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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 i rf i j 1 j i E , : I , : : 1+ i , : ------------- :...rt.l'yclma y----R-_d. _..._. •-______. .. � - _------ � .__._..._ 1►7ei(av cl ga . r1M�RLA D. i i ! , 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 z• :+.ti, 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