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HomeMy WebLinkAboutAPPLICATION FOR CONSTRUCTION PERMITL on STATE OF FLORIDA PERMIT NO. DEPARTMENT OF HEALTH DATE PAID : ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: Clayton Davis 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: na BLOCK: na SUBDIVISION: na PLATTED: na PROPERTY ID #: 3210-111-0003-000-6 ZONING: R I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 4.744 ACRES WATER SUPPLY: [V/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: - FT PROPERTY ADDRESS: Ideal Holding Road, Port St. Lucie, FLORIDA 34987 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 3 1,478 2 3 4 [ ] Floor/Equipment Drains SIGNATURE: DH 4015, 08/09 (Obsolet s p Incorporated 64E-6.001, FAC Other (Specify) GARBAGE GRINDERS / DISPOSALS .01 DATE : F96 ly � 11/ •ions edi ions which may not be used) Page 1 of 4 10/19/2017 Google Maps Map data ©2017 Google United States 2000 ft https://www.google.com/maps/@27.3682457,-80.5052438,14.5z 1/1 s STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT #. APPLICANT: Clayton Davis AGENT : Alexander J. Piazza PSM, Inc. LOT: na BLOCK: na SUBDIVISION: na PROPERTY ID # : 3210-111-0003-000-6 [ 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: 4.744 ACRES TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [RESIDENCES -TABLE VOTHER-TABLE2 ] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 750 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT BENCHMARK/REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS 34 [ INCHES / FT ] [ ABOVE / BELOW 1 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 [v/] 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 FLOOD ELEVATION FOR SITE: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: 10 YEAR FLOODING? ] ] YES ],/] NO SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: OBSERVED WATER TABLE:40+ INCHES [BELOW T] EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.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 ] OTHER (SPECIFY) RE-Ms►RKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: 10-19-2017 DH 4015, 12/11 (obsoletes previous edi which may not be used] Incorporated: 64E-6.001, FAC Page 3 of 4 APPLICANT'S 'NATME: LEGAL DESCRIPTION:_ Clayton Davis PID#: 3210-111-0003-000-6 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 areno wells within 25 feet of apesticide-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: 10/19/17 JOB NO.: 17-3412 docs/rorms/septics/SepticApppPage207