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HomeMy WebLinkAboutOSTDS NEWSTATE OF-FLORIDA I SCANNED DEPARTMENT OF HEALTH le6num, MONSITE SEWAGE TREATMENT SOSAL SYSTEM aa PERMIT FOR: OSTDS New Ronald Myers ADDRESS: 2971 Rogers Rd Fort Pierce, FL 34981 LOT: BLOCK: SUBDIVISION: ID #: 2419-443-0002-000-7 PERMIT #: 56-SF-1879275 APPLICATION #:AP1365528 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1167323 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM T BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS BE AND STANDARDS OF SECTION 381.0065F.S., AND CHAPTER 64E-6, F.A.C. rORSY DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFAC FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SIRVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT PLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, ai LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM D [ R [ A TYPE I CONF N F LOCA I ELEV E BOTTOM L D FILL X The sy O 300 gp T The lic H s.64E- E R AND SPECIFICATIONS ] GALLONS / GPD Septic new CAPACITY ] GALLONS / GPD N/A CAPACITY ] GALLONS'GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] ] SQUARE FEET Drainifled new SYSTEM ] SQUARE FEET N/A SYSTEM :M: [ ] STANDARD [X] FILLED [I MOUND .[ ] 1ION: [X] TRENCH [ ] BED [ ] OF BENCHMARK: Site BM red OF PROPOSED SYSTEM SITE DRAINFIELD TO BE I near SW corner of house [ 5.00 ][ INCHES FT ][ABOVE BELOW] BENCHMARK/REFERENCE POINT [ 3.00 ] [ INCHES FT ] [ABOVE BELOW ] BENCHMARK/REFERENCE POINT tED: [16.003 INCHES EXCAVATION REQUIRED: [ ] INCHES is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of ised contractor installing the system is responsible for installing. the minimum category of tank in accordance with .013(3)(0, FAC. SPECIFICATIONS BY: ^ Brian J Inge TITLE: Environmental Specialist II APPROVED Y: / ' T : Environmental Specialist II St. Lucie CHD Brian J In am DATE ISS D.: 10/15/201 EXPIRATION DATE: 04/15/2020 DR 4016, 9/09 (Obsoletes all previous editions which may not be used) Incorpora ed: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AP1365528 SE1117238 NOTICE OF RIGHTS f adr pro adr Del Ag( ord to go by A party whose substantial interest is affected by this order may petition for an listrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such !edings are governed by Rule 28-106, Florida Administrative Code. A petition for iistrative hearing must be in writing and must be received by the Agency Clerk for the rtment, within twenty-one (21) days from the receipt of this order. The address of the cy Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency 's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will itute a waiver of your right to an administrative hearing, and this order shall become a 'final Should this order become a final order, a party who is adversely affected by it is entitled al review pursuant to Section 120.68, Florida Statutes. Review proceedings are ;d by the Florida Rules of Appellate Procedure. Such proceedings may be commenced one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a copy, accompanied by the filing fees required by law, with the Court of Appeal in the late District Court. The notice must be filed within 30 days of rendition of the final order. St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYIN ON: PERMIT#: 56-SF-1879275 BILL DOC #:56-BID-3973212 CONSTRUCTION APPLICATION #: AP1365528 RECEI ED FROM: Candice Myers AMOUNT PAID: $ 515.00 PAYMENT FORM: CREDIT CARD PAYMENT DATE: 09/21/2018 MAIL TO: : Ronald Myers FACILITY NAME : _ PROPE�TY LOCATION: 2971 fort Lot: Rogers Rd Pierce, FL 34981 Block: roperty ID: 2419-443-0002-000-7 .EXPLANATION or DESCRIPTION: TDS Construction System Inspection Research Fee QUANTITY 1 $ FEE , 5.00 128 - O -1 - Sui harge (All) 1 $ 15.00 -1-OS DS New Permit Surcharge 1 $ 100.00 -1-OS DS Construction Application and Plan Review,New 1 $ 100.00 123 - O B TDS Construction Site Evaluation 1 $ 115.00 126 - O TDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127 - OSTDS Construction System Inspection 1 $ 75.00 133 - O TDS Construction Reinspection 1 $ 50.00 REC VIED BY: VanceMH AUDIT CONTROL NO. 56-PID-3733187 AGENT : MAILING TO BE. CO] BY A PER APPLICAN' PLATTED PROPERTY 4, STATE OF FLORIDA DEPARTMENT OF HEALTH ^a= ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT JN FOR: System [ ] Existing System [ ] Holding Tank r [ 7 Abandonment [ ] Temporary S S : �Awc� PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: G [. ] Innovative C ] TELEPHONE: 'LETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED N LICENSED PURSUANT TO 489.105(3)(m) OR 489.552; FLORIDA STATUTES. IT IS.THE S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR M/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. LOT: BLOCK: SUBDIVISION: �� � ^^ ,� PLATTED: 90 PROPERTY ID ]k : �. ��% " -. %OQ�'d ©�"' ZONING: I/M OR EQUIVALENT: [ Y / N ] PROPERTY IZE: a ACRES WATER SUPPLY: [XI PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? L Y /lam, DISTANCE TO SEWER: All!Ir FT PROPERTY DRESS: ./ o 6 -ezft- l f e, e e. l DIRECTION TO PROPERTY: /,r ,O ,ri A dt /- 11 fl in •0 l� S n /L /I/r. , , b i,/nR BUILDING Unit Typ No Est T J 2 3 II [ ] Flo SIGNATURE DH 4015, , Incotpora L a of iblishment OM& [, ] RESIDENTIAL [ ] COMCERCIAL X No. of Building Commercial/Institutional System Design Bedrooms Area Sgft Table 1, Chapter 64E-6, FAC i3(Obsole!tes '�ment mns [ ] Other (Specify) DATE : • � � � ,� 6 pre us editions which may not be used) .ed 64E-6.001, FAC �^ �� � Page 1 of 4 •� STATE OF FLORIDA DEPARTMENT OF HEALTH ( ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM x SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT Ronald Myers CONTRACTO / AGENT: Candice Myers LOT: I BLOCK: SUBDIVI31ION: ID# : 2419-443-0002-000-7 APPLICATION # AP1365528 PERMIT # 56-SF-1879275 DOCUMENT # SE1117238 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. •ENGINEERS MUST PROVIDE REGISTR2 E N NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY IZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 2.47 ACRES TOTAL EST MATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2' ] AUTHORIZE SEWAGE FLOW: 3704.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 563.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM red capped IR near SW corner Of house ELEVATION F PROPOSED SYSTEM SITE 5.00 [ INCHES / FT ) [ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIM0 SETBACK WHICH CAN BE 14AINTAINEDfFROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE ER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO WELLS: UBLIC: FT LIMITED USE: FT PRIVATE: 95 FT NON -POTABLE: FT BUILDING UNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 'FT SITE SUBJE T TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO] 10 YEAR FLiOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD GATT. ARn7T1.F. TNFnRMATTAN RTmF 9 ROTL PROFILE INFORMATION SITE 2 USDA SOIL Munsell #, ERIES:Nettles sand olor Texture Depth 10YR 4/2 Sand 0 To 14 10YR 5/1 Sand 14 To 19 1 OYR 6/1 Sand 19 To 35 10YR 7/1 Sand 26 To 38 1 OYR 7/2 Sand 38 To 44 10YR 4/2 Sand 44 To 51 7.5YR 4/4 Sand 51 To 55 1 OYR 6/2 Sandy Clay Loam 55 To 72 USDA SOIL SERIES:Nettles sand Munsell #/Color Texture Depth 10YR 4/2 Sand 0 To 17 10YR 5/1 Sand 17 To 26 10YR 6/1 Sand 26 To 37 10YR 7/1 Sand 33 To 41 10YR 4/2 Sand 41 To 48 10YR 4/4 Sand 48 To 57 10YR 5/1 Sandy Clay Loam 57 To 63 10YR 612 Sandy Clay Loam 63 To 72 OBSERVED WATER TABLE: 65.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ) ESTIMATED T SEASON WATER TABLE ELEVATION: 26 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES EX ]NO MOTTLING: [X]YES [ ]NO DEPTH: 26.00 INCHES SOIL TEXTIIE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES DRAINFIELD C ONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determl ed using USDA WSS and soil borings. 19YR7/1 stripp� g in 10YR6/1 matrix >10% with diffuse boundaries starting at 26" In SB1. SB1 5 " above M. SB2 6" above BM. or SITE EVALUA BY: DATE: 10/08/2018 Ingram, Brian (Title: Env mental Specialist II) (ENVIRONMENTAL HEALTH) DH 4015, 08/0, (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3-of 4 AP1366628 EID1879276 v 1.0.2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PPLICANT: IjKej�J, j-,. �1� �"11 AGENT PERMIT It. �{p • � R• �d ° ' 475 OT: BLOCK: SUBDIVISION: �J " 36 "y" :koPERTY ID ]t : _ p2¢� �` ¢4-3t- O O o q---p (7 6 _ .. [ Section/Township/Parce] No. or Tax ID Number ] J BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS JST PROVIDP REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ROPERTY SIZE CONFORMS TO SITE PLAN: [ j YES [ ] NO NET USABLE AREA AVAILABLE: If ACRES UTAL ESTIMATED SEWAGE FLOW: 3b p GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE2 ] UTHORIZED SEWAGE FLOW: 1 V, O GALLONS PER DAY [ 1500 GPD/ACRE OR2500 GPD/ACRE ] 90BSTRUCTE AREA AVAILABLE: 7 7t0-,Z- SQFT UNOBSTRUCTED AREA REQUIRED: b Ci SQFT - - t 11 �lel UNCHMARK/REFERENCE POINT LOCATION: P+o:., LEVATION O� PROPOSED SYSTEM SITE IS [`'INCEIES / FI' ] [ ABOVE / BELOW ] BENCHMARK/REFERENC j POINT HE MINTMU0 SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES URFACE WA R:FT DITCHES/SWALES:�FT NO LY WET? ( ] YES] NO ELLS: PUBC:—10 (�FT `LIMITED USE: FT PRIVAFT NON -POTABLE: �j © FT UILDING FO�INDATIONS: FT PROPERTY LINES:�FT POTABLE WATER LINES: FT ITE SUBJECT TO FREQUENT FLOODING: ( ] YES [k NO 10 YEAR FLOODING? [ ] YES Vj NO 11 0 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROF�, INFORMATION SITE 1 MUNSELL #/JCOLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA soiIll SERIES: SOIL PROFILE INFORMATION SITE 2 MUNSELI; #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: BSERVED WATER TABLE: INCHES [ABOVE/BELOW 1] EXISTING GRADE. TYPE: [ PERCHED /APPARENT ] STIMATED NET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE IGH WATER FABLE VEGETATION: [ ] YES [%] NO MOTTLING: [ ] YES ['] NO DEPTH: INCHES OIL. TEXTU RAINFIELD EMARKS/AD ITE El 11 4015, /LOADING RATE FOR SYSTEM SIZING: ONFIGURATION: [ ] TRENCH [ ] BED TIONAL CRITERIA: BY DEPTH OF EXCAVATION: INCHES I ] OTHER (SPECIFY) (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC DATE: 3 of 4 T Property Page 1 of 1 56. sr r f � 772 75 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Address: 2971 Parcel ID: 2419-443-0002- Account #: 27462 Sec/Town/Range: 1ERS RD 000-7 19/35S/40E ID: 24/19S Zoning: RS-3 Use Type: 0100 Jurisdiction: Saint Lucie County Oyvnership Legal Description Ro1 Myers 19 35 40 N 1/2 OF S 1/2 OF SW 1/4 OF SE 1/4 OF SE 1/4 2971 Rogers RD (2.40 AC) (OR 1471-1927, 1930: 2333-451: 2357-175: 2634- Fo Pierce, FL 34981 1801) Current Values Historical Values 3-year Just arket: $124,800 Assessed: $68,867 Year Just/Market Assessed Exemptions Taxable Exe ptions: $43,867 Taxable: $25,000 2018 $124,800 $68,867 $43,867 $25,000 2017 $103,100 $67,451 $42,451 $25,000 _ 2016 ' $91,000 $66,064 $41,064 $25,000 Sale History Dat . Book/Page Sale Code Deed Grantor Price 08-01 -2006 2634 / 1801 XX01 SP Myers Ron $61,000 08-0 -2005 2333 / 0451 XX01 PR Myers Ron $100 12-2 -2001 1471 / 1927 XX01 AA Bartelt Wesley J $91,500 Primary Building Information Finished Area of this building: 1,558 SF Gross Area of this building: 2,593 SF Exterior Data View: Roof Cover: Roll Comp Roof Structure: Flat/Shed Building Type: HD+ Year Bu It: 1950 Frame: Grade: D+ Effective Year: 1950 Primary Wall: CB Stucco Story Height: 1 Story No. Units: 1 Secondary Wall: Interior Data Bedroo : 2 A/C %: 100% Electric: MAXIMUM Primary Int Wall: Full Bat : 2 Heated %: 100% Heat Type: FrcdHotAir -Avg Hgt/Floor: 0 Half Bat s: 0 Sprinkled %: 0% Heat Fuel: ELEC Primary Floors: Carpet Total Areas Finished/Under Air (SF): Gross Area (SF): Land Size (acres): Land Size (SF): Total Building Count: Special Features and Yard Items Type Qty Units Year Blt. UTILITY AVG 1 360 2000 SITE DEV S-F 1 1 2001 1,558 2,593 2.42 105,224 1 This information is believed to be correct at this time but it is subject to change and is not warranted. © Copyright 2018 Saint Lucie County Property Appraiser. All rights reserved. ffnc-//%nnnnni n cle nrn/RF(`nrrl/ 3 s y C ry 5 �Yt 5 & tl 4r5F :t.;. L } t pp�))VI,� ,� C. Lb 7. yL C `G � ?... ][g�) I +fh f Chd hE T. "C B °9t A 7 c ASYftllgtl W J iC lCb oy` � 7• - 1 •1' 7t � g �i�--C y- .G.� { f Y r "�„�.�i _ ..� y '�ly�� �✓#•1 ti�,.{•�. v '�E� . ��r;.._ ..a �.:i.r•f. +� � ,)i( �;Iti ' • ....71..ry � [, ,;;7h y:.e.�..:�:.JL6� :E..?..[! f � . G9EM��t4, L / w. �,` VG h. aiLo'c rJ ih�C fr� y own tsp rill ALB it OP 1 ' ! ' i � •: t:,• tt 7J I I II rya 4YsrRF A. MR ONO Hap gnaw jog b@ wdod a2 apo c5?'Aqo Custom Soil Resource Report St. Lucie County, Florida 25—Nettles and Oldsmar sands Map Unit Setting National map unit symbol. 1 jpvl Mean annual precipitation: 49 to 58 inches Mean annual air temperature: 70 to 77 degrees F Frost -free period: 350 to 365 days Farmland classification: Farmland of unique importance Map Unit Composition Nettles and similar soils: 40 percent Oldsmar and similar soils: 40 percent Minor components: 20 percent Estimates are based on observations, descriptions, and transects of the mapunit. Description of Nettles Setting Landform: Flatwoods on marine terraces Landform position (three-dimensional): Taff Down -slope shape: Linear Across -slope shape: Linear Parent material: Sandy and loamy marine deposits Typical profile A - 0 to 8 inches. sand E - 8 to 33 inches: sand BhI - 33 to 39 inches: sand Bh2 - 39 to 55 inches: sand Btg - 55 to 80 inches: fine sandy loam Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature: 31 to 50 inches to ortstein Natural drainage class: Poorly drained Runoff class: High . Capacity ,of the most limiting layer to transmit water (Ksat): Moderately low to moderately high (0.06 to 0.20 in/hr) Depth to water table: About 6 to 18 inches Frequency of flooding: None Frequency of ponding. None Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0 mmhos/cm) Sodium adsorption ratio, maximum in profile: 4.0 Available water storage in profile: Very low (about 1.6 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 4w Hydrologic Soil Group: C/D Forage suitability group: Sandy soils on flats of mesic or hydric lowlands (G156BC141FL) Hydric soil rating: No 10 Custom Soil Resource Report Description of Oldsmar Setting Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Convex Across -slope shape: Linear Parent material: Sandy and loamy marine deposits Typical profile A - 0 to 5 inches: sand E - 5 to 32 inches. sand Bh - 32 to 42 inches: sand Btg - 42 to 80 inches: fine sandy loam Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Poorly drained Runoff class: High Capacity of the most limiting layer to transmit water (Ksat): _ Moderately low to moderately high (0.06 to 0.20 in/hr) Depth to water table: About 6 to 18 inches Frequency of flooding. None Frequency of ponding. None Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0 mmhos/cm) Sodium adsorption ratio, maximum in profile: 4.0 Available water storage in profile: Low (about 4.9 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 4w Hydrologic Soil Group: AID Forage suitability group: Sandy soils on flats of mesic or hydric lowlands (G156BC141FL) Hydric soil rating: No Minor Components Ankona Percent of map unit: 4 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Convex Across -slope shape: Linear Hydric soil rating. No Pineda Percent of map unit. 4 percent Landform: Drainageways on marine terraces, flats on marine terraces Landform position (three-dimensional): Dip Down -slope shape: Linear Across -slope shape: Concave Hydric soil rating. Yes 11 UF. Custom Soil Resource Report Typical profile A - 0 to 6 inches: fine sand E - 6 to 28 inches. fine sand BME - 28 to 32 inches: fine sandy loam Btg - 32 to 42 inches: sandy clay loam C - 42 to 80 inches. fine sand Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature: More than 80 inches Natural drainage class. Poorly drained Runoff class: Very high Capacity of the most limiting layer to transmit water (Ksat): Moderately high to high (0.60 to 6.00 in/hr) Depth to water table: About 3 to 18 inches Frequency of flooding: None Frequency of ponding: None Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0 mmhos/cm) Sodium adsorption ratio, maximum in profile: 4.0 Available water storage in profile: Moderate (about 6.0 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 3w Hydrologic Soil Group: AID Forage suitability group: Sandy over loamy soils on flats of hydric or mesic lowlands (G155XB241FL) Other vegetative classification: Slough (RI 55XY011 FL) Hydric soil rating. Yes Minor Components Wabasso Percent of map unit. 8 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Tread, talf Down -slope shape: Convex, linear Across -slope shape: Linear Other vegetative classircation: South Florida Flatwoods (R155XY003FL) Hyddc soil rating: No Hallandale Percent of map unit. 4 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Tread, talf Down -slope shape: Linear Across -slope shape: Linear Other vegetative classification: South Florida Flatwoods (R155XY003FL) Hydric soil rating: Yes Pinellas Percent of map unit. 4 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Tread, tall Down -slope shape: Convex, linear 13 [ II N' [f R, APPLICA7 AGENT : MAILING STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL ram- SYSTEM APPLICATION FOR CONSTRUCTION PERMIT ON FOR: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: System [ ] Existing System [ ] Holding Tank [• ] Innovative air �( (� [ ] Abandonment [ j Temporary [ ] TELEPHONE :1 FL- - ?A J TO BE. COI LETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY.A PER, LICENSED PURSUANT TO 489.105(3)(m) OR 489.552,' FLORIDA STATUTES. IT IS.THE APPLI '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 IIINFORMATION LOT: BLOCK: SUBDIVISION:, e �PLATTED:90 PROPERTY ID #: &��% ' ��J G®e �l9D�--ZONING: I/M OR EQUIVALENT: [ Y / N ] PROPERTY SIZE:rT ACRES WATER SUPPLY: [X] PRIVATE PUBLIC [ ]<=2000GPD [ 3>20006PD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / 1�, DISTANCE TO SEWER: Al,FT PROPERTY ADDRESS: DIRECT IO S TO PROPERTY: �� �I,IJ f p A S 40 e No(j SS: INFORMATION Unit Type of No Es; s S D 11/ 3 `'=Floc SIGNA DH 4015 , ,', 9 (Obsol et 64E-6"001, i Tq - , 41 [ X. RESIDENTIAL [ ] C01d�!ERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area S ft Table 1, Chapter 64E-6, FAC A000-5r [ ] Other (Specify) DATE: i as a editions which may not be used) Page 1 of 4 N STATE OF FLORIDA PERMIT # . DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE'EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT:11 9 ] i AGENT: 2 LOT: BLOCK: SUBDIVISION: c� v � �'� ,J " ¢ 0 PROPERTY II� # : _ ¢1 �¢ pOa�."U d 6 " ... [ Section/Township/Parcel No. or Tax ID Number ] I I TO BE COMPii TED 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 SCZE CONFORMS TO SITE PLAN: [ YES [ ] NO NET USABLE AREA AVAILABLE: !j ACRES TOTAL EST TED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE VOTHER-TABLE2 ] AUTHORIZED SEWAGE FLOW: /� �" n O GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD%ACRE 7 UNOBSTRUC D AREA AVAILABLE: Z 743* SQFT UNOBSTRUCTED AREA REQUIRED: 6-0 0 SQFT BENCHMARK/III FERENCE POINT LOCATION:/fim� 01s7/J �i�yD S!l Qi, aN^ /T /C3"J�. L60Jn�(!/�!W:az�ej ELEVATION QF PROPOSED SYSTEM SITE IS PINCHES/FT ] [ABOVE/BELOW•]• BENCHMARK/REFERENC, POINT THE MINIMUr SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM. TO THE FOLLOWING FEATURES SURFACE WATER:-6IC:/��?��-�—FT DITCHES/SWALES: 1%� /FT ENO LY WET? [ ] YES (-] NO WELLBUILUSINGUF FT � UNDATIONS : E'T LIMITED � USE: PROPERTY S : PR C� - FT POTABLE WATER LINES : T NON -POTABLE: �� FT �� �- .�- SITE SUBJEgT TO FREQUENT FLOODING: [ ] YES [k NO 10 YEAR FLOODING? [ ] YES 90 NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELL #%COLOR TEXTURE USDA SOIL, SERIES: OBSERVED W, ESTIMATED HIGH WATER SOIL. TEXTU. DRAINFIELD REMARKS/AD. DEPTH TO TO TO TO TO TO TO TO TO SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR USDA SOIL SERIES: TEXTURE DEPTH TO TO TO TO TO TO TO TO TO ER TABLE: INCHES [ABOVE/BELOW q EXISTING GRADE. TYPE: [PERCHED/ APPARENT ] T SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE ABLE VEGETATION: [ ] YES [V-4] NO MOTTLING: j ] YES [ J NO DEPTH: INCHES /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES ONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY) TIONAL CRITERIA: SITE EVALUATED BY DR 4015, 12/1� (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC DATE: 3 of 4 LI AGENT : MAILING STATE OF FLORIDA DEPARTMENT OF HEALTH a; ONSITE SEWAGE TREATMENT AND DISPOSAL ,EF SYSTEM APPLICATION FOR CONSTRUCTION PERMIT ON FOR: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: System [ ] Existing System [ ] HoldingTank [. ] Innovative air n [ ] Abandonment [ j Temporary [ ] TELEPHONE : -7'IQ -Li-71 SS:O?�C-Z� TO BE.CO� LETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PER ON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552; FLORIDA STATUTES. IT IS.THE APPLICAN 'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED i4MM/DD/YY) IF.REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS: PROPERTY INFORMATION LOT: I BLOCK: SUBDIVISION: ��� PLATTED: _ 0 PROPERTY ID #:�% `' �`�3r (jp0�00®"' ZONING: I/M OR EQUIVALENT: [ Y PROPERTY SIZE: ACRES WATER SUPPLY: [] PRIVATE PUBLIC [ 3<=2000GPD [ ]>2000GPD IS SEWER VAILABLE AS PER 381.0065, FS? [ Y / 1�, DISTANCE TO SEWER: All 14, FT PROPERTY ADDRESS: l 40©rb v e C l DIRECTION TO PROPERTY: LL, 46 j/ Q Q � / o(I �► �5 QT L. BUILDING ORMATION [, X. RESIDENTIAL [ ] COM RCIAL Unit Typl of No. of Building Commercial/Institutional System Design.. No Est lishment Bedrooms' Area Sqft Table 1, Chapter-64E-6, FAC 1 2 f f 3 II� 4' I [ ] Flo 09(Obslte, Dr ins [ ] Other (Specify) n SIGNATURE�y% ^' DATE: ZLeQ)j� DR 4015, p e ous editions which may not be used) Incorporated 64E-6.001, FA ^ n Page 1 of 4 d STATE OF FLORIDA PERMIT #. DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT :11 ]` m 1-t C<.� !, L AGENT: LOT: BLOCK: SUBDIVISION: cS L CG o / J" ✓�'�� PROPERTY ID # : �` y FP p�a2."p b 6... [ Section/Township/Parcel No. or Tax ID Number ] TO BE COMP$ZTED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS MUST PRO E REGISTRATION NUMBER .AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY'SITZE CONFORMS TO SITE PLAN: [ YES [ ] NO NET USABLE AREA AVAILABLE: �a ACRES TOTAL .EST TED SEWAGE FLOW: �y p GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE 2 ] AUTHORIZED SEWAGE FLOW: ���'r> O GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUC D AREA AVAILABLE: 7,0SQFT UNOBSTRUCTED AREA REQUIRED: 60,0 SQFT ELEVAI�TTON" OF PROPOSEDPOINT SYSTEMSITENI q� 4"� art S �b 0 V4 /TBENCHMP,RI{ � FEREN POINT e� <` INCHES / Ft ] . [ ABOVE / BE • THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM. TO THE FOLLOWING FEATURES SURFACE WA_IMR:�FT DITCHES/SWALES:�FT N�O�ALLY WET? [ ] YES j ] NO WELLS: PUHIILIC:FT LIMITED USE: © FT PRIVA _�FT NON -POTABLE: FT BUILDING FOUNDATIONS: tj�_FT PROPERTY LINES: FT POTABLE WATER LINES: FT SITE SUBJICT TO FREQUENT FLOODING: [ ] YES [k NO 10 YEAR FLOODING? [ ] YES %� NO 10 YEAR OOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL PROFILE INFORMATION SITE 1 MUNSELL I/COLOR TEXTURE DEPTH TO TO TO TO TO TO II TO TO TO USDA SO]L SERIES: SOIL PROFILE INFORMATION SITE 2 MUNSELL #/COLOR USDA SOIL SERIES: TEXTURE DEPTH TO TO TO TO TO TO TO TO TO OBSERVED WATER TABLE: INCHES [ABOVE/BELOW 11 EXISTING GRADE. TYPE:[ PERCHED /APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE HIGH.WATE TABLE VEGETATION: [ ] YES [t] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES SOIL.TEXT�/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES DRAINFIEiZ CONFIGURATION: [ ] TRENCH [ ] BED j ] OTHER (SPECIFY) REMARKS/AD,.ITIONAL CRITERIA: SITE EVALUATED BY DATE: DH 4015, 12/ 1 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC �J Q 3 of 4