HomeMy WebLinkAboutApplication For Construction ( Sewage )STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
•�, SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
PERMIT NO. SF OZ1
DATE PAID: -?-k
FEE PAID: d
RECEIPT #:
APPLICATION FOR:
[✓j New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: Wade Journey Homes
AGENT: Reliable Treasure Coast Services Indian River Septic TELEPHONE: (772)562-4242
MAILING ADDRESS: PO Box 1116, Vero Beach FL 32961
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: 18
BLOCK: 152 SUBDIVISION: LAKEWOOD PARK
PLATTED: i 2
PROPERTY ID # : 1301-613-0363-000-1 1 ZONING: RS-4 I/M OR EQUIVALENT: [ No ]
&r%r0qVLkhr4Ad R" 9Ot4/ )
PROPERTY SIZE: .24 ACRES WATER SUPPLY: [ PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: �:FT
PROPERTY ADDRESS: 5701 Shannon Drive Fort Pierce, FL 34951
DIRECTIONS TO PROPERTY:
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 SFR
q
1650
2
3
4
[ ] Floor/Equipme t Drains
[ ]
Other (Specify)
DATE:
CJ
SIGNATURE:
DR 4015, 08/0 Obsoletes previous
editions which may not be used)
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D=f*o 1 �+f n
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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
� SITE EVALUATION AND SYSTEM SPECIFICATIONS
S
PERMIT # .5( MSF � n q2" -
kPPLICANT : Wade Journey Homes AGENT : Reliable Treasure Coast Services
LOT: 18 BLOCK: 152 SUBDIVISION: LAKEWOOD PARK
PROPERTY ID #: 1301-613-0363-000-1
[ Section/Township/Parcel No. or Tax ID Number ]
r0 BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS
!SST 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: ACRES
rOTAL ESTIMATED SEWAGE FLOW: Affir qotg GALLONS PER DAY [RESIDENCES-TABLEI 1m]
kUTHORIZED SEWAGE FLOW: ! `' S GALLONS PER DAY [1500 GPD/ACRE Imo]
UNOBSTRUCTED AREA AVAILABLE: 750 SQFT UNOBSTRUCTED AREA REQUIRED: _XSQFT
3ENCHMARK/REFERENCE POINT LOCATION: Site BM FND NAIL on N side of property
3LEVATION OF PROPOSED SYSTEM SITE IS7___ [INCHES 01 [ABOVE 0] C REFERENCE POINT
rHE MINIMUM SETBACK WHICH CAN BE MAINTAINED -FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:na FT DITCHE /S -S:22 FT NORMALLY WET? [ YES [✓] NO
TELLS: PUBLIC : na FT LIMITED USE : na FT PRIVATE : 90 FT NON -POTABLE: 85 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES:11 FT POTABLE WATER LINES:65 FT
5ITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? [ ] YES IV] NO
LO YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE IN
MUNSELL #/COLOR
10YR 2/1
10YR 4/1
IOYR 4/2
1 OYR 5/2
10YR 6/3
IOYR 412
SITE 1
TEXTURE
DEPTH
Fill- Sand
0
TO 12
Sand
12
TO 25
Sand
25
TO 36
Sand
30
TO 36
Fine Sand
36
TO 64
Sand
64
TO 72
TO
TO
TO
USDA SOIL SERIES: Lawnwood_�
SOIL PROFILE INFORMATION SITE 2
MMSELL #/COLOR
10YR 3/1
10YR 4/1
10YR 511
10YR 3/3
10YR 6/2
10YR 6/1
1 OYR 6/1
TEXTURE
Fill- Sand
Sand
Sand
Sand
DEPTH
0 TO 7
7 TO 19
19 TO 32
11) rrn IQ
Sand 39 TO 50
Sand 50 TO 65
Loamy Sand 65 TO 72
uual,
TO
USDA SOIL SERIES: Lawnwood j-� I
)BSERVED WATER TABLE: 53 INCHES [BELOW Ejr] EXISTING GRADE. TYPE: [APPARENT Ell
'sSTIMATED WET SEASON WATER TABLE ELEVATION: 30 INCHES [.BELOW M] EXISTING GRADE
iIGH WATER TABLE VEGETATION: [ ] YES [✓] NO MOTTLING: [✓] YES [ ] NO DEPTH:30 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:Sand/.8 DEPTH OF EXCAVATION:na INCHES
)RAINFIELD CONFIGURATION: [✓] TRENCH [ ] BED [ ] OTHER (SPECIFY)
MMARKS/ADDITIONAL CRITERIA: WSWT determined using USDA WSS and soil borings. 10YR 5/2 stripping in a 10YR 4/2 matrix
>10%with diffuse boundaries starting at 30" in SB 1. SB1= 7" above BM, SB2= 5" above BM..
Add 7-r k �i % �!;t`- c }rrV 14,: , X �' i-'� i a: I f r +U < J /�..i��(�13 a-/f ]'� ir.1 .4) Fer0, �)A
0
SITE EVALUATED BY: Dianna Mav C.E.H.P.19-2170 DATE: 6/21/2021
)H 4015, 08/09 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4