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PEAWT WALL BE :91-- DURU,* AU tom. WRCAT:0h. OR -*AW-WtsMSXT ACTMIT198,
-MdKin St. Lucie County
o n me ti Hea
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6
tz
Rr &
sitd,Phan Approved for Construction
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Supersedes All "Previous. Site Plans for
OSTDS ?c� 7 95 & Well #::�f
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:Date; &
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eviewer:
Wer
CUSTOM RESIDENCE FOR:
LABERGE RESIDENCE
'il
REFUGE LANE
ST. LUCIE COON Y, FLORIDA
02 :Fff
K H111-f-M
rl
W., F
Steve LiCausi Design Group,, Inc.
RESIDENTIAL DESIGNERS
10710 SW We9I—Wv&.P-tSLLode, FL, 34 987
OT= & Fm (772) M-6465
m
F
N��E!`g°•E�i !
f
CUSTOM RESIDENCE FOR:
LABERGE RESIDENCE
REFUGE LANE:
ST. LUCIE COUNTY, FLORIDA
Steve LiCausi Design Group, Inc.
RESIDENTIAL DESIGNERS
10710 SW Wtsd—Btv&' port SG Lurie. FL, 34987
Offix & Fax: CM) 785-6465
FOF aeme4vm Pff mryew —j.
. i4
-Anne 7? 2-3to!'6-0(a r
STATE OF FLORIDA
DEPARTMi3NT OF-, HE,
ONSITE SEWAGE" TRl
SYSTEM'
APPLICATION FOR I
APPLICATION FOR:
] New System [ ] Existil
`] Repair [ ] Ab4ndo3
APPLICANT: 144M 1 Grlk n_✓���
AGENT:
MAILING ADDRESS:
i
AND DISPOSAL
TION PERMIT
System [ ]
ent [ ]
PERMIT NO.5�&7
DATE PAID:
FEE PAID: _
RECEIPT #.�y�
Holding Tank [ ] Innovative
Temporary [ ]
ek
AL I`�"'� /<3���i pan
TELEPHONE; Z���
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TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST. BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 4819.3.05(3)(m) OR 489.552, FRLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THEDATE THE LOT WAS'CREATED'OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
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PROPERTY INFORMATION I
LOT: BLOCK: SUBDIVISION: L1ce. Pu q PLATTED:
PROPERTY ID # : `Z • T
Z ' c'�a b?j -^ 0C�O .5 ZONING: ^ C: '1- I /M OR EQIII VALENT : C Y / N ]
PROPERTY SIZE: ACRES
WATER SUPPLY: IM PRIVATE
PUBLIC [ ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065,
FS?
[ Y /(N y
DISTANCE TO SEWER: -^ FT
PROPERTY ADDRESS:
DIRECTIONS TO PROPERTY:
I
i
BUILDING INFORMATION
y ill RESIDENTIAL [
] COMMERCIAL
Unit Type of
No Establishment
i
No.;of
Bedrooms
Building Commercial/Institutional System Design
i
Area Saft Table
1, Chanter 64E-6, FAC
1
2
3
4
,4
Floor/Equipment Drains [ ,] Other (Specify)
`0
SIGNATURE:
DH 4015, 08/09 (Ob'BejAes pj
Incorporated 64E-6.001.; PAC,
editions which'may not be used)
I Page 1 of 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATM
SITE EVALUATION AND
APPLICANT: Anne la
CONTRACTOR / AGENT:
LOT: 2
Land
AND DISPOSAL SYSTEM
'EM SPECIFICATION i
BLOCK:
APPLICATION # AP1293398
PERMIT # 56-SF-1767495
DOCUMENT # SE1037336
SUBDIVISION: Edens Refuge.. ID#: 4504-702-0003-000-5
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': 0.61 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 wUw010 PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 915.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 929,00 iQFT UNOBSTRUCTED AREA REQUIRED: 750A0 SQFT'
BENCHMARK/REFERENCE POINT LOCATION: site BM painted X CL of Rd center of property
ELEVATION OF PROPOSED SYSTEM SITE 55.00 [ INCHES / FT ] [ ABovE / BELOW ] BENCHOUWREFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 50 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 I enTT- nv^wvT_ -
USDA SOIL SERIES:St. Lucie sand
Munsell #/Color Texture
Depth
10YR 411
Sand
0 To 19
10YR 5/1
Sand
19 To 271
1 OYR 6/1
Sand
27 To 40
10YR 7/1
Sand
40 To 531
10YR 811
Sand
53 To 721
I
` I
USDA SOIL SERIES:St. Lucie sand
Munsell #/Color Texture
Depth
10YR 4/1
Sand
0 To 15
10YR 511
Sand
15 To 24.
10YR 6/1
Sand
24 To 44.
10YR 7/1
Sand
44 To 54
10YR 8/1
Sand
54 To 72
OBSERVED WATER TABLE: 72,00 INCHES [ ABOVEI/ BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 1 72 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: ( ]YES [X]NO MOTTLING:[ ]YES. [X]NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ )' OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
i
WSWT determ)ned using USDA WSS, soil borings, and area topography.
No WSWT indicators is either SBs.
Sal 65" above BM. SB2 25" above BM. 3rd SB done down hill to verify no WSWT indicators at lower eievatlen
SITE EVALUATED BY:
Ingram, Brian (e: Environmental Specialist II) (ENVIRONMENTAL HEALTH)
DH 4015, 09/09 (obsoletes previous editions which may Doti be used) Incorporated: 64E-6.001, PAC
DATE: 05/08/2017
Page 3 of 4
AP1293398 EID1767496
i
I
v 1.0.2
STATE OF FLORIDA
DEPARTMENT OF HEALT
ONSITE SEWAGE TREAT
SITE EVALUATION AND
APPLICANT:
LOT: Z BLOCK: — SU
PROPERTY ID #: zi44a 707. --1' 0003
TOBE COMPLETED BY ENGINEER, HEALTH
PERMIT '.17to (f�
fT AND DISPOSAL SYSTEM
'STEM SPECIFICATIONS
G i
AGENT: 1 1�"i-(ren�y tG7n n �A/,'1
1-11
SION:
%p [Section/Township/Parcel No. or Tax ID Number]
ItTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINSEitS
v AND SEAL EAnN pat,.
nta
PROPERTY SIZE CONFORMS TO SITE PLAN- 1 YES [ ] NO NET USABLE AREA AVAILABLE: O'
TOTAL ESTIMATED SEWAGE FLOW: _� !. ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE2]
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY 11500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: SQFT -UNOBSTRUCTED AREA REQUIRED:
SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE'IS e`
(INCHES/FT] OVE/BSLow1
THE MINIMUM SETBACK WHICH CAN BE'MAINTAINED FROM THE PROPOSED 'SYSTEM TO THE FOLLOWING FEA S
SURFACE WATER: I�_PT DITCHES/SWALES: FT NO SALLY WET? [ ] YES �NO
WELLS: PUBLIC:_ a FT LIMITED USE:(_ j a FT PRIVATE: PT NON -POTABLE: FT
BUILDING FOUNDATIONS:_ -7 FT PROPERTY LINES:_ �� FT POTABLE WATER LINES:
FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES jA NO 10 YEAR FLOODING? [ ] YES' �`]
10 YEAR FLOOD ELEVATION FOR SITE: NOFT MSL/NGVD SITE ELEVATION:
FT MSL/NGVD
y1tMATION SITE 1
TEXTURE
r
USDA SOIL SERIES:
o-A- rxvE"m INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO'.
TO
TO
TO.
TO,
TO
TO
TO
USDA SOIL SERIES: I`
i
OBSERVED WATER TABLE :_ PARENT] INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:[PERCHED / Ap
ESTIMATED WET SEASON WATER TABLE ELEVATION:
INCHES (ABOVE / BELOW] EXISTING GRADE
SIGH WATER TABLE VEGETATION: [ j YES [ j NO MOTTLING: [ ] YES [ ] NO. DEPTA:�_INCHSS
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF DRAINFIELD CONFIGURATION: [ ] TRENCH [ I BED I ].OTHER (SPECIFY)
�VATION:INCHES
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
DATE:
DR 4015, 09/09 (Obsoletes Previous editions which may not be used) Incorporated: 64E-6.001, FAC
Page 3 of 4
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT: Anne lannicch
PROPERTY ADDRESS: Raft
LOT: 2 BLOCK:
PROPERTY ID #:. .
OSTDS
Ln Fort Pierce, FL
' �UDL1V151VLV:
PERMIT #:66-SF-1767496'
APPLICATION #:AP1293398
DATE PAID:
FEE PAID:
RECEIPT #:
DocmaNT #: PR1066179
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF- SECTION
381.0065, F.S., AND CHAPTER 64E=6, F.ALC. DEPARTMENT APPROVAL OF SYSTEM DOES' NOT GUARANTEE
SATISFACTORY 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 BEING MADE NULL. AND VOID.
ISSUANCE OF THIS PERMIT DOES NOT E T THE APPLICANT FROM.• COMPLIANCE WITH OTHER FEDERAL,
STATE, -OR LOCAL. PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T {
1,050 ]
GALLONS / GPD Seotic
ne
A L
]
GALLONS / GPD N%A
N [
]
GALLONS GREASE INTERCEPTOR CAPACI
K [
]
GALLONS DOSING TANK CAPACITY
[
D [
500 ]
SQUARE FEET Drainfield new
R {
]
SQUARE FEET N/A
A TYPE SYSTEM: [X] STANDARD [ 7 FILLED
I CONFIGURATION: pc] TRENCH [ ] BED
N
W CAPACITY
CAPACITY
TY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
SYSTEM
SYSTEM
[ ] MOUND [ ]
C] -
F LOCATION OF BENCHMARK: site BM painted X CL of Rd center of property
I ELEVATION OF PROPOSED SYSTEM SITE [ 551.001 INCHES FT ]
E BOTTOM OF DRAINFIELD TO BE [ 25 00 ] [INCHES FT ]
L
D l
0
T
H
E
R
]BENCHMARK/REFERENCE POINT
]BENCHMARK/REFERENCE POINT
'ILL REQUIRED.-, { 0:001 INCHES EXCAVATION REQUIRED: [ ] INCHES
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
400 gpd.
The licensed contractor installing the system is responsible for installing the minimum catdgory of tank in accordance with
s. 64E-6.013(3)(f), FAC.
NO WSWT. BOTTOM DF NOT TO BE > 30"BELOW GRADE.
SPECIFICATIONS BY: Brian J Ingrag TITLE:
Environmental Specialist II
i
APPROVED BY: LE: Environmental Specialist II St.LUCIe CHD
Brian Ingram
DATE ISSUED: 06/13/2017 EXPIRATION DATE: 12/13/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
V 1.1.4 AP1293398 sE1037336
I
I
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 [ I,
APPLICANT: Gj�I YI GG ►^1 L�
AGENT: � (�r�rn-� �- d3 �L'�L / TELEPHONE: ??
"�iC � _ ��G'��
l L /I ;
MAILING ADDRESS: �� r�
I
TO.BE COMPLETED BY APPLICANT OR APP.LI
BY A PERSON LICENSED`..PURSUANT TO
APPLICANT'' S.' RESP,ONSIBt-LITY .-TO f,VP VTDB
PLATTED (MM/DD/YY)"CIF REQIIEST G CONS
PROPERTY INFORMATION
LOT: BLOCK: SUBDIVISI
PROPERTY ID # : +5q • -7 a Z - e-_X7 nl�Z --
PROPERTY SIZE: (3 l ACRES WATER
IS SEWER AVAILABLE AS PER 381.0065,
PROPERTY ADDRESS:
UMT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
.05(3)(m) OR 489.552, FLOR DA STATUTES IT., -IS THE
-r .
DOCUMENNTATION 'OE` THL'` DATE' THSt;OT2 WAS `CREATED' OR
:DERATION OF STATUTORY(GRANDFATHER PROVISIONS.
)N: Ectzr, S �•� �s PLATTED: ..'/
�b •5 .� ZONING: L GI/M OR EQUIVALENT: [ Y / N ]
PLY: [M PRIVATE PUBLIC [ ]c=2000GPD.[ ]>20006PD
g [ Y / DISTANCE TO SEWER: —"^ FT
DIRECTIONS TO.PROPERTY:
•
BIIILDING INFORMATION
I
RESIIDENTIAL [
] COMMERCIAL
Unit
No
Type of
Establishment
NO. of
Building Commercial/Institutional System•D'esign
Bedrooms
Area Sgft Table
1, Chapter 64E-6, PAC
1
3—i
L�Jn �i
�y`C 113
2
3
[ ].
Floor/EquipmeHt Drains
I
I ]- Other (Specify)
,
SIGNATURE:
a DATE:
DR 4.015, 08/09 (Ob es.p,evi us editions which may not be used)
Incorporated 64E-6 00.1;FAC' j Page 1 of 4
j
STATE OF FLORIDA
DEPARTMENT OF NTALT
ONSITE SEWAGE TREAT
SITE EVALUATION AND
1
AND. DISPOSAL SYSTEM
'EM SPECIFICATIONS
LOT: BLOCK: SUBDIVISION: ��
PROPERTY ID # : 2k�64. 70 7_--;- 06 3 ' 'C6lc7 • -
[Sec
TO BE COMPLETED BY ENGINEER,
PROPERTY SIZE'CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED'AREA AVAILABLE:
BENCHMARK/REFERENCE POINT LOCATION:_
ELEVATION OF PROPOSED SYSTEM SITE IS
AGENT:
PERMIT #.
G
NO. or Tax ID Number]
'MMT EL Y3E,OR OTHER QIIALIFIEPERSON:
AND SEAL- E"AF D ENGINEERS
AOAL. COMPLRTP'
to YES [ ] NO NET USABLE AREA AVAILABLE: D-ACRES
GALLONS PER DAY [RESIDENCES-TABLE•1/OTHER-TABLE2]
GALLONS PER DAY [11500 GPD/ACRE OR 2500 GPD/ACRE]
SQFT IINOBSTRUCT ARHA REQIIIRED:' SQF:T
POINT
THE MINIMt7M SETBACK WHICH CAN BE;MAINTAINED•FROM THE PROPOSED 'SYSTEM TO THE FOLLOWING FEA UURES
SURFACE -WATER: IOo FT DITCHES/SWALES: C'" FT NO�A,LY WET? [ ]• YES [ j NO
WELLS: PUBLIC: D FT LIMITED USE:gT PRIVATE:;' S FT NON-:P.OTABLEi
BUILDING FOIINDATIONS:��� FT PROPERTY LINES:—. 1 FT POTABLE WATER LINES: p,rg� gT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [% NO
10 YEAR FLOOD ELEVATION FOR SITE: 10 YEAR FLOODING? [ ] YES NO
FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
" I
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE DEPT!
-_ TO
TO
TO
TO
TO
TO I
TO
TO
USDA SOIL SERIES: —TO
�
SOIL
2
-- n, ....Lvn rL"xTIIRE DEPTH
TO
TO
TO
' TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE _ INCHES [ABO,VE / BELOW] EXISTING GRADE. TYPE:[PERCHED /APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: _
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO LING:INCHES [ ] [ BOS E [/ ] BELOW]
W] EXISTING- GRADE
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION. [ ] TRENCH NG BED DEPTH OF EXCAVATION: INCHES
REMARKS/ADDITIONAL CRITERIA: [ ] OTHER (SPECIFY)
i
SITE EVALUATED BY:
DATE:
DH 4015, 08/09 (Obsoletea previous editions which ma not be used) Incorporated: rporated: 64E-6.001, FAC Page 3 of 4
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