HomeMy WebLinkAboutONSITE SEWAGESCANNED)
STATE OF FLORIDA
DEPARTMENT OF HEALTH O 9Irlp ,RIME
s., ONSITE SEWAGE TREATMENT ANDIDISPOSAL SYSTEM
, SITE EVALUATION AND SYSTEM SPELEFICATIONS
'PLICANT:
)T:0�6 BLOCK: SUBDIVISION:
WPERTY ID #:
PERMIT #.
AGENT:
10A
[ Section/Township/Parcel No. or Tax ID Number ]
) BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT'EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS
JST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
IOPERTY SIZE. CONFORMS TO SITE PLAN: i" YES I[ ] NO NET USABLE AREA AVAILABLE: 0o47 ACRES
)TAL ESTIMATED SEWAGE FLOW: 31)O , GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE2 ]
JTHORIZED SEWAGE FLOW: O 0 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE I
JOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: 5QFT
ZNCHMARK/REFERENCE POINT LOCATION: Y! D, c3 ""
EaVATION OF PROPOSED SYSTEM SITE IS I RICHES /Vr ] [ ABOVE/BELOW 7 BENCHMARK/REFERENCE POINT
HE MINIMUM SETBACK J WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
URFP.CE WATER: /7' FT DITCHES/SWALES: �FT NORMA•.LLY WET? [ j YES ]!. NO
CLLS: PUBLIC:FT LIMITED USE: /11/ FT PR TE:__FT NON -POTABLE: FT
UILDING FOUNDATIONS: FT PROPERTY~LINES: -yFT POTABLE WATER LINES: FT .
ITE SUBJECT TO FREQUENT FLOODING: j ] YES NO 10 YEAR FLOODING?. [ ] YES I ] NO
0 YEAR FLOOD.ELEVATION FOR SITE: kmSLINM SITE ELEVATION: FT MSL/NGVD
SITE 1 I enTT. PRnPTTE INFORMATION SITE 2
aUlL rnvr �uc� INFORMATION
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
-TO
TO
TO
TO
USDA SOIL SERIES:
)BSERVED WATER TABLE: INCHES [ABOVEJBELOW '] EXISTING GRADE. TYPE: [PERCHED [APPARENT ]
.STIMATED WET SEASON WATER TABLE ELEVA I N: INCHES [.ABOVE/BELOW ] EXISTING GRADE
iIGH WATER TABLE VEGETATION: [ ] YES NO MOTTLING: j I YES NO DEPTH: INCHES
302L TEXTURE/LOADING RATE FOR SYSTEM SIZING': DEPTH OF -EXCAVATION: INCHES
)RAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED j 7 OTHER (SPE('I�'X%.
2EMARKS/ADDITIONAL CRITE
31TE EVALUATED Y: _ DATE:
)H 4oi5, 12/11 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC age 3 of 4
ek- ID y
;J
STATE OF FLORIDA I APPLICATION # AP1333956
DEPARTMENT OF HEALTH I PERMIT # 56-SF-1831039
ONSITE SEWAGE TREATMENT AM DISPOSAL SYSTEM DOCUMENT # SE1069330
SITE EVALUATION AND SYSTEM SPECIFICATION
i
APPLICANT: Jeffrey Chesser
CONTRACTOR / AGENT: Gem Builders, [no
LOT: 20
SUBDIVISION: Lane Pine
BLOCK:
ID#: 3409-505-0025-000-5
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: 0.38 ACRES
TOTAL ESTIMATED SEWAGE FLOW:
400 GALLINS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 950.01 GALLINS PER DAY [ 1500 GPD/ACRE OR 1 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1566.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
Orange paint triangle CL of Rd center of property
ELEVATION OF PROPOSED SYSTEM SITE
1.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT
DITCHESI/SWALES: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: I FT PRIVATE: FT NON -POTABLE, FT
BUILDING FOUNDATIONS: 5 FT
PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING?
[ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [XINO]
10 YEAR FLOOD ELEVATION FOR SITE:
FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
enTT. nonVTT.V TW7nnMnmTnN QTMV 1
SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:Wabasso fine sand
Munsell #/Color Texture
Depth
10YR 5/3
Loamy Sand
0 To 5
10YR 4/1
Sand
5 To 15
10YR 5/1
Sand
15 To 29
10YR 6/1
Fine Sand
19 To 29
10YR 5/3
Fine Sand
29 To 42
10YR 3/3
Fine Sand
42 To 52
10YR 4/3
Sandy Clay Loam
52 To 59
1 OYR 5/1
Loamy Sand
59 To 72
i
USDA SOIL SERIES:Wabasso fine sand
Munsell #/Color Texture
Depth
10YR 5/3
Loamy Sand
0 To 7
10YR 411
Sand
7 To 17
10YR 5/1
Sand
17 To 30
10YR 6/1
Sand
30 To 35
10YR 513
Sand
35 To 45
1 OYR 3/3
Fine Sand
45 To 54
10YR 4/3
Sandy Clay Loam
54 To 66
10YR 4/1
Sandy Loam
66 To 72
OBSERVED WATER TABLE: 67.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 119 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X)NO MOTTLING: [X]YES [ ]NO DEPTH: 19.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: I Sand/0.60 DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X ]'BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings.
10YR6/1 stripping In 10YR511 matrix >10% with diffuse boundariesistarting at 19' In S131.
SB1 V below BM. 8132 V above BM.
SITE EVALUATED BY:
Ingram, Brian (Title: E ironmental Specialist 11) (ENVIRONMENTAL HEALTH)
DR 4015, 08/09 (Obsoletes previous editions which y not be used) Incorporated: 64E-6.001, FAC
AP1333956 EID1831039
DATE: 03/20/2018
Page 3 of 4
v 1.0.2
i
'(NE
STATE OF FLORIDA PERMIT NO.
-� DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:`'
F - SYSTEM RECEIPT #
z APPLICATION FOR CONSTRUCTION PERMIT
P�L ICATION FOR:
[ X] New System [ ] Existing System [ ] Holding Tank [. 1 Innovative
[ � i, Repair q [ ] Aba-qdonment [ ] Temporary [ ]
APPLIWT,,V zt
AGENT ` Pr ( TELEPH 74
MAILING ADDRESS: �. NA t 1 /)F� 1 �i ngy R N
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3)1(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
I'
LOT: '-1-= BLOCK: SUBDIVISION: ('�/J(� .5o 1)PLATTED:
PROPERTY ID #: ZONING: I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: 0140 ACRES WATER SUPPLY:'[ ] PRIVATE PUBLIC [x]<=2000GPD [ 1>2000GPD
. j ��,
IS SEWER AVAILABLE AS PER 381.0065, FS? DISTANCE TO SEWER:
PROPERTY ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION [] RESIDENTIAL [ ] COML�RCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
i
2 -\J°
3.33 �-r.4
Al
[ ] Other (Specify)
DH 4 15, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
I
Page 1 of 4
r
HEALTH
PAYING ON:
RECEIVED FROM:
PAYMENT FORM:
MAIL TO: Jeffrey Chesser
FACILITY NAME:
PROPERTY LOCATION:
1317 Lone Pine Dr
Fort Pierce, FL 34982
f
i
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
#• 56-SF-1831039 BILL DOC #?56-BI D-3686970 CONSTRUCTION APPLICATION #. AP1333956
Builders, Inc AMOUNT PAID: $ 515.00
;K 12558 PAYMENT DATE: 03/15/2018
Lot:
20 Block:
Property ID: 3409-505-0025-000-5
EXPLANATION or DESCRIPTION:
128 - OSTDS Construction System Inspection Research Fee
-1 - Surcharge (All)
-1 - OSTDS New Permit Surcharge
I
-1 - OSTDS Construction Application and Plan Rev iew,New
123 - OSTDS Construction Site Evaluation
126 - OSTDS Construction Permit (New or Mod, Amendment)
127 - OSTDS Construction System Inspection
133 - OSTDS Construction Reinspection
QUANTITY
FEE
1
$
5.00
1
$
15.00
1
$
100.00
1
$
100.00
1
$
115.00
1
$
55.00
1
$
75.00
1
$
50.00
RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-3498319
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT:
PROPERTY ADDRESS:
Chesser
OSTDS New
1317 Lone Pine Dr Fort Piet
FL 34982
LOT: 20 BLOCK: SUBDIVISION:
PROPERTY ID # : 3409-505-0025-000-5
PERMIT #:56-SF-1831039 -
APPLICATION #: AP1333956
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1098741
Lone Pine
[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, E.A.C. 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 MAMADE NULL AND RESULT IN THIS PERMIT BEING MVOID.
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT 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 Septic new CAPACITY
A [ ] GALLONS / GPD N/AI CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ]
D [ 667 ] SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ]
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:. Orange p,,
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
[x] BED 1 [ ]
of Rd center of
[ 1:00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
[ 4.00 ] [ INCHES FT ] [ ABOVE BELOW ] BENCHMARK/REFERENCE POINT
D FILL REQUIRED: [23.00 INCHES Cint;tivtsllva� ^"•y�v��.c.•. - The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
0 400 gpd.
T The licensed contractor installing the system is responsible for installing the minimum category of tank In accordance with
H s. 64E-6.013(3)(f), FAG.
E
I
R
SPECIFICATIONS BY: Brian J.In979A TITLE: Environmental Specialist II
APPROVED BY42�—ITLE: Environmental Specialist II St. Lucie CHD
Brian J Ingr77
DATE ISSUED: 03/20/2018 EXPIRATION DATE: 09/20/2019
I
DR 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC i Page 1 of 3
v 1.1.4 AP1333956 SE1069330