Loading...
HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA E DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DSAL SYSTEM IT #:56-SF-1907674 COON #:AP1386795 RYACT'EIPAID: FEE PAID: RECEIPT N: DOCUMENT s: PR1197523 SCANNED CONSTRUCTION PERMIT FOR: OSTDS New BY St Lucie County APPLICANT: Richard & Rita King PROPERTY ADDRESS: 1365 CopenhaverRd Fort PierceFL34954 LOT: BLOCK: SUBDIVISION: PROPERTY ID k: 2313-214-0006-000-6 [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 SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic new 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 NPumps [ E D [ 500 ] SQUARE FEET Dralnfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED (XI MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [] N F LOCATION OF BENCHMARK: Site BM NID CL Of Rd S pro I ELEVATION OF PROPOSED SYSTEM SITE [ 13.001 E BOTTOM OF DRAINFIELD TO BE [ 6.00 ] L 42 0 T H E R line extended E CHES FT ][ABOVE /LpALOW_p BENCHMARK/REFERENCE POINT CHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT REQUIRED: [Lb.UU] INCHES EXCAVATION REQUIRED: t J/.UUJ 1NUBEJ system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom). for a total estimated flow of gpd. SPECIFICATIONS BY: A Brian J Ingryy TITLE: Environmental Specialist II APPROVED BY: LE: Environmental Specialist II St. Lucie CHD Brian J Ingt DATE ISSUED: 01/09/2019 EXPIRATION DATE: 07/09/2020 DH 4016, 08/09 (Obsoletes all previous a ns which may not be used) Incorporated: 64E-¢-003;7vFr—Tv � l�I Page 1 of 3 1.11.4 nn nn A 13S5795 SE1147237 5 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. HEALTH PAYING ON: RECEIVED FROM PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PERMIT#:56-SF-1907574 BILL DOC#:56-BID-4049509 CONSTRUCTION APPLICATION#: AP 1386795 Alexander J. Piazza PSM, Inc John Erick AMOUNT PAID: $ 515.00 CHECK 4133 PAYMENT DATE: 12/07/2018 MAIL TO: Richard & Rita king FACILITY NAME: PROPERTY LOCATION: 1385 Copenhaven Rd Fort Pierce, FL 34954 Lot: Block: Property ID: 2313-214-0006-000-6 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 1 $ 15.00 -1 - OSTDS New Permit Surcharge 1 $ 100.00 -1 - OSTDS Construction Application and Plan Review,New 1 $ 100.00 123 - OSTDS Construction Site Evaluation 1 $ 115.00 126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127 - OSTDS Construction System Inspection 1 $ , 75.00 133 - OSTDS Construction Reinspection 1 $ 50.00 RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-3825290 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL ,K SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [VI New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ ] Temporary APPLICANT: Richard & Rita 5 1-Zq/49 PERMIT NO . ' -1 `l DATE PAID: i� V, FEE PAID: ( 3 5]J RECEIPT #: aU iCp :ice [ ] Innovative AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE. 772-340-7770 ADDRESS: 619 SW Biltraore Street, Port St. Lucie, Florida 34983 TO BE iCOMPLETED 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: na BLOCK: na SUBDIVISION: na PLATTED: na PROPERTY ID (1: 2313-214-0006-000-6 ZONING: R I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 0.735 ACRES WATER SUPPLY: [/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 1385 Copenhaver Road, Fort Pierce, FL 34954 DIRECTIONS TO PROPERTY: SEE MAP BUILDING INFORMATION RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sq£t Table 1, Chapter 64E-6, FAC I RESIDENCE 3 1,429 2 3 4 [ ] Floor/Equipment Drains other (Specify) GARBAGE GRINDERS/DISPOSALS DiOu IyevWbYA" , Je j AlexanderJ Piazza D ouso•UmRi Mm•naHzzPmal6s[IL C9OA11961,m•Nemn l SIGNATURE: • o.m iomua o:¢:uasm DATE: 11-21-18 DH 4015, 08/09 (Obsoletes previous editions which may not be used)' Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA APPLICATION # AP1386795 DEPARTMENT OF HEALTH PERMIT # 56-SF-1907574 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1147237 SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Richard & Rita King CONTRACTOR / AGENT: Alexander J. Piazza PSM, Inc John Erickson 772-260-5049 LOT: BLOCK: SUBDIVISION: I1341:2313-214-0006-000-6 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: EX ]YES [ ]NO NET USABLE AREA AVAILABLE: 0.73 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 1095.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 750.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM NiD CL of Rd S property line exte ELEVATION OF PROPOSED SYSTEM SITE 13.00 [ INCHES / FT ) [ ABOVE / BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 100 FT DITCHES/SWALES: 100 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100 FT NON -POTABLE: FT BUILDING FOUNDATIONS: 15 FT PROPERTY LINES: 12 FT POTABLE WATER LINES: 75 FT SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]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 USDA SOIL SERIES:Pineda Sand Munsell #/Color Texture Depth 1 OYR 3/1 Fill - Sand 0 To 13 1 OYR 4/4 Organic Soil 13 To 15 1 OYR 3/1 Sand 15 To 19 10YR 5/3 Sand 19 To 24 1 OYR 5/1 Gravelly & Larger Mineral 19 To 37 1 OYR 7/2 Fine Sand 24 To 36 10YR 7/1 Loamy Fine Sand 36 To 40 1 OYR 7/1 Fine Sand 40 To 54 10YR 6/1 Fine Sand 54 To 72 USDA SOIL SERIES:Pineda Sand Munsell #/Color Texture Depth 10YR 5/3 Loamy Fine Sand 0 To 14 10YR 5/2 Fine Sand 14 To 25 1 OYR 518 CMN/PRM RF 17 To 25 10YR 7/2 Fine Sand 25 To 32 10YR 711 Loamy Sand 32 To 40 1 OYR 7/1 Fine Sand 40 To 54 1 OYR 6/1 Fine Sand 54 To 72 OBSERVED WATER TABLE: 63.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE .ELEVATION: 17 INCHES [ ABOVE / EELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES Ex ]NO MOTTLING: [X]YES [ ]NO DEPTH: 17.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Fine Sand/0.60 DEPTH OF EXCAVATION: 37 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ X ] BED [ REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR5/8 CMN PROM RF mottling in 10YR5/2 matrix>2% starting at 17" in SB2. SB1 15" below BM. SB2 13" below BM. SITE EVALUATED BY: ] OTHER (SPECIFY) Ingram, Brian (Till Environmental Specialist II) (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsoletes previous editions whi may not be used) Incorporated: 64E-6.001, FAC AP1386796 EID1907574 DATE: 01/07/2019 Page 3 of 4 v 1.0.2 Michelle Franklin, CFA - Saint Lucie County Property Appraiser WT,�lJLr,2' f ` n September 20, 2018 )-T tlj 1:18,056 0 0.15 0.3 0.6 mi 0 0.25 0.5 1 km Swn:es: Esd. HERE, Gemun, USGS, Vda p, INCREMENT P, NRCw. EsrlJwen, METI, Esd Chne (Hong Kong), Esri Kona, Esd (Thaibnd� 59 _ 29 1W0 51 7,111q7 0�mE s� 4,. STATE OF FLORIDA PERMIT r DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: Richard & Rita K]ng AGENT: Alexander J. Piazza PSM, Inc. LOT: na BLOCK: na SUBDIVISION: na PROPERTY ID #: 2313-214-0006-000-6. [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: 0.735 ACRES TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [RESIDENCES -TABLE UOTHER-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? [ J YES J✓] 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: [ J YES [✓] NO 10 YEAR FLOODING? [ ] YES J✓] 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: OBSERVED WATER TABLE:40+ INCHES [BELOW ESTIMATED WET SEASON WATER TABLE ELEVATION:_ HIGH WATER TABLE,VEGETATION: [ ] YES [ ] NO SOIL PROFILE INFORMATION SITE Z MUNSELL #/COLOR TEXTURE DEPTH TO TO TO TO TO TO TO TO TO USDA SOIL SERIES: r] EXISTING GRADE. TYPE:[ PERCHED/ APPARENT ] _ INCHES [.ABOVE/BELOW ] EXISTING GRADE MOTTLING: [ J YES [ ] NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: IV] TRENCH [ J BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: Alexander J Piazza onoos,a+v..mmre¢a.�mnrz00000iev,usaea000,xi. H.u...m�., SITE EVALUATED BY: �•�__��_�_-__� DATE: 11-21-18 DH 4015, 12/11 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 Of 4 %-sr. 190757V APPLICANT'S NAME: Richard & Rita King S`l- 2gl Li LEGAL DESCRIPTION: Parcel ID: 2�13-214-0006-000-6 t 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. Mgllally 51gnNb Ale ded Plana AlexanderJ Piazza °J •AO n*OA I6fAIFE3C9dgW]19BI CERTIFIED BY: Da..IMR,111]1 ?I3330Tw FLORIDA PROFESSIONAL NO.: 6330 DATE: 11/21/18 JOB NO.: 18-4192 dots/foms/septics/SepticApppPage207 .r Mission: ei.�„}�ri r ' s.� Rick Scott Governor of protect, promote 8 improve the health of all people in Florida through integrated �T 1 ie Ilb"�MD, MPH state, county& community efforts. ������ ene and Secretary Vision: To be the Healthiest State in the Nation Florida Department of Health in St. Lucie County Conditions for Issuance of Water Well Permits Effective July 24, 2017 • Contact the Florida Department of Health in Saint Lucie County (FDOH - St. Lucie) prior to constructing or abandoning any well. a. Call the FDOH - St. Lucie Well Line at 772-873-4936 or email SLC DOH-WELLS(a)FLH EALTH. GOV a b. Provide the following information: i. Permit number ii. Driller name iii. Address iv. Date and time to begin construction/abandonment • A minimum of 24 hours' notice is required before constructing any public water supply wells. Please call our main office at 772-873-4931 and speak with Environmental Health Staff or provide notification by email to SLCDOH-WELLSna,FLHEALTH.GOV • Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. mn 9.4 7519 �„��, Permitting y, Luc _..`- _. Florida Department of Health St Lucie County • Division of Disease Control and Health Protection Bureau of Environmental Health 5150 NW Milner Drive Port St. Lucie, FL 34983 PHONE: 772/873-4931 • FAX: 772/595-1306 FloridaHealth.gov _j - Accredited Health Department = Public Health Accreditation Board x STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, o ho REPAIR, MODIFY, OR ABANDON A WELL OSouthwest Pere b PLEASE FlLLOVTALLAPPUGr3LE FIELDS Floe DNorthwest ('Denotes Required Fields Where Applicable) Pere ❑St. Johns River ❑South Florida The mia "# Contractor is mspan.naa for co*9bng Suwannee aysaimnandruraaniVV.isemr3aourzaConrolha O — liras: ❑SuP eWW-te detesafedauUmly a hem app Icable _._p.... ❑Delegated Authority (if Applicable) CUP, R' u fJ iG-IJ, 5b -SF- lao`15�� Unique ID Stipulations Required (see Atladled) 'State 'ZIP 'Telephone Number c/Y 0006-0"0 -(j Attema Ke Clyde One f Lot stock L t/�, ,� Unit G m 'Tm"ship ange County u-tTMsnon Check if 62-524: _ Yes —No r boas' 1�a-ats-s''� MPUWeI{Dr'l` CTgrnail.ecTh Enactor 'License Number Telephone Number E-maltAddress v rGrf T.'Type of Work- onstrud) In Repair Modrfika. amen ZIP B.'Numbar Of Proposed a s_L nxeasa, kr aapaa, McEifrayon. orADaMommarrt 9. -Specity Intended Use(s) of Wefts): n p omesuc Landscape Irrigation _Agrirvitural Irrigation Site Investigation !/rAti\1 _Bottled Water Supply _Recreation Area Irrigation _Livestock _Monitoring _Public Water Supply (Limited UsefDOH) _Nursery Irrigation _Test _Public Water Supply (Commuyfy a Non-Community/DEP) —Commercial/Industrial _IAN Earth -Coupled Geothermal q C q ff _Class I injection _Golf Course Irrigation _HVAC Supply .. J I J 2019 __HVAC ReturnClass V Injection: _Recharge _,CommerdaUlndustrial Disposal _Aquifer Storage and Recovery_Drinage Remedation: _Recovery _Air Sparge _Other (oesmee) _ rr nm In IQ/ I n..rs m. (Nste Not allrypesN ,Lspare permW by a wen fenrafrV a."'W.o.s..�.LQQ1wr rr- 10.'DistanW from Septic System if 5200 fL 11. Facility Description __ Irt 13.'Estmated Well Depth 12. Estimated Start Date p __ft. 'Estimated Casing Depth _—ft. -primary Casing Diameter in. Open Hole: From To_R 14. Estimated Screen Interval From_To_fl. 15.-Primary Casing Material: _Black Steel _Galvanized PVC __Stainless Steel _NotCased —Other. Secondary Casing: _Telescope Casing _ Liner _ Sur -'ace Casing Diameter in. . 17. Secondary Casing Material, _Black Steel _Galvanized _PVC _Stalnless Steel er 18.'Mefftod of Construction, Repair, or Abandonment: _Auger _Cable Tod _Jetted Rotary Sonic _Combination (TWO or More Methods) _Hand Driven (Well Point, Sand Point) _Hori—_Hydr Int (Direct Push) zontal Drilling _Plugged by Approved Method Other (D_esmLa) I,9. Proposed Grouting Interval for the Prunary Secondary and Additional Casing: From To Seal Material ( Bentonite_Nest Cement Other ) 'From To Seal Material L_Bentonite_Neat Cement OtiTer ) From To Seal Material (—_Bentonde_Neat Cement 1 From To Seal Material (_—Bentonite_Neat Cemeht Other ) 20. Indicatetotal number Ofexisting wells on site List numberof existing unused wells on site 21.1s this well or any existing well orwaterwithdmwal on the ovmer s contiguous property covered under a Consumptive)Water Use Permit (CUPIWUP) or CUPNVUP Application? _Yes�llo If yes, camplete the following: CUP)WUP No. Distrid We(110 No. 22. Latitude Longitude 23. Data Obtained From: GPS Map _Survey to Approval Granted By Issue Date Fee Received $ - Receipt No. THIS PERMIT IS NOT VALID UNTIL PROPERLY SIAED BYAN AIITHORI7ED nRRrrr Datum:_NAD 27 _MAD 83 __WG,9 84 .Date WMD OR DELEGATED AL HORnIY. THE EP ortn: 62532.90o(t) Inwrpurated in lira-532.400(7 ), FA.C. EfiecOve Dale: October 7. 2010 DRAINn LCD AREA SST 152.41' J FND IRC "PLS 3435" 0.13'S, 0.16'E 90.00' 6' CLF END 7.90F 0. R~ THE EAST 130' N W M'W OZ LLI P:0 Zi N07 Lo H aM N 9g w� z z 70.00' O 0.00 O NOT PLATTED Liaum N 2313-214-0006-000-6 < Zw 2.5 16.64 `� � � 1ZQj 2.5 Ld �. + o. K O< COVERED = tWn +6 e.re, 001.1 01II V ENTRY It m vy O� o ol- WELL TO BE o: O < nod ABANDONED - 142.41' 3.5 ' 32'DO' a 00 ��-' O OI & +16.98 53.00' cli PROPOSED I PROPOSED 1' WATER SERVICE WELL 1 m O N m m i ,'a ry6 O +by 152.38 D) yb 152.41' C 90.00' rya 1^tip ��� S8 '40 38 W 242.41 (c �a 40.o +16.48 242.38' D �oLE \ n= \ NOT PLATTED VACANT 2313-214-0000-000-4 / \ W Z � ' 3 � I O < Q 0 O� 10 a Lo M = � d W a Q b f0 = N r = I O to O U n 0 J W Property Card Page 1 of 1 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: 1385 Parcel ID: 2313-214-0006- Account #: 13721 Sec/Town/Range: COPENHAVER RD 000-6 13/35S/39E Map ID: 23/13N Zoning: RS-2 Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description Richard A King (LF EST) 13 35 39 FROM NE COR OF NW 1/4 RUN S 1213 FT, TH W Rita K King (LF EST) 40 FT TO POB, TH CONT W 242.41 FT, TH S 132 FT, TH E PO Box 741 242.38 FT, TH N 132 FT TO POB (0.73 AC-31,798 SF) Fort Pierce, FL 34954 Current Values Historical Values 3-year Just/Market: $46,300 Assessed: $25,894 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $25,894 2018 $46,300 $25,894 $0 $25,894 2017 $32,800 $23,540 $0 $23,540 2016 $21,400 $21,400 $0 $21,400 Sale History - Date Book/Page Sale Code Deed Grantor Price 04-20-2018 4189 / 1683 0111 WD Cordisco Kimberly $100 04.20-2018 4189 / 1683 0111 WD King Richard A $100 04-20-2018 4124 / 0589 0001 WD Hall Sherry L $68,000 Type Total Areas Finished/Under Air (SF): Gross Area (SF): Land Size (acres): Land Size (SF): Total Building Count: Special Features and Yard Items Qty Units Year Blt This information is believed to be correct at this time but it is subject to change and is not warranted. © Copyright 2019 Saint Lucie County Property Appraiser. All rights reserved. 0 0 0.73 31,798 ittps://www.paslc.org/RECard/ 1/15/2019 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL Richard TAGENT: John Erickson 772-260-5049 APPLICATION #:AP1386795 PERMIT #:56-SF-1907574 DOCUMENT #:FI1339384 DATE PAID:12/07/2018 FEE PAID-515.00 RECEIPT #:56-PID-3825290 PROPERTY ADDRESS: 1385 CopenhaverRd Fort Pierce FL34954 SCANNED LOT: BLOCK: BY svBDxvxsxoN: ID#: 2313-214-0006.000-6 St Lucie County CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. INSTALLATION [01] TANK SIZE [1] 1090.00 121 [021 TANK MATERIAL Polyethylene [031 OUTLET DEVICE [041 MULTI -CHAMBERED [ Y N ] [051 OUTLET FILTER Polylok PL-68 [061 LEGEND 1. 70-143-11DC4 2. [071 WATERTIGHT [081 LEVEL [091 DEPTH TO LID DRAINFIELD INSTALLATION [101 AREA [1] 509.4 [111 DISTRIBUTION BOX [121 NUMBER OF DRAINLINES [131 DRAINLINE SEPARATION [141 DRAINLINE SLOPE [151 DEPTH OF COVER (161 ELEVATION [ ABOVE [171 SYSTEM LOCATION (18] DOSING PUMPS [191 AGGREGATE SIZE [21 SQFT HEADER X 1. 5.00 2. / BELOW ] BM 3.50 (201 AGGREGATE EXCESSIVE FINES [211 AGGREGATE DEPTH SETBACKS [ ] [271 SURFACE WATER [ ] [281 DITCHES [ ] [291 PRIVATE WELLS [ ] [30] PUBLIC WELLS 100+ FT 50 FT FT FT [ ] [311 IRRIGATION WELLS FT [ ] [321 POTABLE WATER 60 FT [ ] [331 BUILDING FOUNDATIONS 12 FT [ ] [341 PROPERTY LINES 5 FT [ ] [351 OTHER FT FILLED / MOUND SYSTEM [ ] [361 DRAINFIELD COVER [ ] [371 SHOULDERS [ ] [381 SLOPES [ ] [391 STABILIZATI�ON J10/21/2. 019 I,ZAOR ONAL'yINF ,,,UNOBRUTEO4]JAA [ ] [411 STORMWATER RUNOFF [ 1 [421 ALARMS [ ] [431 MAINTENANCE AGREEMENT [ ] [441 BUILDING AREA [ ] [451 LOCATION CONFORMS WITH SITE PLAN [46] FINAL SITE GRADING FILL / EXCAVATION MATERIAL L 1 [ 1 [471 CONTRACTOR MICHAEL STUHR(ASHTON [ I [221 FILL AMOUNT [ 1 [481 OTHER INFILTRATOR Quick4 Plus EQ36 LP [ ] [231 FILL TEXTURE [ ] [241 EXCAVATION DEPTH ABANDONMENT [ ] [251 AREA REPLACED [ ] [491 TANK PUMPED [ ] [261 REPLACEMENT MATERIAL [ ] [501 TANK CRUSHED 6 FILLED Comments: Comments are on page 2. / V�%i`.C��. St. Lucie CHD DATE: 09/09/2019 CONSTRUCTION L APPROVED DISAPPROVED ] E r nmental S eclalist I H erA Collier (Florida Department of Heal FINAL SYSTEM [ APPROVED / DISAPPROVED ]: �,' "- /W— St. Lucie CHD DATE: 10/25/2019 Environmental Specialist I Hunter A Collier (Florida Department of Has (Explanation of Violations on following page) DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 2 of 3 EH Database v 1Al AP1386795 EID1907574 Violation Number Comments STATE OF FLORIDA ,DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL Comment APPLICATION #:AP1386795 PERMIT #:56-SF-1907574 DOCUMENT #:FI1339384 DATE PAID:12/07/2018 FEE PAID:515.00 RECEIPT #:56-PID-3825290 The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 A. New septic tank installed. New filter installed. 9x5 long DF installed. System ok to cover. Contractor notified by phone. Beds final inspection for mound system, location conforms with site plan, private/irrigation well setback, well abandonment, and Ial site grading. Requested as built site plan from agent. 5-built site plan provided reflecting absence of wells. Property connected to city water. Final system approved. Emailed to DR 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 2 of 3 EH Database v 1.0.1 AP1300795 EID1907574 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL APPLICANT: Rita K11 AGENT: Rita King PROPERTY ADDRESS: LOT: SCANNED BY WOOD �qo i-c75a7� AP1357929 APPLICATION . PERMIT #:56-SF-1867332 DOCUMENT #:F11207873 DATE PAID:08/01/2018 FEE PAID.65.00 RECEIPT #:56-PID-3633728 .3 01019 1385 Copenhaver Rd Fort Pierce FL 34945 St Luo� - BLOCK: SUBDIVISION: ID#: 2313.214.0006-000-6 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. TANK INSTALLATION SETBACKS [ ] [01] TANK SIZE [1] 121 [ ] 1271 SURFACE WATER FT [ ] [021 TANK MATERIAL [ ] [28] DITCHES FT [ ] [03] OUTLET DEVICE ( 1 1291 PRIVATE WELLS FT [ 1 [04] MULTI -CHAMBERED [ Y / N ] [ ] [301 PUBLIC WELLS FT [ ] [05] OUTLET FILTER [ 1 [311 IRRIGATION WELLS FT ( ] [06] LEGEND 1. 2. [ ] 1321 POTABLE WATER FT I 1 I073 WATERTIGHT [ ] [331 BUILDING FOUNDATIONS FT [ ] [081 LEVEL [ ] [34] PROPERTY LINES FT [ ] [091 DEPTH TO LID ( 1 [351 OTHER FT DRAINFIELD INSTALLATION FILLED / MOUND SYSTEM I ] [10] AREA [1[ I21 SQFT [ ] 1361 DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX _ HEADER [ ] [371 SHOULDERS [ 1 [12] NUMBER OF DRAINLINES 1. 2. [ 1 [381 SLOPES [ ] 1131 DRAINLINE SEPARATION [ 1 [39[ STABILIZATION [ ] [14] DRAINLINE SLOPE [ 1 [151 DEPTH OF COVER ADDITIONAL INFORMATION [ 1 [161 ELEVATION I ABOVE / BELOW ]BM [ ] [401 UNOBSTRUCTED AREA [ ] [171 SYSTEM LOCATION [ ] [41] STORMWATER RUNOFF [ ] [18] DOSING PUMPS [ ] [421 ALARM [ ] [19] AGGREGATE SIZE [ ] 1431 MAINTENANCE AGREEMENT [ 1 [201 AGGREGATE EXCESSIVE FINES [ 1 [441 BUILDING AREA [ [ [211 AGGREGATE DEPTH [ ] [451 LOCATION CONFORMS WITH SITE PLAN I ] 146] FINAL SITE GRADING FILL / EXCAVATION MATERIAL I ] [47] CONTRACTOR [ 1 [221 FILL AMOUNT [ ] [481 OTHER [ ] [231 FILL TEXTURE [ ] 1241 EXCAVATION DEPTH ABANDONMENT [ ] [25[ AREA REPLACED [ ] [491 TANK PUMPED 09/07/2018 [ ] [261 REPLACEMENT MATERIAL [ ] (50] TANK CRUSHED 6 FILLED 09/07/2016 Comments: Comments are on page 2. CONSTRUCTION I APPROVED / DISAPPROVED 1: II Br),*J Ingram CHU DATE: 09/07/2018 FINAL SYSTEM [ pppgOVED / DISAPPROVED 1: �'�+-�� St. Lucie CHD DATE: /�0✓99/0/7/2018 (Explanation of Violations on following page) Environmental Specialist II Br n J Ingram (ENVIRONMENTAL HEALTH) y�// l DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, PAC Page 2 of 3 EH Database V 1.0.1 AP1357929 EID1867332 Violation Number STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL Comment APPLICATION #:AP1357929 PERMIT #:56-SF-1867332 DOCUMENT #:F11207873 DATE PAID:08/01/2018 PEE PAID:65.00 RECEIPT #:56-PID-3633728 Tank pumped and abandoned by Gotta Go Green. SR0181821 Tank pumped and abandoned properly. No violations, system ok to cover. Contractor notified onsite. No final Inspection required. Contractor emailed final approval. DH 4016, 08/09 (Obsoletes all Previous editions which may not be used) Incorporated: 64E-6.003, PAC Page 2 0£ 3 EH Database v 1.0.1 AP1367929 EI01967332 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Rita King PROPERTY ADDRESS: LOT: 1385 Copenhaver Rd Fort Pierce FL 34945 BLOCK: SUBDIVISION: PERMIT f1:56-SF-1867332 APPLICATION n:AP1357929 DATE PAID: FEE PAID RECEIPT # DOCUMENT #: PR1138323 PROPERTY ID N: 2313-214-0006-000-6 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUNMER] 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 PERFORMANCEFOR 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 [ 500 ] GALLONS / GPD Septic existino abandonment CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS B[ ]DOSES PER 24 HRS #Pumps [ D [ ] SQUARE FEET R [ ] SQUARE FEET A TYPE SYSTEM: [ ] STANDARD I CONFIGURATION: [ ] TRENCH N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.001 INCHES 0 T H E R SYSTEM SYSTEM [ ] FILLED [ ] MOUND [ ] ] BED [ ] [ I / ][ABOVE/ BELOW] BENCHMARK/REFERENCE POINT [ I / ][ABOVE/ BELOW] BENCHMARK/REFERENCE POINT ve the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The k shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system Inspected the health department after it has been pumped and ruptured but before it is filled with sand and covered. SPECIFICATIONS BY: TITLE:42 Septic contractor APPROVED BY: //��1 � +-�-_- ITLE: Environmental Specialist II St. Lucie C arl. S In9 DATE ISSUED: 08/03/2018, EXPIRATION DATE: 11/01/2018 DH 4016, 08/09 (Obsolates all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page ^ f v 1.1.4 A 1357929 SE-1 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. f' ap,y kc -IO HEALTH PAYING ON: RECEIVED FROM: PAYMENTFORM: MAIL TO: Rita King St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PERMIT# 56-SF-1867332 RILL DOC Ar56-BID-3853914 CONSTRUCTION APPLICATION A AP1357929 Rita King AMOUNT PAID: $ 65.00 CREDIT CARD PAYMENT DATE: 08/01/2018 FACILITY NAME: _ PROPERTY LOCATION: 1385 Copenhaver Rd Fort Pierce, FL 34945 Lot: Block: Property ID: 2313-214-0006-000-6 EXPLANATION or DESCRIPTION: 134 - OSTDS Construction Abandonment Permit and Inspect! -1 - Surcharge (All) QUANTITY FEE 1 $ 50.00 1 $ 15.00 RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-3633728 4. STATE OF FLORIDA PERMIT NO. &-,V11jybMjZ DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT f APPLICATION FOR! [ ] New System [ ] Existing System [ I Holding Tank [ ] Innovative [ J Repair /]J Abandonment [ ]-L,,,Temporary [. ] APPLICANT: / I iI / (7... k` 61 f'l / iMa d A`H/mi ,33 Q&DI,ki AGENT: �1. 9'VLQP/�J //�^ �' 2 / TELEPHONE: /%,Z-Z��•"y SPIV MAILING ADDRESS: 9 ,G: &y -7Y( Z-4, / / �Y C, !� l J [( I S Y 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. CCC=OOCCOOOOCCCpOCOC OC C C C CC 0 = r- _ PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: PLATTED: PROPERTY ID #: 1313 -21 q - (3oac.- Ddo '� ZONING: I/M OR EQUIVALENT: [ Y/N 1 PROPERTY SIZE: : T1 ACRES WATER SUPPLY: [.�1 lRIV PUBLIC [)e4<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS7 [ Y/QJ I DISTANCE TO SEWER: FT PROPERTY ADDRESS: /_, DIRECTIONS TO PROPERTY: BUILDING INFORMATION p<] RESIDENTIAL [ ] COMMERCIAL Unit Type of No, of Building Commercial/Institutional System Design No Establishment 'Bedrooms Area Sgft Table 1, Chapter 64E-6, FAC I SFR —goo 2 3 4 [ ] Floor/Equipment Drains [ 1 Other (Specify) �jcSIGNATURE: 6"11L11A DATE: DE 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 IIC 4 N:1Lt� 4 Cl CONTRACTOR / AGENT•: ✓ v LOT: BLOCK: SUBDIV: ID*: aovr sevo—ce--c�==ee= TO BE COMPLETED HY FLORIDA REGISTERED ENGINEER,, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED. EXISTING TANK INFORMATION MATERIAL: cap-h6 (OG1L. BAFFLED: [Y /Gi) [ ;!�p 0 ] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL„ BAFFLED:[Y / N] [ j GALLONS SEPTIC TANK/GPD ATU LEGEND: [ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: [ ] GALLONS DOSING TANK LEGEND: MATERIAL: q PUMPS:[ 7 HAVE I CERTIFY THAT THE LISTED TANKS WERE PUMPED ON / / / HY THE VOLUMES SPECIFIED AS DETERMINED BY [ DIMENSIONS / ILF LING /LEGEND ], ARE FREE OF OBSERVABLE SOLIDS D FLTE1CCTION DEVIC / OUTLET FILTER DEVICE ] INSTALLED. DEC�HLTS�_ SS�Z[1 {111�[�i TV aTmmnmrmrt nr .T.rRNsm CONTRACTOR BUSINESS NAME DA EXISTING DRAINFIELD INFORMATION ( ] SQUARE FEET PRIMARY DRAINFIELD- SYSSTEM No. OF TRENCHES [ [ ]-SQUARE FEET TYPE OF SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH [ ) BED [ ) DESIGN: I [ ] HEADER [ 7 D-BOX [ ] GRAVITY SYSTEM 'ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE _ 'YSTEM FAILURE AND REPAIR INFORMATION ] DIMENSIONS: X ] DIMENSIONS: X [ ] DOSED SYSTEM INCHES [ ABOVE / BELOW] ] SYSTEM INSTALLATION DATE TYPE OF WASTE [ ] DOMESTIC [ I C0M4ERCIAL GPD ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [ ] TABLE 1, 64E-6, FAC ITE [ ] DRAINAGE STRUCTURES [ ONDITIONSi [ ] SLOPING PROPERTY [ POOL [ ] PATIO / DECK [ ] PARKING 1TURE OF [ ] HYDRAULIC OVERLOAD [, ] SOILS: [ ] MAINTENANCE 1ILURE: [ ] DRAINAGE / RUN OFF [ ] ROOTS [ ] WATER TABLE ,ILURE [ 1 SEWAGE ON GROUND ( ) TANK.. [ ) D BOX/HEADER 14PTOM: [ ] PLUMBING BACKUP [ 1 [ ] SYSTEM DAMAGE [ ] DRAINFIELD MARKS/ADDITIONAL CRITERIA 74, k A-dA-noopne,-F WITTED BY: , """"----' - 4015, 08/09 (Obsoletea r"iova editions which may not be used) Page 4 of 4 orporated 64E-6.001, FAC FDoN in St. Lucie CouptY Environmental Health truction Site Plan APPi fever us Site Plans for Supersedes F1�6 3s &VVel1 #�1 osTQS #� pate: Reviewer: