Ernesto Gamez(SEPTIC EN [ ] [23] FILL TEXTURE [ ] [4B] OTHER INFILTRATOR EQ36(Single Chambe [ ] [24] EXCAVATION DEPTH ABANDONMENT [ ] [25] AREA REPLACED [ ] [491 TANK PUMPED [ ] [26] REPLACEMENT MATERIAL [ ] [50] TANK CRUSHED & FILLED Comments: Comments are on page 2. /17 CONSTRUCTION [ APPROVED / St. Lucie CHD DATE': 05/30/2018 DISAPPROVED ]' Ea=::z:=LLjde rtment of Healt FINAL SYSTEM [ APPROVED / DISAPPROVED ]: CHD DATE: .02/05/2019 Environmental Specialist If Bri J Ingram(ENVIRONMENTAL HEALTH) (Explanation of Violations on following page) DH 4016, 09/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 2 of: 3 EH Database v 1.0:1 AP1276646 EID1741002 0 APPLICATION # AP1276.6.46 STATE: OF FLORIDA PERMIT # 56=SF-1741002 DEPARTMENT OF HEALTH DOCUMENT # F11264205 �. ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM, ',y CONSTRUCTION INSPECTION AND. FINAL APPROVAL DATE .PAID 101.04/2017 FEE PAID:I 4 O.00 RECEIPT #:56-PID-3403153 Violation Number Comment Comments: The.system is sized for 5 bedrooms with a maximum occupancy of 10 persons(2 per bedroom);for a total:estimated flow'of 460 gpd• New ST and DF installed 5x`6 5 chambers:long. Infiltrator EQ36 Quickcut chambers used.No violations observed,system ok to cover:Contractor.notifed•onsite. Needs final for filled system and,final site-grading. Final system approved.Contractor and building department emailed final-approval. DH 4016,, 08-/0.9 (Obsoletes all previous editions which maY not be used) Page 2':of 3 Incorporated: 64E'-6,003, FAC EH Database v 1..0.1 AP1276646 EID174100T