HomeMy WebLinkAboutAPPLICATION FOR CONSTRUCTION PERMIT 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 : Poll St. Lucie Properties, Inc.
AGENT : Alexander J. Piazza PSM, Inc. TELEPHONE : 772-340-7770
MAILING ADDRESS : 619 SW Biltmore Street, Port St. Lucie, Florida 34983
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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 .
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PROPERTY INFORMATION
LOT : 41 BLOCK : 51 SUBDIVISION : Indian River Estates Unit 7 PLATTED : 1956
PROPERTY ID # : 3402-608-0435-000-7 ZONING : R I /M OR EQUIVALENT : [ No ]
PROPERTY SIZE : 0.23 ACRES WATER SUPPLY : [ - ] PRIVATE PUBLIC [✓] <=2000GPD [ ] >2000GPD
IS SEWER AVAILABLE AS PER 381 . 0065 , FS ? [ No ] DISTANCE TO SEWER : FT
PROPERTY ADDRESS : 5305 Hickory Drive, Fort Pierce, Florida 34982
DIRECTIONS TO PROPERTY : SEE MAP
BUILDING INFORMATION [ v( ] 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 19585
2
3
4
[ ] Floor/Equipment Drains [ v/ ] Other ( Specify) GARBAGE GRINDERS / DISPOSALS
Dighadly Alexander J Piazza pV°�Mbded ^°�°
SIGNATURE : au _zrm°°oie�rn. cru=.�e.,J DATE : 7-14-21
DH 4015 , 08 / 09 ( Obsoletes previous editions which may not be used )
Incorporated 64E- 6 . 001 , FAC Page 1 of 4
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DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT : Port St. Lucie Properties, Inc. AGENT : Alexander J. Piazza PSM, Inc.
LOT : 41 BLOCK : 51 SUBDIVISION : Indian River Estates Unit 7
PROPERTY ID # : 3402-608-0435-000-7 [ 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 : I✓] YES [ ] NO NET USABLE AREA AVAILABLE : 0 ,23 ACRES
TOTAL ESTIMATED SEWAGE FLOW : 500 GALLONS PER DAY [ RESIDENCES-TABLE I /OTHER-TABLE 2 ]
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 IS34 [ 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? [ I YES I✓ ] 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 : [ I YES [ ✓] NO 10 YEAR FLOODING? I ] YES I ✓ ] NO
10 YEAR FLOOD ELEVATION FOR SITE : FT MSL/NGVD SITE ELEVATION : FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
MUNSELL # /COLOR TEXTURE DEPTH MUNSELL # /COLOR TEXTURE DEPTH
TO TO
TO TO
TO TO
TO TO
TO TO
TO TO
TO TO
TO TO
TO TO
USDA SOIL SERIES : USDA SOIL SERIES :
OBSERVED WATER TABLE : 40+ INCHES [ BELOW EXISTING GRADE . TYPE : ( PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION : INCHES [. ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION : [ ] YES [ J NO MOTTLING : [ ] YES [ ] NO DEPTH : INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING : DEPTH OF EXCAVATION : INCHES
DRAINFIELD CONFIGURATION : IV] TRENCH [ I BED I ] OTHER ( SPECIFY)
REMARKS /ADDITIONAL CRITERIA :
Alexander J Piazza °'°°°° °°°""""`°'°°°"""
BITE EVALUATED BY : DATE : 7- 14-21
DH 4015 , 12/ 11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001 , FAC Page 3 of 4
APPLICANT'S NAME : Port St. Lucie Properties, Inc.
LEGAL DESCRIPTION : Lot 41 , Block 51 , Indian Riyer Estates Unit 7 (PB 10 , PG 75)
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.
Alexander Piazza °�;R ;=w =F43m,67m
NOTE: MUST BE CERTIFIED BY A FLORIDA CERTIFIED BY:
REGISTERED SURVEYOR OR ENGINEER. FLORIDA PROFESSIONAL NO. : w < +6330 -
DATE: 07/14/21 JOBNO.: 21 -7364
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