HomeMy WebLinkAboutSEWAGE APPLICATION FOR CONSTRUCTION PERMITSTATE OF FLORIDA �t Lucile County
= DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM /
""e'�' APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[�1 ] New System [ ] Existing S;
[ ] Repair [ ] Abandonmen
APPLICANT: Martin L. Riccio
AGENT: KARNER SURVEYING 1NU
MAILING ADDRESS: 2740 SW MARTIN
)WNS BLVD #333
PERMIT NO. �% 'SF ►�ys��'�
DATE PAID:
FEE PAID:
RECEIPT #:
[ ] Holding Tank [ 7 Innovative
[ ] Temporary [ ]
TELEPHONE (772) 288 .7206
CITY, FL. 34990
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: 5 BLOCK: 28 SUBDIVISI.ON: Revised Plat of Unit 5 Ft. Pierce Shores PLATTED: 1951
AOPERTY ID #: 1436-602-0010-000-3 ZONING: I/M OR EQUIVALENT: [ Y N ]
PROPERTY SIZE: 0.27 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ ]<=2000GPD [✓
]>2000GPD
IS SEWER AVAILABLE PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: / Oak Dr., Fort Pierce
DIRECTIONS TO PROPERTY: SEE ATTACHED
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 2275
2 /
3 /
4 /
[ ] Fl� or/Equipment Drains [ ] O r-(Specify)BU9
i
SIGNATURE: DATE: 5-2-18
DH 4015, 10/97 (Previous ' ions May Be Used) ONLINE VERSION F;1e
Co
APPLICANT: ICANT: Property owner's full name. . . - Ic
i
STATE OF FLORIDA PERMIT
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT ANDIDISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: Martin L. Riccio AGENT: KARNER SURVEYING INC
I
LOT: 5 BLOCK: 28 SUBDIVISION: 'Revised Plat of Unit 5 Ft. Pierce Shores
PROPERTY ID #:1436-602-0010-000-3 [Section/Township/Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR.OTHER QUALIFIED PERSON. ENGINNEERS
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: 0.27 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE2]
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: 1115 SQFT UNOBSTRUCTED AREA REQUIRED: 1000.5 SOFT
i
BENCHMARK/REFERENCE POINT LOCATION: MagNail/Disk in West edge of Road (Oak Drive) El. 3.67
ELEVATION OF PROPOSED SYSTEM SITE IS 0.27 [INCHES/*1'�] [ABOVE/BELOW] BENCE@OARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED
SURFACE WATER: 75 FT DITCHES/S1
WELLS: PUBLIC:N/A FT LIMITED USE:
BQILDING FOUNDATIONS: 5 FT PROPERTY L
THE PROPOSED SYSTEM TO -THE FOLLOWING FEATURES
15 FT NORMALLY WET? [ ] YES [ ] N
T PRIVATE: 75+ FT NON -POTABLE: 50 FT
10 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING: [
['�] NO
] YES �FT
10 YEAR FLOODING? [
] YES ['] NO
10 YEAR FLOOD ELEVATION FOR SITE:
MSL/NGVD
SITE ELEVATION:
FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO.
TO
TO
TO
TO
TO
'USDA SOIL SERIES:
SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:
TEXTURE
DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:[PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION:i INCHES [ABOVE / BELOW] EXISTING GRADE
SIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
I
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: 141 TRENCH [ ]iBED' [ ] OTHER (SPECIFY)
RY21ARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
O
DR 4015, 10/96 (Replaces ERS-E rcr'6j015 [page 31 which may be used) Page 3 of 4
STATE OF FLORIDA
-- DEPARTMENT OF HEALTH I
ONSITE SEWAGE TREATMENT AND -DISPOSAL
SYSTEM
�"16'�• APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[� ] New System [ ] Existing System
[ ] Repair [ ] Abandonment
APPLICANT: Martin L. Riccio
AGENT: EARNER SURVEYING INC
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
[ ] Holding Tank [ ] Innovative
[ ] Temporary [ ]
TELEPHONE(772) 288 7206
MAILING ADDRESS: 2740 SW MARTIN DOWNS BLVD #333,� PALM CITY, FL. 349
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE
CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489105(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: 5 BLOCK: 28 SUBDIVISION: Revised Plat of Unit 5 Ft. Pierce Shores PLATTED: 1951
PROPERTY ID #: 1436-602-0010-000-3 ZONING: I/M OR EQUIVALENT: [ Y-/ N
I
PROPERTY SIZE: 0.27 ACRES WATER SUPPLY: [�'+�] PRIVATE PUBLIC [ ]<=2000GPD [
]>2000GPD i
IS SEWER AVAILABLE AS
PER 381.0065, FS?
[ Y / N ]
DISTANCE TO SEWER: FT
PROPERTY ADDRESS:
Oak Dr., Fort Pierce
DIRECTIONS TO PROPERTY: SEE ATTACHED
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
2275
2
3
4
[ ] Floor/Equipment. Drains [ ] (-her (Spcify)
SIGNATURE: DATE: 5-2-18
DH 4015, 10/97 (Previous Editions �jy
Be Used) ONLINE VERSION Page 1 of 4
APPLICANT: Property owner's full name.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT ANDIDISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT:
LOT: 5 BLOCK: 28 SUBDIVISION:
PROPERTY ID #:1436-602-0010-000-
PERMIT #.
: KARNER SURVEYING INC
Plat of Unit
re
[Section/Township/Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS
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:400
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:-1115 SQFT
YES [ ]',NO NET USABLE AREA AVAILABLE: 0.27 ACRES
_GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE21
_GALLONS PER DAY (1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA REQUIRED: 1000.5 SOFT
BENCHMARK/REFERENCE POINT LOCATION: MagNail/Disk in West edge of Road (Oak Drive) El. 3.67
ELEVATION OF PROPOSED SYSTEM SITE IS 0.27 [INCHES/FT] [ABOVE/BELOW] SENCHMAitiC/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 75 FT •DITCHES/SWALES: 15 FT NORMALLY WET? ( ] YES [ ] NO
WELLS: PUBLIC:N/A FT LIMITED USE: FTI PRIVATE: 75+ FT NON -POTABLE: 50 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER -LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES 10 YEAR FLOODING? [ ] YES [�] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:[PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: . 'INCHES [ABOVE / BELOW] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YSS [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [q] TRENCH [ ] BED [ ] OTHER (SPECIFY)-
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
DR 4015, 10/96 (Replaces HRS-H Form 401Vj age 33 Which may be used) Page 3 of 4