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HomeMy WebLinkAboutRevisions (3) OFFICE USE ONLY:
DATE FILED:�6�--�- • 17 PERMIT# ` l J ' 07.
REVISION FEE: RECEIPT# a SY
PLANNING&DEVELOPMENT SERVICES
BUILDING&CODE REGULATION DMSION
Wiw2300 VIRGIMA A
• FORT PIERCE,FL 3498
ISION .
(772)462-1553 FAX(772)4 NEV .
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
1. LOCATION/SITE �� �'�Z x Z
upy
ADDRESS: C
2. DETAILED DESCRIPTION OF PROJECT
REVISIONS: / r
�/�l�/ LfjG°I��7 Uh P�(� dL tXll4li Gpn� 7l P 1�rru S�
3. CONTRACTOR INFORMATION:
STATE of FL REG./CERT.#: ST.LUCIE COUNTY CERT.#:
BUSINESS NAME:
QUALIFIERS NAME: -3 e• 2S 1 Y1�
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): - FAX: '7> -3 ^CSf-Z i_
4. OVMR/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX:
5. ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE(DAYTIME): FAX: ----—- ---___.--
Revised 07/22/2014
OCT f.7 2,017
PERMIT #:56-SF-1741002
I APPLICATION #:AP 1276646
STATE OF FLORIDA
y; DEPARTMENT OF HEATH DATE PAID
L
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM :r
RECEIPT #:
riLE d0WQ& D NT #: PR1061116
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 [ 1,200 ] GALLONS / GPD SeDtic 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 [ 575 ] SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [X] FILLED [ j MOUND [ ]
I CONFIGURATION: (X] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: Orange spot center of catch basin near center of E property line
I ELEVATION OF PROPOSED SYSTEM SITE [ 17.00 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 19.00 ] [ INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT
; L
D FILL REQUIRED: [20.001 INCHES EXCAVATION REQUIRED: [ 45.00 ] 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)(f), FAC.
UPDATED BENCHMARK AFTER REVISION
E
R
SPECIFICATIONS BY:ff!:��TITLE:
TIC: Environmental Specialist II
APPROVED BY: Environmental Specialist II St. Lucie CHD
Brian J Ingr .
DATE ISSUED: 02/27/2017 il 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 SE1024469
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
HEALTH
PAYING ON: PERMIT#:56-SF-1741002 BILLDOC#:56-BID-3603500 CONSTRUCTION APPLICATION#:AP1276646
RECEIVED FROM: Alexander J. Piazza PSM, Inc AMOUNT PAID: $ 140.00
PAYMENT FORM: CREDIT CARD PAYMENT DATE: 10/04/2017
MAIL TO: Demetrio Garcia
J
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 Revision 1 $ 25.00
123- OSTDS Construction Site Evaluation 1 $ 115.00
RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3403153
� $ St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: PERMIT#:56-SF-1741002 BILL DOC*56-BID-3349000 CONSTRUCTION APPLICATION A 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 NO. - -( 100,g,
>� DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: S7
+y WE
c' SYSTEM RECEIPT #: Ig3,5 9 3w(
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[v/] New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ I
APPLICANT: Demetrio Garcia JC Sfa s h we b,4d6s Cwlm-cw 7;,z)
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 [ V ] Other (Specify) GARBAGE GRINDERS/DISPOSALS
SIGNATURE: Z_ 4� "— DATE: 1-13-2017
DH 4015, 08/09 (Obsole"tes previous editions which may not be used)
Incorporated 64E-6.001, PAC Page 1 of 4
STATE OF FLORIDA APPLICATION # AP1276646
DEPARTMENT OF HEALTH PERMIT,# 56-SF-1741002
~ K ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
DOCUMENT # SE1024469
SITE EVALUATION AND SYSTEM SPECIFICATION
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/AC;�E7 OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1278.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1278.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Orange spot center of catch basin near center of E property line
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: 100 FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON-POTABLE: 75 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 40 FT POTABLE WATER LINES: 55 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 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:Tantile sand USDA SOIL SERIES:Tantile sand
Munsell#/Color Texture Depth Munsell#/Color Texture Depth
1OYR 4/2 Sand 0 To 5 10YR 4/2 Sand 0 To 7
1 OYR 5/1 Sand 5 To 25 10YR 5/1 Sand 7 To 35
10YR 6/1 Sand 21 To 34 10YR 6/1 Sand 26 To 39
10YR 211 Spodic Material 34 To 45 7.5YR 311 Spodic Material 39 To 45
10YR 3/4 Sand 45 To 55 7.5YR 4/3 Sand 45 To 56
HOLE CAVING Refusal 55 To 72 HOLE CAVING Refusal 56 To 72
OBSERVED WATER TABLE: 20.00 INCHES [ ABOVE /EE3, EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 22 INCHES [ ABOVE / HELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 22.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: 45 INCHES
DRAINFIELD CONFIGURATION: [X] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings
10YR6/1 stripping in 10YR511 matrix>10%with diffuse boundaries starting at 22" In SB1.
SB1 17"above RP.S6219"abov P.
SITE EVALUATED BY: 4H2__�
DATE: 10/10/2017
Ingram,Brian(Title:En nmental Specialist II)(ENVIRONMENTAL HEALTH)
DR 4015, 08109 (Cbsoletes previous editions which not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP127664G EID1741002 v 1.0.2
STATE OF FLORIDA PERMIT #. Slo,Si7yra�Z
t. 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: Mode]Land Company
PROPERTY ID #: 3406-501-0004-000-1 [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: 4.617 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 833 GALLONS PER DAY [RESIDENCES-TABLE UOTHER-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 IS 34 [INCHES/Fr ] [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 j✓] 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 j,/] 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 EXISTING GRADE. TYPE: PERCHED APPARENT ]
EST B ESTIMATED NET SEASON WATER TABLE ELEVATION: INCHES .A 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
DRAINFIELD CONFIGURATION: [,/] TRENCH [ ] BED j ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY: DATE: 1-13-2017
DH 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001,FAC Page 3 of 4
A.PPLICA.NT'S NA IME: Demetrio Garcia 5t,_5r,. 7y/oa-1.
LEGAL, DESCRIPTION. S 112 of Lots 1,2 and 3, Model Land Company, Plat book 4, page 34
VF
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 than25 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: +. L
REGISTERED SURVEYOR OR ENGINEER. FLORIDA PROFESSION O.: ° /-
DATE: 01/13/17 ' JOB 0.: T6- 89
docs/forms/septics/Septi cApppPage207
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Property Card Page 1 of 1
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 6-3640 N 220 FT OF S 1/2 OF
697 NW Archer Ave LOTS 1,2 AND 3-LESS E 50 FT OF LOT 1-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
i ate Rt f
Finished/Under Air 0
r Gross Area(SF): 0
ilr r Land Size(acres): 4.62
for
`ris ?y 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.
'V://www.paslc.org/RECard/ 2/17/2017
PERMIT #; 56-SF-1741002
N STATE OF FLORIDA APPLICATION #;AP 1276646
ti ?� DEPARTMENT OF HEALTH DATE PAID;
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT #
- DOCUMENT #: PR1051116
CONSTRUCTION PERMIT FOR:
APPLICANT: Demetri g_pafGbia - ,�1&
PROPERTY ADDRESS: el�fz,R lerce, FL34981
LOT: 1/2/3 BLOO !UBDIVISION: Model Land Company
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 3406-501-0004-000-1 [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 [ 1,200 ] GALLONS / GPD SeOfIC neZ\ CAPACITY
A [ ] GALLONS / GPD f':N/A CAPACITY
rx
N [ ] GALLONS GREASE INTERCEPTOR CA CITlv. IMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAP' LONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 767 ] SQUARE FEET Dram ii S
R [ ] SQUARE FEET sl,.VUA& STEM
A TYPE SYSTEM: [ ] STAND [X] IFTED s [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH B [ ]
N `.
F LOCATION OF BENCHMARK: Site BM fnd b0 near front of property(elev 17.95')
I ELEVATION OF PROPOSED SYSTEM SITE [ 17.001 INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 15.001 INCHES FT ] [ ABOVE BELOW]BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 16.00] 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
•0 460 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)(f), FAC.
E
RM �s as
L4 �„1 a Asa •.u:..,�.
SPECIFICATIONS BY: Brian J Ingram P
vironmental Specialist II
}1
APPROVED BY•. aronti Specialist II St. Lucie CHD
Brian J Ingr T� E '�.,
DATE ISSUED: 02/27/2017 h,. EXPIRATION DATE: 08/27/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC 4,e 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 ida Administrative Code. A petition for
administrative hearing must be in writing a t be received by the Agency Clerk for the
Department, within twenty-one (I . a , o . h- , eceipt of this order. The address of the
Agency Clerk is 4052 Bald Imr S y,` Tallahassee, Florida 32399. The Agency
Clerks facsimile numbe :8< -4 W..,
Mediation is not av a ri er" tive remedy.
Your failure to submit titi hearing within 21 days from receipt of this order will
constitute a waiver of your right" n 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.
STATE OF FLORIDA APPLICATION # AP1276646
DEPARTMENT OF HEALTH PERMIT # 56-SF-1741002
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
DOCUMENT # SE1024470
SITE EVALUATION AND SYSTEM SPECIFICATION
I
APPLICANT: Demetri0 Garcia 110%Nk '
CONTRACTOR / AGENT: AlexanderJ. Piazz _ , I
LOT: 1/2/3 ! OC
SUBDIVISION: Model Land Corn• s' A ,' 34 6-501-0004-000-1
TO BE COMPLETED BY ENGINEER, HEALTH TMW EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE
REGISTRATION NUMBER AND SIGN AND SEAL EAC GE 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
a
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FAq ROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT D �CHEt 5 FT NORMALLY WET: [ ]YES [X]NO
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WELLS: PUBLIC: FT LIMITFED 7 .T ' PRIVATE: 75 FT NON-POTABLE: FT
BIIILDING FOUNDATIONS: 5 'y�LjS:R Y`IjTNES: 22 FT POTABLE WATER LINES: 45 FT
SITE SUBJECT TO FREQUENT FLOODIN t9�'a.]_ S [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 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
10YR 3/2 Sand 8 To 19 1 OYR 3/2 Fine Sand 10 To 21
1OYR 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 2.5/2 Spodic Material 49 To 63 t :ir,b
7.5YR 3/3� i•, Sand 62 To 72
.7.5YR 3/2 Fine Sand 63 To 72 —
OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW ] ,/, �IS�3^g1N YPE: [ PERCHED / APPARENT
ESTIMATED WET SEASON WATER TABLE ELEVATION: 26 'S E]� ' / HELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X ]NO ING _ YES [ ]NO DEPTH: 26.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: San DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings.
10YR6/1 stripping in 10YR511 matrix,>10%with diffuse boundaries starting at 26"in SB1.
SB1 17"above BM.SB1 18"above BM.
SITE EVALUATED BY:
DATE: 02/24/2017
Ingram,Br)a Title:Environmental Specialist II)(ENVIRONMENTAL HEALTH)
DH 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