HomeMy WebLinkAboutD O H APPLICATION FOR CONSTRUCTION PERMITCopRECEIVEDSEP 4) 2.��,8y
c� STATE OF FLORIDA PERMIT NO.
DEPARTMENT OF HEALTH ST. Lucie County, Permitting PATE PAID:({��I[_�i
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: fZM
•~�owv SYSTEM _ _ RECEIPT #:�{� neac� �r�eannKail
APPLICATION FOR CONSTRUCTION PERMIT
APPL CATION FOR:
[✓] New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ]
APPL ANT : Gentile Corporation
I
AGEN Gentile Corporation TELEPHONE: 954-520-0548
MAILING ADDRESS: 3160 TURTLE COVE, WEST PALM BEACH, FLORIDA, 33411
TO B.ICOMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUC
BY AIPERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPL CANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATREEED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
LOT: 17 & 18 BLOCK: 5 SUBDIVISION: WILBUWE PLATTED: APR. 1929
PROPERTY
ID #:
2408-603-0056-000-6
ZONING: RS-4
I/M OR EQUIVALENT:
[ No ]
PROPERTY
SIZE:
0.215 ACRES WATER SUPPLY:
[ ✓] PRIVATE
PUBLIC [ ]<=2000GPD [
1>2000GPD
IS S WER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROP I LY ADDRESS: 205 NORTH 40TH STREET, FORT PIERCE, FLORIDA
i i
DIRECTIONS TO PROPERTY: FROM ANGLE ROAD GO WEST ON ORANGE AVENUE TO NORTH 39TH STREET.
GO NtRTH ON NORTH 39TH STREET TO AVENUE "B". GO WEST ON AVENUE "B"TO NORTH 40TH STREET.
11
GO N ! RTH ON NORTH 40TH STREET TO PROPERTY ON LEFT.
Unit
No
1
2
3
4
ING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL
Type of No. of Building Commercial/Institutional System Design
Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
SINGLE FAMILY 2 1000
Floor/Equipment Drains
[ ] Other (Specify)
SIGN ;TUBE : v l/
DE 4 15, 08/09 (Obsoletes previous editions which may not be used)
Incopporated 64E-6.001, FAC
DATE: 08/17/2018
Page 1 of 4
r
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #.
: GENTILE CORPORATION AGENT: GENTILE CORPORATION
LOT: 17AND 18 BLOCK: 5 SUBDIVISION: WILBUWE
ID # : 2408-603-0056-000-6
[ Tax ID Number
11
TO BE MPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS
MUST P ^VIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTi
SIZE CONFORMS TO SITE PLAN:
[✓] YES [ ]
NO NET USABLE AREA AVAILABLE: 0.215
ACRES
TOTAL E
TIMATED SEWAGE FLOW:
GALLONS
PER DAY [ RESIDENCES -TABLE 1/OTHER-TABLE 2
]
AUTHORI
11
ED SEWAGE FLOW:
GALLONS
PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE
]
UNOBSTRUCTED
AREA AVAILABLE:
SQFT
UNOBSTRUCTED AREA REQUIRED:
SQFT
REFERENCE POINT LOCATION: (SITE BENCHMARK ONE) SEE SURVEY
OF PROPOSED SYSTEM SITE IS 0.2 [Fr ] [ABOVE ] BENCHMARK/REFERENCE POINT
THE MIN MUM 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:UBLIC:200 FT LIMITED USE:100 FT PRIVATE:75 FT NON-POTABLE:50 FT
BUILDIN FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES:10 FT
SITE SUBJECT TO FREQUENT FLOODING:
10 YEARRfiFLOOD ELEVATION FOR SITE:
SOIL P OFILE INFORMATION SITE 1
[ ] YES [ ] NO
FT MSL/NGVD
MUNSELh #/COLOR TEXTURE DEPTH
II TO
TO
TO
II TO
II TO
II TO
II TO
II TO
II TO
USDAISOIL SERIES:
10 YEAR FLOODING? [ ] YES ] ] NO
SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVE J111,ER,
WATER TABLE: INCHES [ ABOVE / BELOW f ] EXISTING GRADE. TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE
HIGH WA TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
SOIL
E/LOADING RATE FOR SYSTEM SIZING:
CONFIGURATION: [ ] TRENCH [ ] BED
ITIONAL CRITERIA:
SITE EVALUATED BY:
DEPTH OF EXCAVATION:
] OTHER (SPECIFY)
DATE: 08/17/2018
INCHES
DH 4015, 1�2/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4