HomeMy WebLinkAboutApplication For Construction Permit("E
STATE OF FLORIDA
DEPARTMENT OF HEALTH
` T
'� a3 ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
COp WE.``� APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
New System [ ] Existing System [ ] Holding Tank
[ ] Repair [ ] Abandonment [ ], Temporary
APPLICANT: CELESTINO FUENTES PONCE
AGENT: Alexander J. Piazza PSM, Inc.
MAILING ADDRESS: 619 SW Biltmore Street, Port St. Lucie, Florida 34983
PERMIT NO. 50,SFA 11OJ
DATE PAID: a "I
FEE PAID:
RECEIPT #:-��1
[ ] Innovative
TELEPHONE: 772-340-7770
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: - BLOCK: - SUBDIVISION: NOT PLATTED
PLATTED:
PROPERTY ID # : 2309-122-0000-000-9 ZONING: R I /M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 12.10 ACRES WATER SUPPLY: [,(] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: BERGER ROAD, Fort Pierce, Florida 34945
DIRECTIONS TO PROPERTY: SEE MAP
BUILDING INFORMATION
Unit Type of
No Establishment
1 RESIDENCE
2
3
4
[v/] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
4 3,436
[ ] Floor/Equipment Drains [ ,/ ] Other (Specify) GARBAGE GRINDERS / DISPOSALS
UlRimlly rirA.J by Al..dlr J Pi —
Alexander J Piazza PINUS. -L;.f,1W.,..-AOIJ27000IIOO165R ICIJC90000019RI,m-Al..&rJ
m,,,
SIGNATURE : 1br.2ms.12.1s09:44a2-0sm• DATE* 12-18-18
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
Page 1 of 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Celestino Ponce
CONTRACTOR / AGENT: Alexander J. Piazza PSM, Inc John Erickson 772-260-5049
LOT: BLOCK:
SUBDIVISION: ID# : 2309-122-0000-000-9
APPLICATION # AP1389929
PERMIT # 56-SF-1841839
DOCUMENT # SE1147199
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: 12.10 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 460 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 18150.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1200.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1150.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: site BM red Capped IR N Of system
ELEVATION OF PROPOSED SYSTEM SITE 4.00 [ INCHES / FT ] [ ABOVE /
BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 75 FT DITCHES/SWALES: 75 FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100 FT NON -POTABLE: 100 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 50 FT POTABLE WATER LINES: 75 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 SOTL PROFILE TNFORMATTON STTE 2
USDA SOIL SERIES:Nettles sand
Munsell #/Color Texture
Depth
1 OYR 4/2
Sand
0 To 11
10YR 5/1
Sand
11 To 29
10YR 6/1
Sand
23 To 29
1 OYR 2/1
Spodic Material
29 To 34
10YR 3/3
Sand
34 To 38
10YR 3/3
Loamy Sand
38 To 47
10YR 4/4
Sand
47 To 54
10YR 5/2
Sand
54 To 72
USDA SOIL SERIES:Oldsmar sand
Munsell #/Color Texture
Depth
10YR 4/2
Sand
0 To 10
10YR 5/1
Sand
10 To 35
10YR 6/2
Sand
25 To 35
1 OYR 3/2
Sand
35 To 44
10YR 5/3
Loamy Sand
44 To 46
5GY 5/1
Loamy Sand
46 To 60
5GY 511
Sand
60 To 72
OBSERVED WATER TABLE: 70.00 INCHES -[ ABOVE / BELOW ] EXISTING GRADE TYPE:
ESTIMATED WET SEASON WATER TABLE ELEVATION: 23 INCHES C ABOVE / BELOW ]
HIGH WATER TABLE VEGETATION: [ ]YES EX ]NO MOTTLING: [X]YES [ ]NO
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH OF E=
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 23" in SB1.
SB1 and SB2 4"below BM.
SITE EVALUATED BY:
Ingram, Brian (TiWEnvironmental Specialist II) (ENVIRONMENTAL HEALTH)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
C PERCHED / APPARENT ]
EXISTING GRADE
DEPTH: 23.00 INCHES
NTION: 34 INCHES
DATE: 01 /04/2019
Page 3 of 4
AP1389929 EID1841839 v1.0.2
zttE
�X STATE OF FLORIDA PERMIT # .
DEPARTMENT OF HEALTH
'�•/ ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
.�,,� ,;' SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: CELESTINO FUENTES PONCE AGENT: Alexander J. Piazza PSM, Inc.
LOT: - BLOCK: - SUBDIVISION: NOT PLATTED
PROPERTY ID # : 2309-122-0000-000-9
[ 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: [✓]
TOTAL ESTIMATED SEWAGE FLOW: 767
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE: 1200
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS 34
YES [ ] NO NET USABLE AREA AVAILABLE:
_GALLONS PER DAY [ RESIDENCES -TABLE 1 /OTHER -TABLE 2
_GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE
SQFT UNOBSTRUCTED AREA REQUIRED: 1200
ACRES
SQFT
[ 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? [ ] YES [�/] 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
MUNSELL #/COLOR
TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE:40+ INCHES [BELOW
ESTIMATED WET SEASON WATER TABLE ELEVATION:_
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [v/] TRENCH [ ]
REMARKS/ADDITIONAL CRITERIA:
BED
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
�] EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ]
_ INCHES ABOVE BELOW ] EXISTING GRADE
MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
DEPTH OF EXCAVATION:
] OTHER (SPECIFY)
INCHES
oyiv�y d�nm M nm� a,. � vma.
Alexander J Piazza ova°»E OOOIb58iEE]C96WWI981, mRN u+MJPYm
SITE EVALUATED BY: wle:nial:Isoe a:u.mnu DATE: 12-18-18
DH 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
�jC�
APPLICANT'S NAME: CELESTINO FUENTES PONCE - SF-
LEGAL DESCRIPTION: NOT PLATTED PIP# 2309-122-0000-000-9'
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
REGISTERED SURVEYOR OR ENGINEER.
CERTIFIED BY:
FLORIDA PROFESSIONAL O.:
DATE: 04/12/18 1 JOB NO.: 14-1918
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