HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA
DEPARTMENT OF HEALTH RF�F��ED
SONSITE YSTEM SEWAGE TREATMENT AND DISPOSAL DEC 7;9?01B
Perml447 D
St. LuCIO C " melt
PERMIT #:56-SF-1902302
APPLICATION #:AP1383458
DATE PAID:
PH PAID:
RECEIPT #:
DOCUMENT #: PR1194374
CONSTRUCTION PERMIT FOR: OSTDS New SCANNED
APPLICANT: I Christopher&Nancy (Velardo) BY
PROPERTY ADDRESS: 6105 Balsam Dr Fort Pierce FL 34982 St Lucie County
i
LOT: 34
PROPERTY ID, #:
BLOCK: 87 SUBDIVISION: Indian River Estates
3402-610-0530-000-0 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE
SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS,
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. 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, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND
T [
900 '] GALLONS / GPD
Septic new
CAPACITY
A [
11 GALLONS / GPD
NIA
CAPACITY
N [
'] GALLONS GREASE
INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK:I250 GALLONS]
K [
] GALLONS DOSING
TANK CAPACITY [
]GALLONS @[ ]DOSES PER 24 HRS #Pumps [
D [ 50013 SQUARE FEET Drainfield new SYSTEM
R [ I] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ]' STANDARD [ ] FILLED (X] MOUND
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: Site BM paint X CL of Balsam, center of prope
I ELEVATION I OF PROPOSED SYSTEM.SITE
[ 9.00
][INCHES
FT I ABOVE
E BOTTOM OF:DRAINFIELD TO BE
[ 3.00
][INCHES
FT ][ABOVE
L
D E
0
T
H
E
R
BENCHMARK/REFERENCE POINT
BENCHMARK/REFERENCE POINT
ILL REQUIRED: [24.00] INCHES EXCAVATION REQUIRED: [ b/.UU] INCHES
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
M.
d contractor installing the system is responsible for installing the minimum category of tank in accordance with
3(3)(f), FAC.
I
SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist II
APPROVED BY! TITLE: Environmental Specialist II St. Lucie CHD
Brian J Ingram
DATE ISSUED:I 12/13/2018 EXPIRATION DATE: 06/12/2020
DE 4016, 08/,09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, PAC ® ,gyp ff Page 1 of 3
v 1.1.4 AP13834 elia o0
NOTICE OF RIGHTS
A party whose substantial interest is affected by this order may petition for an
administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such
proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for
administrative hearing must be in writing and must be received by the Agency Clerk for the
Department, within twenty-one (21) days from the receipt of this order. The address of the
Agency; Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency
Clerk'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
constitute a waiver of your right to an administrative hearing, and this order shall become a 'final
order'.
'Should this order become a final order, a party who is adversely affected by it is entitled
to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are
governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced
by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a
second copy, accompanied by the filing fees required by law, with the Court of Appeal in the
appropriate District Court. The notice must be filed within 30 days of rendition of the final order.
St. Lucie County Health Department
Y. d 5150 NW Milner Dr Port Saint Lucie, FL 34983
i-Mil
I '
PAYING ON: PERMIT#56-SF-1902302 BILL DOC#:56-BID-4027609 CONSTRUCTION APPLICATION #: AP1383458
I
RECEIVED FROM: Alexander J. Piazza PSM, Inc AMOUNT PAID: $ 515.00
PAYMENT, FORM: CHECK 4074 PAYMENT DATE: 11/15/2018
1
MAIL TO: iChristopher & Nancy (Velardo)
I
I
FACILITY NAME: _
PROPERTY LOCATION:
6105 Balsam or
FortPierce, FL 34982
I
Lot:1 34 -
ID: 3402-610-0530-000-0
EXPLANATION or DESCRIPTION:
87
Block: _
1
128 - OSTDS Construction System Inspection Research Fee
-1 - Surcharge (All)
i
-1 - OSTDI New Permit Surcharge
-1 - OSTD1 Construction Application and Plan Review,New
123 - OSTDS Construction Site Evaluation
I
126 - OSTDS Construction Permit (New or Mod, Amendment)
I
127 - OSTDS Construction System Inspection
i
133 - OSTI DS Construction Reinspection
I '
RECEIVED BY: MontanezNM
I
I
I
QUANTITY FEE
1 $
5.00
1 $
15.00
1 $
100.00
1 $
100.00
1 $
115.00
1 $
55.00
1 $
75.00
1 $
50.00
AUDIT CONTROL NO. 56-PID-3803579
d j11E �`
o� STATE OF FLORIDA
r DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[✓] New System [ ] Existing System [ ] Holding Tank
[ ] Repair [ ] Abandonment [ ] Temporary
PERMIT NO.
DATE PAID: {
FEE PAID: �^ ``S "{q
RECEIPT #: ,.y�!Ja,p
[ ] Innovative
APPLICANT: CHRISTOPHER & NANCY VELARDO
AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE : 772-340-7770
MAILING ADDRESS: 619 SW Bilonore Street, Port St. Lucie, Florida 34983
---------------___=_______ _—__---=
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
APPLICANTS RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
------------------------ --------- — ------------------ ----- _________________________
PROPERTY 1INFORMATION
LOT: 34
BLOCK:
87 SUBDIVISION:
Indian River Estates Unit 9
PLATTED:
1958
PROPERTY AID
#:
3402-610-0530-000-0
ZONING: R
I/M OR EQUIVALENT: [
No ]
PROPERTY SIZE: 0.300 ACRES WATER SUPPLY: [,/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 6105 BALSAM DRIVE, Fort Pierce, FL 34982
DIRECTIONS TO PROPERTY: SEE MAP
BUILDING INFORMATION [✓] RESIDENTIAL I ] COMMERCIAL
Unit Type of
No Establishment
i
1 RESYDENCE
2
3
4
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
3 1,638
[ ] Flor/Equipment Drains [ ✓ ] Other (Specify) GARBAGE GRINDERS / DISPOSALS
old 1+M.Ipm by Al—&r l P'",
Alexander J Piazza ; Us.. n,R,e,�.o Ao��:,.W, .WI... .1,-Al-,1
SIGNATURE: nk±aia.im�io.n.0 wm DATE: 10-26-18
DH 4015, O8/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
Page 1 of 4
I
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: I Christopher & Nancy (Velardo)
A4PPLICATION # AP1383458
PERMIT # 56-SF-1902302
DOCUMENT # SE1144200
CONTRACTOR / AGENT: Ralph J Chapin
LOT: 34 BLOCK: 87
SUBDIVISIOk: Indian River Estates ID#: 3402-610-0530-000-0
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE
I
REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.23 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 345.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTEDi AREA AVAILABLE: 760.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Site BM paint X CL Of Balsam, Center Of property
ELEVATION OFi PROPOSED SYSTEM SITE 9.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMOM SETBACK WHIOH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT
DITCHES/SWALES: 65} FT
NORMALLY WET: [ ]YES
[X]NO
WELLS: PUBIC: FT LIMITED USE: FT PRIVATE:
85 FT NON -POTABLE:
FT
BUILDING FOUIDATIONS: 5 FT
PROPERTY LINES: 9 FT
POTABLE WATER LINES:
FT
SITE SUBJECT TO FREQUENT FLOODING?
[ ]YES [R ]NO 1
10 YEAR FLOODING? [ ]YES
[X]NO]
10 YEAR FLOOD ELEVATION FOR SITE:
FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL
/ NGVD
SOTT. PROFIT.EITNFORN1ATTON SITE 1
SOIL PROFILE
INFORMATION SITE 2
USDA SOIL SERIES:Waveland fine sand
Munsell #/Color Texture
Depth
I OYR 4/1
Sand
0 To 12
10YR 5/1
Sand
12 To 26
10YR 6/1
Sand
18 To 29
1 OYR 6/3
Sand
29 To 35
1 OYR 2/1
Spodic Material
35 To 57
10YR 4/3
Fine Sand
57 To 68
HOLE CAVING
Refusal
68 To 72
I
USDA SOIL SERIES:Waveland fine sand
Munsell #/Color Texture
Depth
1 OYR 4/1
Sand
0 To 12
1 OYR 5/1
Sand
12 To 26
10YR 6/1
Sand
18 To 29
10YR 6/3
Sand
29 To 35
1 OYR 2/1
Spodic Material
35 To 57
10YR 4/3
Fine Sand
57 To 68
HOLE CAVING
Refusal
68 To 72
35.00 INCHES [ ABOVE BELOW ] EXISTING GRADE
TYPE: [ PERCHED / APPARENT ]
OBSERVED WATER TABLE: /
ESTIMATED WET (SEASON WATER TABLE ELEVATION: 18 INCHES [ ABOVE /
BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X ]NO MOTTLING: [X]YES [
]NO DEPTH: 18.00 INCHES
SOIL TEXTURE/ LOADING RATE FOR SYSTEM SIZING: Sand/0.60 DEPTH
OF EXCAVATION: 57 INCHES
DRAINFIELD CONIFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determinetl using USDA WSS and soil borings. .
10YR6/1 stripping in 10YR5/1 matrix > 10% with diffuse boundaries starting at 18" in Sal and S132.
Sat 9" below BM. SB2 9" below ". 1�7
SITE EVALUATEDIBY:
Ingram, Brian (Title: EV ronmental Specialist II) (ENVIRONMENTAL HEALTH)
DH 4015, 06/09 %Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
AP1383458 EID1902302
DATE: 12107/2018
Page 3 of 4
v 1.0.2
0� (HE
' e� STATE OF FLORIDA PERMIT #. 5'6-5z r-607WO
`"" �� DEPARTMENT OF HEALTH
t%gJ ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: CHRISTOPHER & NANCY VELARDO AGENT: Alexander J. Piazza PSM, Inc.
LOT: 34 BLOCK: 87 SUBDIVISION: Indian River Estates Unit
PROPERTY ID #: 3402-610-0530-000-0 [Tax ID Number
TO BE COMPLETED 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 SIZE CONFORMS TO SITE
PLAN:
[✓] YES [ ]
NO NET USABLE AREA AVAILABLE: 0.298 ACRES
TOTAL ESTIMATED SEWAGE FLOW:
500
GALLONS
PER DAY [RESIDENCES -TABLE I /OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW:
GALLONS
PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE:
750
SQFT
UNOBSTRUCTED AREA REQUIRED: 750 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS 34 [ MCHES/Fr ] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER:100 FT DITCHES/SWALES:15 FT NORMALLY WET? [ I YES [✓] NO
WELLS: PUBLIC: 200 FT LIMITED USE:100 FT PRIVATE: 75 FT NON—POTABLE:100 FT
BUILDING FOUNDATIONS:5 FT PROPERTY LINES:10 FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [✓] NO 10 YEAR FLOODING? [ ] YES [✓] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
MUNSELL #/.COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
mn
USDA SOIL SERIES:
MUNSELL #/COLOR TEXTURE
USDA SOIL SERIES:
DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
OBSERVED WATER TABLE:40+ INCHES [BELOW r] EXISTING GRADE. TYPE:[PERCHED /APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [ J NO MOTTLING: [ J YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: 14 TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
' .gyitlM1Y� NAluMnl Nava
AlexanderJ Piazza °°�°° ��°
SITE EVALUATED BY: DATE: 10-26-18
DH 4015, 12/11', (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
76-5F-1902-302--
APPLICANT'S NAME:CHRISTOPHER & NANCY VELARDO
LEGAL. DESCRIPTION: Lot 34, Block 87, Indian River(Estates - Unit NINE (PB 10, PG 74)
PROPO OS SEP.Wsy 7 1 7 Q`RIVD f01 ; .
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 no 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 proposed 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 theproposed septic system and the benchmark must
be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic
system.
NOTE: MUST BE CERTIFIED BY A FLORIDA
REGISTERED SURVEYOR OR ENGINEER.
p9��a�I �4 ud M ANUMer l GYm
�J
Okc•LS,a.0�ulLlb�c{
Alexander I Piazza auMOla])FIXO 16 81 FlC9 OT19B1.
CERTIFIED BY: aka o�16�9Q W
FLORIDA PROFESSIONAL NO.: 6330
DATE: 10/26/18 JOB NO.: 18-4002
dots/forms/septies/SepticApppPage207
R@cENfD
DEC 1`97018
e STATE OF FLORIDA 1 efmlttin
f DEPARTMENT OF HEALTH St- Luce Cppnment
�p ONSITE SEWAGE TREATMENT AND RS)YSPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATIION FOR:
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
[v/] New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ I Repair Abandonment [ ] Temporary [ ]
APPLICANT: CHRISTOPHER & NANCY VELARDO
AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE: 772-340-7770
MAILING ADDRESS: 619 SW Biltmore Street, Port St. Lucie, Florida 34983 SCANNED SLaa
Liirip nniiniv
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.
LOT: 34 BLOCK:
PROPERTY ID #:
87 SUBDIVISION: Indian River Estates Unit 9
3402-610-0530-000-0
PLATTED: 1958
ZONING: R I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 0.300 ACRES WATER SUPPLY: PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 6105 BALSAM DRIVE, Fort Pierce, FL 34982
DIRECTIONS TO PROPERTY: SEE MAP
BUILDINGINFORMATION
Unit Type of
No Establishment
1 RESIDENCE
[ ,/ ] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
3 1,638
2
3
4
[ ] Floor/Equipment Drains [ /] Other (Specify) GARBAGE GRINDERS/DISPOSALS
�i8iWlY .ip.N hY NeuvMlPivva
Alexander J Piazza ��'� �ir'm "-naun�m ime w isai ao mi
SIGNATURE: ./ ao:zou.mu�u.w.noror DATE: 10-26-18
DH 4015,108/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC FILE P S Page 1 of 4
6=2018
8105 Balsam Dr-Google Maps
6105 Balsam Dr
V6105 balsam Drive
Busch Morineg
;5
E Ca:j St
E E.-sy St
E Easy St
E Eny St
https:liwww.google.com/maps/place/6lO5+Balsam+Dr,+Fort+Pieme.+FL+349821@27.3547395,-80.2990774.17zldata=!4m5!3m4!lsOx88deef9f786lddl7:OxBec6f287283ff5ldl8m2!3d27.3538057!4d-80,2987663
�pte
STATE OF FLORIDA PERMIT #.
DEPARTMENT OF HEALTH
p ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT:.CHRISTOPHER & NANCY VELARDO AGENT: Alexander J. Piazza PSM, Inc.
LOT: 34 BLOCK: 87 SUBDIVISION: Indian River Estates Unit
PROPERTY ID #: 3402-610-0530-000-0 [Tax ID Number ]
TO BE COMPLETED 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 SIZE CONFORMS TO SITE PLAN: [✓] YES [ ] NO NET USABLE AREA AVAILABLE: 0.298 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [RESIDENCES -TABLE I/OTHER-TABLE2 ]
AUTHORIZED SEWAGE FLOW:. GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 750 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS 34 [INCHES/FT ] [ABOVE/BELOW'] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 100 FT
DITCHES/SWALES:15
FT
NORMALLY WET?
[ I YES I✓]
NO
WELLS: PUBLIC: 200 FT
LIMITED USE: 100 FT PRIVATE: 75
FT NON—POTABLE:100
FT
BUILDING FOUNDATIONS:5
FT PROPERTY LINES:10
FT
POTABLE WATER
LINES:
FT
SITE SUBJECT TO FREQUENT
FLOODING: [ ] YES [✓] NO
10 YEAR FLOODING?
[ ] YES [✓]
NC
10 YEAR FLOOD ELEVATION
FOR SITE: FT MSL/NGVD
SITE
ELEVATION:
FT MSL/NGVD
ov11 rnvgC 4am 1449v=9 'W1V4N o1xm 1
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
tY�i•�J;U)aF•��M � I7CH:�v'r:4 Y (�) ��-YY 4��
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE:40t INCHES [BELOW f] EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE
HIGH WATER,TABLE VEGETATION: [ I YES [ I NO MOTTLING: [ ] YES I ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING
DRAINFIELD CONFIGURATION: [✓] TRENCH [ ]
REMARKS/ADDITIONAL CRITERIA:
BED
DEPTH OF EXCAVATION:
[ ] OTHER (SPECIFY)
°N�•u�bu.we..,wv
SITE EVALUATED BY:
Alexander J Piazza
/'�m�•,�=.,>-�=�mm
INCHES
DATE: 10-26-18
DH 4015, 12/1l (Obsoletes previous editions which may not be used)., Incorporated: 64E-6.001, FAC Page 3 of 4
APPLICANT'S
CHRISTOPHER & NANCY VELARDO
LEGAL DESCRIPTION: Lot 34, Block 87, Indian River,.Estates - Unit NINE (PB 10, PG 74)
PI PPS ED SE F T J Q (
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 no 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
15homes or businesses within.100 feet of the proposed septic system, that there are no public
wells ithat 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 watef meter or well to the structure is
at least 10 feet from the available area for the proposed 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 proposed septic system and the benchmark must
be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic
system.
NOTE: MUST BE CERTIFIED BY A FLORIDA
REGISTERED SURVEYOR OR ENGINEER.
Olgitall sIgnedby Alended Plam
Y waa=ys.o=enMW,a
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FLORIDA PROFESSIONAL NO.: 6330
DATE: 10/26/18 JOB NO.; 18-4002
dots/ forms/septics/SepticApppPage207
RECEIVED
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Permitting
Department
p:AP1383458
St. Lucie county
APPLICATION
STATE OF FLORIDA
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DEPARTMENT OF HEALTH
DOPERMIT CUMENT e: F6 129902302
. ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
,
DATE PAID: 11I15IZO18
CONSTRUCTION INSPECTION AND FINAL
APPROVAL
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sve.�`•
FEE PAID:515.00
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RECEIPT #:56-PID-3803579
APPLICANT:
Christopher & Nancy Velardo
-
_
AGENT:
Ralph
Chapin
PROPERTY ADDRESS: 6105 Balsam Dr Fort Pierce, FL 34982
LOT: 34
BLOCK: 87
SUBDIVISION:
Indian River Estates IDit: 3402.610.0530.000.0
CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED.
TANK INSTALLATION
SETBACKS
[
]
1011
TANK SIZE [1] 1090.00 [21 483.00
[ ] [271
SURFACE WATER FT
[
]
1021
TANK MATERIAL Polyethylene
[ ] [281
DITCHES 70 FT
[
]
[03]
OUTLET DEVICE
[ ] 1291
PRIVATE WELLS 77 FT
[
]
[041
MULTI -CHAMBERED [ Y N ] [ ] [301
PUBLIC WELLS FT
[
]
[051
OUTLET FILTER Polylok PL-68
[ ] (311
IRRIGATION WELLS FT
[
]
[061
LEGEND 1. 70-143-11DC4 2. 70-143-54SC4
[ 1 (321
POTABLE WATER 35 FT
[
]
1[071
WATERTIGHT
[ ] 1331
BUILDING FOUNDATIONS 6 FT
[
]
[081
LEVEL
[ ] (341
PROPERTY LINES 10 FT
[
1
[091
DEPTH TO LID
[ ] 1351
OTHER FT
DRAINFIELD INSTALLATION
FILLED / MOUND SYSTEM
[
]
[101
AREA [1] 509.4 121 SOFT
[ ] (361
DRAINFIELD COVER
[
1
[113
DISTRIBUTION BOX _ HEADER x
[ 1 [371
SHOULDERS
[
]
(121
NUMBER OF DRAINLINES 1. 6.00 2.
[ ] [361
SLOPES
[
]
1131
DRAINLINE SEPARATION
[ ] [391
STABILIZATION 08/05/2019
[
]
[141
DRAINLINE SLOPE
[
]
[151
DEPTH OF COVER
ADDITIONAL INFORMATION
[
1
[161
ELEVATION ( ABOVE / BELOW ]BM 1.00
[ 1 [401
UNOBSTRUCTED AREA
[
]
[171
SYSTEM LOCATION
[ ] [411
STORMNATER RUNOFF
[
]
(18]
DOSING PUMPS 1.00
( ] 1421
ALARMS
[
]
(191
AGGREGATE SIZE
[ ] (431
MAINTENANCE AGREEMENT
[
]`
(201
AGGREGATE EXCESSIVE FINES
[ ] [441
BUILDING AREA
[
]
[211
AGGREGATE DEPTH
[ ] [45]
LOCATION CONFORMS WITH SITE PLAN
i
C ] [46)
FINAL SITE GRADING
FILL
/ EXCAVATION MATERIAL
.FILL
[ ] C471
CONTRACTOR MICHAEL W STUHR (ASHTO
C
]
[221
AMOUNT
C ] [481
OTHER INFILTRATOR Quick4 Plus EQ36 LP
(
]
E231
FILL TEXTURE
[
]
[241
EXCAVATION DEPTH
ABANDONMENT
[
]
[25]
AREA REPLACED
[ ] 1491
TANK PUMPED
[
]
(261
REPLACEMENT MATERIAL
( ] [50]
TANK CRUSHED 6 FILLED
Comments: Comments are on page 2.
CONSTRUCTION C APPROVED / DISAPPROVED
]' F vir mnnlai Soap
FINAL SYSTEM [ APPROVED / DISAPPROVED ]:
nv nmanml Speolallstll
(Explanation of violations on following page)
DH 401I6, 08/09 (Obsoletes all previous editions which may not
Incorporated: 64E-6.003, FAC
i EH Database v 1.0.1 AP1383458
St. Lucie CHD
Department of Heal
-St-Lucie CHD
used)
EID1902302
DATE: 07/03/2019
DATE: 08/05/2019
Page 2 of 3
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION INSPECTION AND FINAL APPROVAL
• � Wtwn�
Violation Number Comment
r•„m,,,a,.r4
APPLICATION d:AP1383458
PERHIT tt:56-SF-1902302
DOCUMENT n:F11312996
DATE PAID:11/15/2018
FEE PAID:515.00
RECEIPT a:56-PID-3803579
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of.300
gpd. New ST installed, New filter installed. Liberty 1/3 HP dosing pump installed. 483 gal dosing lank. 7x3 + 8x3 long DF
Installed. No violations, system ok to cover. Contractor notified by phone. Needs final inspection for filled/mound system, alarms,
and final site grading.
Final system approved. Contractor and building department entailed final approval
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 2 of 3
1 EH Database v 1.0.1 AP1183458 EID1902702