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STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
I
CONSTRUCTION PERMIT FOR:
APPLICANT: Joseph Westt
PROPERTY ADDRESS: 105
LOT: 1-3 BLOCK: G
OSTDS New F L
ort Pierce, FL 349M
SUBDIVISION: Jay Gardens
PERMIT #:56-SF-1360971
APPLICATION # : AP 1042429
DATE PAID:
FEE PAID:
RECEIPT #:
%DoC ME P ; : PR851691
SCANNED
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
ID #: 231160100860002 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTI
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANI
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACT
WHICH ' SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY I
PERMIT, APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND Vol
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDEW..
STATE,,OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEMIDESIGN AND SPECIFICATIONS
T [ 900 ] GALLONS / GPD Septic CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps
D [ 500 1 SQUARE FEET SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE'SYSTEM: [ ] STANDARD [ ] FILLED [xl MOUND [ ]
I CONFIGURATION: [ ] TRENCH [xl BED [ ]
N
F LOCATION OF BENCHMARK: FFE OF EXISTING RESIDENCE
I ELEVATION BELOWTION OF PROPOSED SYSTEM SITE [ 36.0011 INCHES FT ][ABOVE BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 30.0011 INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL' REQUIRED: [24.001 INCHES EXCAVATION REQUIRED: [ ] INCHES
iThe licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
s. 64E-6.013(3)(f), FAC.
T
H
E
R
SPECIFICATIONS BY: James C Duncan TITLE: Environmental Specialist II
APPROVED BY: A TITLE: Environmental Specialist II St. Lucie C:
James D can
DATE ISSUED: 08/10/2011 EXPIRATION DATE: 02/10/2013
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1042429 SES49827
I
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
\ SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:.,
[ ►/] Near System
[ ] Repair
PERMIT NO. SDI b�y7/
DATE PAID:
FEE PAID:
RECEIPT #:
[ ] Holding Tank [ ] Innovative
`,� t [ ] Temporary [ ]
APPLICANT: W\y—=Sz l WeS'f(3EI22:/
AGENT: I PAux- \�UHN TELEPHONE: ZIG-66I2
MAILIN ADDRESS:
[ ] Existing System
[ ] Abandonment
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.
INFORMATION
LOT: BLOCK: G SUBDIVISION: JA1` VA9-4FENS' 1 T �Irzur PLATTED:
I
PROPERI' Y ID #: 7_3��'C�G\'GG86-Cxx�-Z ZONING: I/M OR EQUIVALENT: [ Y / N ]
SIZE: O.G4 ACRES WATER SUPPLY: [X] PRIVATE PUBLIC'[ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: FT .
PROPERTY ADDRESS: \0; S CAR.Z\xv j, PL
DIRECTT�IIONS TO PROPERTY: V ROA'\ THE I NTERGEeTwA, Or l QAma AVE c-,o w sT
CAN QWN6E I'-i//VE. TO S. "tlAI PL.. CCU k4LT k -- Uhl S C.Actb\AIAL �- . �QOPEQT-t 1 S
Cott Orr TNGE W-TERsecswAi cx-
I
BUILDING INFORMATION
Unit Type of
No Establishment
I
1 I
SINGLE FAMILY
2
3
4
DH 4015, 08
Incorporated 64E-6.001, FAC
[X] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
CJ 1
Other (Specify)
DATE: 7/ 1-M \
Page 1 of 4
• .Sly C 1�`�J
APPLICANT:i
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #.
AGENT: PAUL- VwW ty
LOT: _ BLOCK: SUBDIVISION: \q'( Gftawws Fj 1 imw
PROPERTY ID #: 2311-6U1-0086-Ocri-7- [Section/Township/Parcel No. or Tax ID Number]
TO BE COMPLETED BY'ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS
MUST PROVIIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [)Q YES [ ] NO NET USABLE AREA AVAILABLE: 0-6`( ACRES
TOTAL ESTIMATED SEWAGE FLOW: :300 GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE21
AUTHORIZED SEWAGE FLOW: 58G GALLONS PER DAY 15500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRU7D AREA AVAILABLE: 9UCJi SQFT UNOBSTRUCTED AREA REQUIRED: loy SQFT
BENCHMARK/REFERENCE POINT LOCATION: AGG16NE4 Gj_ scj,cc. crm PFF Op NsE 4s iOy
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES/FT] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: -75T FT
DITCHES/SWALES: 154-
FT NORMALLY WET?
[ ] YES [X] NO
WELLS: PUBLIC: ZOOf FT
LIMITED USE: ICCj-t FT PRIVATE: 76t FT NON -POTABLE: p-r FT
BUILDING FOUNDATIONS:
%�' FT PROPERTY LINES: 114
FT POTABLE WATER
LINES: to+ FT
SITE SUBJECT TO FREQUENT
FLOODING: [ ] YES [C] NO
10 YEAR FLOODING?
[ ] YES [ ] NO
10 YEAR FIAOD 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
USDA SOIL -SERIES:
TU
TO
TO
TO
TO
TO
TO
TO
OBSERVED WATER TABLE: r.0 INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE:[PERCHED / APPARENT]
ESTIMATEDWET 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
DRAINFIELDI CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
DATE: 711 z i
DS 4015, 08/99 (Obsoletes previous editions whioWm.ay not be used) Incorporated: 64E-6.001, FAC Page 3 of 4