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ST. LUCIE COUNTY HEALTH DEPARTMENT
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06/24/2001 23:49 5628784122 ACCURATE UTILITIES _ PAGE
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ST. LUCIE COUNTY HEALTH! DEPARTMENT
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Sept : Tame: r„q"I;ractor TJL-+- License it
EXCAVATION CERTIFICATION
T:':s '8 !^ Ct"litl an aria of _13 feet oy .,3? feet by- _ feet Keep has been ezcavateo in
accNrulense w.:!) the above referenced St. Lucie Co:jnly `Onsite Sewage Treatment 8 disposal System
cionvrut:!'^r• permit. and the e+CaVehon has been refilled with sligraty lirniled.soim :n comptlarce w.tn
..
rs a" app!nved 9::e P.an Sh-1w .; tn.; loci+t,on of the ex;.a'rat:on tiny ;te�':a!!cn ,ro :r-m
I+;:�•� tG'..' 31;r. t;•F3rt nt:?5t t1��t' j:t•tsr iioal!tti O�=tJo:t!tltlnt tif)prgV�l .
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CERTIFICATION OF INSTALLATION
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I•u.e':' "!.Cersed Septic Tar^ . Con!raCtor .•'_......�_ LKer se it Date
• • ■ 1 1 1 • • • ■ . ■ ■ r • • i ■ r r • r r • . • • .... • • r r r r . r ■ r ..• • . r .. ■ r • 1 s . ■ . • r .. ■ ■ . • r ... ■ • ■ • ■ r • • • • .
EXIST;NG SEPTIC TANK APPROVAL
sept C :a^•. P, _
••'•t,'4:: a sul os -etlechr •s .n place. and the
?— ;vi wG- o' Comp•r•tr.:x=a Tne v:'',,'r4 of the sopt:c tiirk is GAr o`9
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Ll�a:.se
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SEPTIC TANK ABANDONMENT
r'a� beet acar'voneo In accc,:;grace ar;n Cr:apter. 54E-6'01' F.A C
STATE OF FLORIDA
DEPAM P I I OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT:
►
s as7(
I.oT: aIOCK:s.. soBDlvssloN: T�.e&Supz GoA�C Q.IRt�Att-
PROPERTY ID #s 49 ��. �21- 000 /2 tSaction/Township/Range/Parcel No. or Tax iD Number]
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MOST
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 AVAILl_ �J� ACRES
TOTAL ESTIMATED SEWAGE FLOW: 'd 00 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOWS J700 } GALLONS PER DAY 11SOO GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: t:�D SQFT UNOBSTRUCTED AREA REQUIRED: 122 SQFT
ELF_u. IOo . C) AS9
--- . .'n-
BENCEMARK/REFERENCE POINT LOCATION:l&IL
ELEVATION OF PROPOSED SYSTEM SITE IS f-:
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: 75 t' FT DITCHES/SWALES: FT NORMALLY WET? [ ] YSS [cfJ NO
WELLS: PUBLIC: FT LIMITED USE: 1(00 FT PRIVATE: '75 PT NON-POTABX2: r FT
BUILDING FOUNDATIONSi _-7_ FT PROPERTY LINES: _-II_ FT POTABLE WATER LINES2 /0 FT
SITE SUBJECT TO FREQUENT FLOODING:
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
t ] YES tC4, No
FT MSL/NGVD
Munsell 0/Color Texture Depth
to
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USDA SOIL SERIES:
naawRvre WATER TABLE:
10 YEAR FLOODING? t ] YES illf NO
SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 2
mussel: 1'/Calor Texture veipth
to
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USDA SOIL SERIES:
[ABOVE legiOjp EZIsTING GRADE_- TYPE: [PERCHED /
nRAng.
t.9
AP CATION FOR:
I P�j Now System
I ] Repair
APPLICANT:
AGENT: �[c�
NAILING ADDRESS:
STATE OF,FLORIDA'
. DEPARTMENT OF,. HEALTH
ONSITE,SEWAGE.DISPOSAL SYSTM
APPLICATION FOR CONSTRUCTION PERMIT.'
Apthorityt Chapter.381, FS is Chapter 10D-6, FAC
[ ] Existing System
I ] Abandonment
] Holding Tank
] Other(Specify)
[ ] Temporary/Experimental:
Ce/!561-.339- 5131-
TELEPHONE: a L Sjn-,5 d 6
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT.-=--- -
SIT$ PLAN SHOWING PERTINENT ATTACH BUILDING PLAN AND TO -SCALE
PLAN
SHOWING
FEATURES REQUIRED BY CHAPTER -IOD=6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION
[IF LOT IS,NOT-IN A RECORDED SUBDIVISION; ATTACH LEGAL �DESCRIPTION OR DEED]
LOT: .� t BLOCK: SUBDIVISION:
DATE OF
PROPERTY ID 1:y64�UcG fA� � SUBDIVISION:
DO,a (- �Qd [Section/Township/Range/Parcel Ne. ] ZONING:
PROPERTY SIZE: ACRES [Sgft/43560
a ] PROPERTY WATER SUPPLYs I x] PRIVATE [ j PUBLIC
PROPERTY STREET ADDRESS: 1 _. _ _
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
EX ] RESIDENTIAL
I COMIMRCIAL
Unit Type of No. of
No
Building
EstablishmentBedrooma . Area s ft�.� Servedons
1 P 4eF F-loar
12eS 3 — �L-1 FIc
2 � 14. -
Business Activity
For Coaaercial Only
STATE OF FLORIDA
DEPARTMENT OF HEALTH.
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SF
PERMIT #
sa 57(
APmIc!ANT= AGENT= u/
LOTs BLOCK: 4UBDIVISIONs
PROPERTY ID # s yao ` 501 -OGaI '-000 �a [Section/Township/Range/Parcel No. or Max ID Nnaberj
TO BE COMPLETED BY ENGINEER, HEALTH UNIT'EMPLOYEE, OR OTHER QUALIFIED PERSON. ZKOIHEER'S MUST
PROVIDE REGISTRATION NUMBER, AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: VQ YES [ ] NO NET USABLE AREA AVAILABLES ACRES
TOTAL ESTIMATED SEWAGE FLOWS .306 GALLONS PER DAY RESID - 1 OTHER -TABLE 21
AUTHORIZED SEWAGE FLOW: _ � GALLONS PER DAY_ 11500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: /Don SQFT UNOBSTRO RED: SQFT
BENCHK1=/REFERENCE POINT LOCATION:j
ELEVATION OF PROPOSED SYSTEM SITE IS
BENCHMARK/REFERENCE POINT
F�
THE MINIMUM SETBACK WHICH CAN -BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATERS PT DITCHES Ss lye FT NORMALLY WET? [ ] YES W NO
WELLS: PUBLICS FT LIMITED USE: _NA PT PRIVATE: '7r, FT NON -POTABLE: ,_ r2 FT
BUILDING FOUNDATIONS: Q.2 1 FT PROPERTY LINES: 9Q FT POTABLE WATER LINES: ,/J_ FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES ()Q No 10 YEAR FLOODING? [ ] YES [iQ NO
10 YEAR FLOOD ELEVATION FOR SITES -- FT MSL/NGVD SITE ELEVATION: — FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
Russell #/Color Texture Depth
1:21107
Fi to
to
to
to
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USDA SOIL SERIES: to
_ e 4 ¢e ...
s•ll #/Color Textu-"- mayth
-OVA OR ig to2y__
2U " '3y
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� � to
USDA. SOIL SERIESs ..s Sa.•�
OBSERVED WATER TABLE: �, INCHES (ABOVE / EXISTING GRADE TYPEERCSED / P
STATE OF FLORIDA PERMIT NO.
DEPARTMENT OF SBALTH DATE PAID a
ONSITE SENAQE TREATMENT AND DISPOSAL SYSTEM FEE PAID:
CONSTRUCTION PERMIT RECEIPT #:
CONSTRUCTION PERMIT FORS
[ j�] NOW System [ ] Existing System
[ ] Repair L ] Abandonment
APPLICANT:
PROPERTY AD
s'Q57(
SD017
0
[ ]
Holding Tank
[
] M=avative
[ ]
ToMporary
[
]
LOT: 91 SLOCR: SUBDIVISION:
PROPERTY ID #: 9gpq 5Q1 OWI 0 G0/a
•%r'¢®•sv�t �aasL Jai:�oe..�
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEK MUST BE COIQSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,
F.S., AND CHAPTER 64E-6, F.A.C. T APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY
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 BRING MADE NOLL AND VOID. ISSUANCE OF THIS PERMIT
DOES NOT EXEH3?T THE APPLICANT FROM comPLIAHCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMlENNT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [fGPD TIC TANK AEROBIC UNIT CAPACITY TI-CHAMSER IN -SERIES [ ]
A [ ] / GPD CAPACITY [ ]
N [ ] GALLONS GREA38 IIQTERCEPTOR CAPACITY [MAM30M CAPACITY SINGLE TANK: 1250 GALLONS]
K L ] GALLONS DOSING; TANK CAPACITY [ ] GALLONS ® L ] DOSES PER 24 HRS # PUMPS L ]
D [ '7 Ga ] SQUARE FEET PRIMARY DRA WXELD SYSTEM
R L ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STAMM [ ] FILLED [ X3 MDUND
I CONFIGURATION: I ] TRENCH [ Y'] BED [ ] 3 -! R c Cie n .
N l / n
F LOCATION OF BENCHMARK: 16il e,n nx )r 1% cd1 e / n � �,b 1 in 4A 0�
I ELEVATION OF PROPOSED SYSTEK SITE -- ] [MBMIS/FT] [ABOVE/BELOM BENCSMARK/RBFZlt NCR POINT
E BOTTOM OF DRAINFIRLD TO SH 1i ] i�/FT] BO /BwAm REFSRE = POINT
L i
D FILL REQUIRED: S EXCAVATION REQUIRED: [ 9 & ] =c=S
1 041`4 I've
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[ ] 1251
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