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HomeMy WebLinkAboutSewage( 11u6r 0.')-°1a_,
� RF�FA'Fo
STATE OF FLORIDA Per Fp1�?01g
DEPARTMENT OF HEALTH St�41,
e
ONSITE SEWAGE TREATMENT AND DISPOSAL UgeCo nfyet?t
SYSTEM
, CONSTRUCTION PERMIT FOR: OSTDS New
PERMIT #:56-SF-1978105
APPLICATION #:AP1425805
DATE PAID:
FEE PAID:
RECEIPT #:.
DOCUMENT #: PR1248459
APPLICANT: Adams Homes of Northwest Florida, Inc)
PROPERTY ADDRESS: 5811 Balsam Dr Fort Pierce, FL 34982
LOT: 18 BLOCK: 81 SUBDIVISION: Indian, River Estates
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 3402-610-0344-000-9 [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 [ . 1,050 ] 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 [ 500 ] . SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A - SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED DO MOUND
I CONFIGURATION: [X1 TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: Orange paint "X" CL if Rd, center of property
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.00 it INCHES FT.] C BELOW] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 9.00 ][ INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT
L
D
0
T
H
E
R
I
REQUIRED: [25.001 INCHES EXCAVATION REQUIRED: [ l.UU ] INCHES
system is sized for 4 bedrooms with a maximum occupancy of 8 persons (2 per bedroom), for a total estimated flow of
gpd•
FILE, COPY
SPECIFICATIONS BY: Brian J In TITLE'. Environmental Specialist II
G.
APPROVED BY: ITLE: Environmental Specialist II St. Lucie CHD
Brian J In
DATE ISSUED: 08/14/2019 EXPIRATION DATE: 02/14/2021
DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 1 of 3
Incorporated: 64E-6.003, PAC
v 1.1.4' AP1425805 SE1197679 '
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
HEAEFH
PAYING ON: #: 56-SF-1978105 BILL DOC #:56-BID-4268676 CONSTRUCTION APPLICATION #: AP1425805
RECEIVED FROM: Benjamin Drew"s Plumbing &_Drain Ser _ AMOUNT PAID: $ 545.00
PAYMENT FORM: CHECK 172876 PAYMENT DATE: 07/26/2019
NAIL TO: (Adams Homes of Northwest Florida, Inc)
FACILITY NAME:
PROPERTY LOCATION:
5811 Balsam Dr
Fort Pierce, FL 34982
Lot: 18 Block: 81
Property ID: 3402-610-0344-000-9
EXPLANATION or DESCRIPTION:
QUANTITY
FEE
128 - OSTDS Construction System Inspection Research Fee
1
$ -
5.00
-1 - Surcharge (All)
1
$
45.00
-1 - OSTDS New Permit Surcharge
1
$
100.00
-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
133 - OSTDS Construction Reinspection
1
$
50.00
RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-4023916
Note: Ck for $515.00, Cash $30.00
STATE OF FLORIDA PERMIT NO.5b-SF-JC V
• •i DEPARTMENT OF HEALTH DATE PAID: lq
-
ONSITE SEWAGE TREATMENT AND DISPOSAL, FEE PAID: �'7,�
SYSTEM RECEIPT #:
• t~r�ONe � APPLICATION FOR CONSTRUCTION PERMIT ii�"142JAI 3i
APPLICATION FOR:
[7(] New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary ( ]
APPLICANT:
AGENT: ��x11�NU N ` )Tr' :xi S 1' 1 vv Ai nr �A .l r� . T2 nr 1 �L5 . TELEPHONE:
MAILING ADDRESS: H `v,,-\A �16,-c-e-
TO BE COMPLETED BY APPLICANT ORiA.PPLICANT'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 ?�+,c�
LOT: f if BLOCK: �}(� SUBDIVISION: Er1d;Gh 'j jfX PLATTED: 1 `I J Cp
PROPERTY ID # : O)4 Q A " CQ 1()' C)S qlq,. 000 - 01 ZONING: /ZS I/M OR EQUIVALENT: [ Y / IJ ]
PROPERTY SIZE:(). 3 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [x]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y A3 ] DISTANCE TO SEWER: N lA FT
PROPERTY ADDRESS: S l IJ C, l Sgnp �r i V
DIRECTIONS TO PROPERTY: se , c.d6rheA Mop
BUILDING INFORMATION [ x] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
1
1_ 7_
2
3
4
[ ] Floor/Equipment Drains [ ] Other (Specify)
SIGNATURE: � DATE: ZI�
DH 4015, 08/09 (Obsolet se previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
I
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Adams Homes of Northwest Florida, Inc
APPLICATION # AP1425805
PERMIT # 56-SF-1978105
DOCUMENT # SE1197679
CONTRACTOR / AGENT: Benjamin Drew"s Plumbing & Drain Services
• LOT: 18 BLOCK: 81
SUBDIVISION: Indian River Estates ID#. 3402-610-0344-000-9
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: 0.23 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 575.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 1 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
BENCHMARK/REFERENCE POINT. LOCATION: Oranqe paint "X" CL if Rd, center of
ELEVATION OF PROPOSED SYSTEM SITE .2.00 [ 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 [ ]NO
WELLS: PUBLIC: FT LIMITED USE: FTPRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 25 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
QnTT. VVnWTT.T._ TWVt'%PMnTTAN CTTP._ 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:Waveland fine sand
Munsell #/Color Texture
Depth
10YR 3/1
Organic Soil
0 To 5
1 OYR 411
Sand
5 To 13
10YR 5/1
Sand
13 To 36
1 OYR 6/1
Sand
17 To 44
1 OYR 4/2
Sand
44 To 56
HOLE CAVING
Refusal
56 To 72
USDA SOIL SERIES:Waveland fine sand
Munsell #/Color Texture
Depth
1 OYR 3/1
Organic Soil
0 To 7
1 OYR 4/1
Sand
7 To 14
10YR 6/1
Sand
14 To 33
10YR 611
_ Sand
19 To 49
10YR 5/2
Sand
49 To 56.
HOLE CAVING
Refusal
56 To 72
OBSERVED WATER TABLE: 15.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 17 INCHES [ ABOVE / BEE] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 17.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: 7 INCHES
DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
7 REMARKS/ADDITIONAL CRITERIA
IT determined using USDA WSS and soil borings.
tripped matrix-10YRS/1 stripping In 10YR511 matrix >10% with diffuse tioundarles starting at 17" In SB1.
2" above BM. SB2 4" abov"M.. ' /)
SITE EVALUATED BY:
Ingram, Brian (Title: En1-not
onmental Specialist II) (ENVIRONMENTAL HEALTH)
a De 4015, 08/09 (Obsoletes previous editions which mbe used) Incorporated: 64E-6.001, SAC
AP1426805 EID1978105
DATE: 08/02/2019
Page 3 of 4
v 1.0.2
PropL'rt�.
Page 1 , l !
Michelle Franklin. CFA --,,Saint Lucie County Property Appraiser -- All rights reserved.
Property Identification
• tiuC Address: BALSAM DR Parcel ID: 3402-610-0344- ACaxuu 38474 n/Range:
000-9 12/36S!40E
Map ID: 34/12S Zoning: RS-4 Use Typc: 0000 Jurisdiction: Saint Lucie
County
Ownership Legal Description
Adams Homes of Northwest Florida Inc INDIAN RIVER (-,STATES-UNIT-09- BLK 81 LOT 18 (MAP
3000 Gulf Breeze PKWY 34/12S)
Gulf Breeze, FL 32563
Current Values Historical Values 3-year
Just/Market: $10,000 Assessed: $10,000 Year Just/Market Assessed Exemptions Taxable
Exemptions: $0 Taxable: $10,000 2018 $10,000 $10,000• $0 $10,000
2017 $9,400 $9,400 $0 $9,400
2016 $9,400 $5,989 $0 $5,989
Sale History
Date
Book/Page Sale Code Deed Grantor Price
02-19-2019
4235 / 1900 0001 WD IRE DD LLC $16,000
10-27-2016
3928 / 0135 0001 WD Johnstone Jeffrey G $8,500
06-09-2010
3205 / 0083 0130 WD Johnstone James G $6,000
Primary Building Information
Finished Area of this building: 0 SF
Gross Sketched Area: 0 SF
Exterior Data
View:
Roof Cover: Roof Structure: Building Type:
Year Built: N/A
Frame: Grade: Effective Year: N/A
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.
Finished/Under Air 0
(SF):
Gross Sketched Area 0
f'f:;; .Gt':..;` '• Land Size (acres): 0.23
Land Size (SF): 10,000
Total Building Count: 1
Type
Special Features and Yard Items
Qty Units Year Blt
All information is believed to be correct at this time, but is subject to change and is provided without any warranty.
© Copyright 2010 Saint Lucie County Property Appraiser. All rights reserved.
tttps://Paslc-dev.org/RECard/ I 1 7/26/2019
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Custom Soil Resource Report
St. Lucie County, Florida
50—Waveland and Immokalee fine sands
Map Unit Setting
National map unit symbol: ljpwd
Elevation: 20 to 200 feet
Mean annual precipitation: 49 to 58 inches
Mean annual air temperature: 70 to 77 degrees F
Frost -free period: 350 to 365 days
Farmland classification: Not prime farmland
Map Unit Composition
Waveland and similar soils: 44 percent
Immokalee and similar soils: 44 percent
Minor components: 12 percent
Estimates are based on observations, descriptions, and transects of the mapunit.
Description of Waveland
Setting
Landform: Flatwoods on marine terraces
Landform position (three-dimensional): Talf
Down -slope shape: Convex
Across -slope shape: Linear
Parent material: Sandy marine deposits
Typical profile
A - 0 to 4 inches. fine sand
Eg - 4 to 32 inches: sand
Bh1- 32 to 40 inches: loamy sand
Bh2 - 40 to 53 inches: sand
Cg1- 53 to 66 inches. sand
Cg2 - 66 to 80 inches: sand
Properties and qualities
Slope: 0 to 2 percent
Depth to restrictive feature: 31 to 50 inches to ortstein
Natural drainage class: Poorly drained
Runoff class: High
Capacity of the most limiting layer to transmit water (Ksat): Moderately low to
moderately high (0.06 to 0.20 in/hr)
Depth to water table: About 6 to 18 inches
Frequency of flooding. None
Frequency of ponding: None
Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0
mmhos/cm)
Sodium adsorption ratio, maximum in profile: 4.0
Available water storage in profile: Very low (about.0.8 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (nonirrigated): 4w
Hydrologic Soil Group: C/D
10
Custom Soil Resource Report
Forage suitability group: Sandy soils on flats of mesic or hydric lowlands
(G156BC141FL)
Hydric soil rating: No
Description of Immokalee
Setting
Landform: Flatwoods on marine terraces
Landform position (three-dimensional): Talf
Down -slope shape: Convex
Across -slope shape: Linear
Parent material: Sandy marine deposits
Typical profile
A - 0 to 6 inches: fine sand
E - 6 to 35 inches: fine sand
Bh - 35 to 54 inches: fine sand
Cg - 54 to 72 inches: fine sand
Properties and qualities
Slope: 0 to 2 percent
Depth to restrictive feature: More than 80 inches
Natural drainage class: Poorly drained
Runoff class: High
Capacity of the most limiting layer to transmit water (Ksat): Moderately high to
high (0.57 to 1.98 in/hr)
Depth to water table: About 6 to 18 inches
Frequency of flooding: None
Frequency of ponding. None
Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0
mmhos/cm)
Sodium adsorption ratio, maximum in profile: 4.0
Available water storage in profile: Low (about 5.3 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (nonirrigated): 4w
Hydrologic Soil Group: B/D
Forage suitability group: Sandy soils on flats of mesic or hydric lowlands
(G156BC141FL)
Hydric soil rating: No
Minor Components
Jonathan
Percent of map unit: 3 percent
Landform: Knolls on marine terraces, ridges on marine terraces
Landform position (three-dimensional): Interfluve
Down -slope shape: Convex
Across -slope shape: Linear
Hydric soil rating. No
Salerno
Percent of map unit. 3 percent
Landform: Flatwoods on marine terraces
Landform position (three-dimensional): Talf
Down -slope shape: Convex
11
Custom Soil Resource Report
Across -slope shape: Linear
Hydric soil rating: No
Lawnwood
' Percent of map unit: 3 percent
Landform: Marine terraces on flatwoods
Landform position (three-dimensional): Talf
' Down -slope shape: Linear
Across -slope shape: Linear
Hydric soil rating: No '
Electra
Percent of map unit: 3 percent
Landform: Rises on marine terraces, knolls on marine terraces
Landform position (three-dimensional): Interfluve
Down -slope shape: Convex
Across -slope shape: Linear
Hydric soil rating: No
12
NDARY /1F(DPOGRAPHIC S
F?V EY
LEGAL DESCRIPTION:
(Supplied by Client)
LOT 18 IN BLOCK 81 OF INDIAN RIVER
ESTATES UNIT NINE, ACCORDING TO THE
PLAT THEREOF AS RECORDED IN PLAT BOOK
10. PAGE 74, OF THE PUBLIC RECORDS OF ST.
LUCIE COUNTY, FLORIDA.
'ABBREVIATIONS:
SCA5//NM54W1 WITH
YELL RKED PS53
FD = FOUND 5/8 IRON REBAR
= �I GHT OF JAY
EASURED
P = PLATTED
C = CALCULATED
i= RADIUS OF CURVE
L = LENGTH OF CURVE
D= DELTA OF CURVE
FFE = FINISHED FLOOR ELEVATION
OH -OH -OH- = OVERHEAD WIRES
X-X-X- = CHAINLINK FENCE
-0-0-0-= PLASTIC FENCE
0-0-0- = WOOD FENCE
CONC. = CONCRETE
C.P.= CONCRETE PAD.
COV.= COVERED
r DRAINAGE PROPOSED
AND EXISTING
110"
00
l0-
ne.
10
1
sal <4y'P oPpd �O�>s'
0P ` .8
\v1)00
SURVEYORS NOTES:
1, UNLESS OTHERWISE NOTED ONLY PLATTED EASEMENTS ARE SHOWN HEREON.
2. ALL LOT DIMENSIONS SHOWN ARE PER PLAT UNLESS OTHERWISE SHOWN.
3. NO UNDERGROUND UTILITIES OR IMPROVEMENTS WERE LOCATED UNLESS
OTHERWISE SHOWN.
4, THIS SITE LIES WITHIN FLOOD INSURANCE RATE . MAP ZONE X MAP#
12111CO281 J DATED: 2-16-12.
5. FLOOD ZONE -SHOWN HEREON IS AN INTERPRETATION BY THE SURVEYOR
AND IS PROVIDED AS A COURTESY, THE FLOOD ZONE SHOULD BE VERIFIED
BY A DETERMINATION AGENCY•+
6, BEARINGS SHOWN HEREON ARE BASED ON THE CENTER LINE OF
BALSAM DRIVE, AS BEING S3110300"E ACCORDING TO THE PLAT
DESCRIBED HEREON.
7. P.U.D.E. DENOTES PUBLIC UTILITIES AND DRAINAGE EASEMENT,
U.E. DENOTES UTILITY EASEMENT.
8. THE ACCURACY OF THIS SURVEY IS PREMISED ON THE EXPECTED USE OF
THE SURVEY, THE EXPECTED USE / PURPOSE OF THIS SURVEY IS HOME
CONSTRUCTION. ACCURACY=1 FOOT IN 7.500 FEET OR BETTER.
9, ADDITIONS OR DELETIONS TO THIS SURVEY MAP BY ANYONE OTHER THAN
THE SIGNING SURVEYOR IS PROHIBITED WITHOUT WRITTEN CONSENT,
ALL ELEVATIONS SHOO HEREON ARE BASED ON
NORTH AMERICAN VERTICAL DATUM OF 1988(N.A.V.D.'88)
\
'98 6'p,
149
70
0730
h• eo QC ®� �O% 598
16.
S
,OIL
179,4 f 0� �p0
ovv
01
' FDOH` in`St. L ie County
.Environ.men I Health
Site Plan Approve' ��or Construction
.Supersedes All Prflious Site. Plans for
OSTDS & Wen #
Date:
I
PROPOSED PLGT PLAN "I
(OuBJEdT To doNTRAdTok HEALTH DEPT.. AND BWLD1Nd' .DEP7: APPROVAL)
5811 BALSAM DRIVE
SCALE:1 n=30' Atlantic Land Designs
of the Treasure Coast, ILB7468
DATE:2-4-19 754 NE Jensen Beach Blvd. Jensen Beach, FL 34957
DRAIN: SW\JC Mailing Address:
P.O. Box 1421 Jensen Beach, FL 34958
20 1 9-0030 ALD5543@gmail.com (772) 398-4290
DATE: REVISIONS
7/3/19 PLOT PLAN
LAST FIELD DATE:6-3-19
Certified to: Adams Homes of Northwest Florida, Inc.
hereby certify that the survey sho*n hereon is true and correct
rid is based on actual measeuremenls taken in the field. This
urvey meets the Minimum Technical Standards of Chapter 5J-17
lori admi stroll a code.
�EgTIFf Cg7°f
PSM 5543
coder.
signed by James A Cesbolr.
Jam A. Cesir J \DN:m=11m 1Ceftl,.o-Atlml, land Designs
o(thIT4 09, emaIl,11-5543®9ma11-n-US
1 Da[`c2019.07.0408:1357-04'00' ?
O ::� STATE OF
NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC P FGORL 0P
SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL RFO s RVE