HomeMy WebLinkAboutAPPLICATION FOR CONSTRUCTION PERMITSTATE OF FLORIDA
f DEPARTMENT OF HEALTIL
ONSITE SEWAGE TREATMENT
SYSTEM
° �''`�. APPLICATION FOR CONSTR/C
APPLICATION FOR:
New System [ ] Existing System
[ ] Repair [ ] Abandonment
APPLICANT: Rosario Reyes ^ n k1hl
AGENT: Alexander J. Piazza PSM, Inc.
MAILING ADDRESS: 619 SW Biltmore Street, ortt 1 Luc
/ C
0ERM?LT NO.
"" °°DATE PAID:
AND DISPOSAL FEE PAID:
RECEIPT #:
TION PERMIT
[ ] Holding Tank
[ ] Temporary
34983
[ ] Innovative
TELEPHONE: 772-340-7770
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: 18 BLOCK: 54 / SUBDIVISION: Indian River Estates Unit 8 PLATTED: 1958
PROPERTY ID #: 3402i609-0076-000-5 ZONING: R I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 0.230 ACRES WATE
R SUPPLY: [od PRIVATE PUBLIC [V ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS/PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 5604 Seagrape Drive, Fort Pierce, Florida 34982
DIRECTIONS TO PROP / TY: SEE MAP
BUILDING INFORMATION [�/] RESIDENTIAL [ ] COMMERCIAL
Unit Type / No. of Building Commercial/Institutional System D
No Establishment Y Design
Bedrooms Area SQ_ft Table 1, Chapter 64E-6, FAC
1 RESIDENCE 3 1,376
2 /
3
4
I I Floor/Equipment Drains
P
Other. (specify) GARBAGE GRINDERS /DISPOSALS
Of
4015, 08/09 (Obsoletes previous edit
orporated 64E-6.001, FAC
which may not be used)
DATE:
K1�E •,
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM', SPECIFICATIONS
APPLICANT: Rosario
LOT: 18 BLOCK: 54 SUBDIVISION:
PROPERTY ID #:
4 �
PERMIT #.
AGENT: Alexander J. Piazza PSM, Inc.
Indian River Estates Unit 8
[ Tax ID Number
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT tMPLOYEE,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:
TOTAL ESTIMATED SEWAGE FLOW: 500
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE: 750
[✓] YES
[I] NO NET USABLE AREA AVAILABLE: ACRES
SONS PER DAY [ RESIDENCES -TABLE VOTHER-TABLE 2 ]
SONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE ]
SQFT I UNOBSTRUCTED AREA REQUIRED: 750 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS 34 [
/FT ] [ABOVE/BELOW'] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROMITH
SURFACE WATER:100 FT DITCHES/SWALES:115
WELLS: PUBLIC:200 FT LIMITED USE:100 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINE
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES 14 NC
10 YEAR FLOOD ELEVATION FOR SITE: FT MSI
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
E PROPOSED SYSTEM TO THE FOLLOWING FEATURES
FT NORMALLY WET? [ I YES [✓] NO
PRIVATE: 75 FT NON —POTABLE: 100 FT
S:10 FT POTABLE WATER LINES: FT
i
10 YEAR FLOODING? [ ] YES ],/] NO
SITE ELEVATION: FT MSL/NGVD
.,
IMUNSELL #/COLOR TEXTURE DEPTH
TO
TO
I TO
TO
I TO
TO
TO
TO
TO
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 [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [./'] TRENCH [ ] BED [+] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY: 1. DATE: 2-02-18
i
DH 4015, 12/11 (Obsoletes previous editio /s.'�hich may riot, be used):Incorporated: 64E-6.001, FAC Page 3 of 4
` I
APPLICANT'S NAIME:
LEGAL DESCRIPTION:
Rosario Reyes
'Lot 18, Block 54, Indian River Estates Unit 8
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 rio 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 pr, oposed 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. proppsed septic system and. the benchmark must
be shown on the site plan. Please. locate the benck mark 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: 02/02/18 JOB NO.: 18=3528
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