HomeMy WebLinkAboutD O H PAPERWORK`QVJ W� PERMIT FILg6'Jr-'1FJUE70
APPLICATION #: AP1383942
DEPARTMENT OF HEALTH DATE PAID: T
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
FEB 0 6 2019 FEE PAID:
permitting DepeKhie"r RECEIPT #;
st, i"pie POV^ DocD1-oNT #: PR1194700
CONSTRUCTION PERMIT FOR: OSTDS New SCANNED
APPLICANT: Gwendolvn Hutchinqs
PROPERTY ADDRESS: TBD Seagrape Dr Fort Pierce, FL 34982 St. Lucie County
LOT: 42 BLOCK: 1 sDBDxvxsION: Indian River Estates
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 3402-608-0117-000-2
_ - [OR TAX ID NUMBER]
SYSTEM MOST 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 HULL 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 ERS #Pumps [
D [
375 ] SQUARE FEET Drainfield new
SYSTEM
R [
] SQUARE FEET N/A
SYSTEM
A TYPE
SYSTEM: ( ] STANDARD [x] FILLED
[ I MOUND [ ]
I CONFIGURATION: (X] TRENCH [ ] BED (
]
N
F LOCATION OF BENCHMP.RK: Site BM NID, CL of Seagrape, S property line extended W
I ELEVATION OF PROPOSED SYSTEM SITE ( 8.00 3 [1 INCHES FT IABOVE BELOW I BENCHHARN/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE 15.00 it INCHES FT IABOVE BELOW I BENCEMARK/REFERENCE POINT
L
D
0
T
H
E
R.
L REQUIRED: [15.001 INCHES EXCAVATION REQUIRED: C 4tl.UUJ IN4:n4s
e system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
0 gpd.
e licensed contractor Installing the system is responsible for Installing the minimum category of tank in accordance with
64E-6.013(3)(0, FAC.
SPECIFICATIONS BY: J)rAan J IngrAM-) _TITLE: Environmental Specialist II
APPROVED BY: TITLE: Environmental Specialist II St. Lucie CED
Brian J Ingr
DATE ISSUED: 12/13/2018 EXPIRATION DATE: 06/1312020
DH 4D16, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 2.1.4 AP2383942 SE1143822
• 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-M ealth-Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: PERMITa56-SF-1903060 BILL Ooc#56-BID-4030169 CONSTRUCTION APPLICATION #: AP1383942
RECEIVED FROM: Kerner Surveying, Inc AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 2150 PAYMENT DATE: 11/19/2018
MAIL TO: Gwendolyn Hutchings
FACILITY NAME:
PROPERTY LOCATION:
TBD Seagrape or
Fort Pierce, FL 34982
Lot: 42 Block: 1
Property ID: 3402-608-0117-000-2
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: Montane2NM AUDIT CONTROL NO. 56-PID-3806406
STATE—OF—FLORIDA — --
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
K`Op""� APPLICATION FOR CONSTRUCTION PERMIT
—PERI-UT-NO,--S'F — i CAo '30L90—
DATE PAID: l G
FEE PAID: L---wr 50 05
RECEIPT #: 20 LV4_1
APPLICATION FOR:
[d ] New System [ ] Existing System ( ] Holding Tank [ l Innovative
[ J Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: Gwen M. Hutchin s
AGENT: KARNER SURVEYING INC TELEPHONE(772) 288 7206
MAILING ADDRESS: 2740 SW MARTIN DOWNS BLVD #333 PALM CITY FL. 34990
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.
PROPERTY INFORMATION
LOT: 1 BLOCK: 42 SUBDIVISION: Indian River Estates unit 7 PLATTED: May 2005
PROPERTY ID #: 3402-608-0117-000-2 ZONING: I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: 0.34 ACRES WATER SUPPLY: [] PRIVATE PUBLIC [-� ]<--2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ]
PROPERTY ADDRESS: XXX Sea ra a Dr, $gq'lb2
DIRECTIONS TO PROPERTY: SEE ATTACHED
DISTANCE TO SEWER: FT
BUILDING INFORMATION [ q] RESIDENTIAL, [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sq£t Table 1 Chapter 64E-6, FAC
1
RESIDENCE 33 1632 _ ..
2
3
4
[ ] Floor/Equipment Drains [ 1 Other (Specify)
SIGNATURE:
DH 4015, 10/97 (Previous Editions May Be Usod) ONLINE VERSION
DATE: 10-15-18
Page 1 of 4
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
(0;��
� STATE OF FLORIDA APPLICATION # AP1383942
DEPARTMENT OF HEALTH PERMIT # 56-SF-1903060
ONSITE-SEWAGE-TREATMENT-AND -DISPOSAL SYSTEM— -- - — - - --
DOCUMENT # SE1143822
% SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Gwendolyn Hutchings
CONTRACTOR / AGENT: Kerner Surveying Inc
LOT: 42 BLOCK: 1
SUBDIVISION: Indian River Estates ID#:
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOXEE, 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: IX]YES [ ]ND NET US..NBLE AREA AVAILABLE: 0.34 ACRES
TOTAL ESTIMATED SEWAGE FLAW: 300 GALLONS PER DAY [ RESIDENCES—TAELEI / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 849.98 GALLONS PER ,DAY [ 1500GPD/ACRE OR 1 2500 Gil)/ACHE]
UNOBSTRUCTED AREA AVAILABLE: 1005.00 SOFT UNOBSTRUCTED AREA REQUIRED! 563.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION:
CL of Seaqrape, S property line
ELEVATION OF PROPOSED SYSTEM SITE 8.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN RE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/S4TALES: 20 FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE; FT NON -POTABLE: 75 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 60 FT
SITE SUBJECT TO FREQUENT FLOODING?
7.0 YEAR FLOOD ELEVATION FOR SITE:
nowmmrnq CrmF. 1
( ]YES IX]NO IO YEAR FLOODING? [ ]YES IX]NO)
FT I MSL / NGVD ) SITE ELEVATION: FT I MSL / NGVD
SOI• PROFILE INFORMATION SITE 2
VUSDA SOIL SERIES:Wave}and £ine sand
Munsell #/Color Texture
Depth
IOYR 3/1
Sand -
0 To 9
1OYR 411
Sand
9To18
1 OYR 5/2
Sand
18 To 22
_
10YR 612.
Sind
22 To 37
10YR 7/1 -
Sand
27 To 37
10YR-7/2
Sand
37 To 43
1 OYR 2/1
Spodic Material
43 To 48
1OYR 312
Loamy Sand
4848 To 52
IOYR 4/4
Sand
62To72
OSDA Doll, SERIES: Waveland Pine sand
Munsell #/Color Texture_
Depth
1 OYR 3/1
Sand
-
0 To 9
16YR 4/1 `
Sand
9 To 18
tOYR W f
Sand T-.
18 To 22
10YR fj12
Sand
22 To 37
10YR 711 - --
Sand _
27 To 37
10YR71?-
Sand
37To43
tOYR 211
Spodic Material
43 To 48
IDYR Sly 2
Loamy Sand
48 To 52
1OYR 4/4
-Sand
Q2 To 72
OBSERVED WATER TABLE: 60.00 INCHES I ABOVE
/I
AELOF7]
4427
EXISTING GRADE TYPE: [ PERCHED /, APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION:
INCHES
I ABOVE
EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO
MQTTLING:
IX IYES [ ]NO DEPTH:
27.00^ INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:
5andI0.80
DEPTH OF EXCAVATION:
48 INCHES
DRAINFIELD CONFIGURATION: I X ] TRENCH [
] BED f .'1OTHER
(SPECIFY)
r REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soft borings.
10YR7/1 stripping in 10YR612 matrix,, 10% with diffuse boundaries starting at 27" In SB1.
SB1 a" above BM. SB2 6" above B
SITE EVALUATED BY: RATE; 12/0� 7/2018
Ingram, Brian (Title: Enviro ntei SpeOlallst 10 (BNVIR014MENT44 HEALTH)
DH 4015, 08109 (obsoletae ptgvioua edition- v2♦1ch may no bo U40d) IAC0rP0Fnted: 64E-0.001, FAC Page 4 of 4
AP1303942 EID1903060 v 1.0.2
--- --STATE—OF—FLORIDA-- -- --PERMIT«b�---
DEPAREOF T OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: Gwen M. Hutchings AGENT: KARNER SURVEYING
LOT: N/A BLOCK: N/A SUBDIVISION: N/A
PROPERTY ID #:3402-608-0117-000-2_ [Section/Township/Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [4] YES [ ] NO NET USABLE AREA AVAILABLE:0.34 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE21
AUTHORIZED SEWAGE FLOW: 500 GALLONS PER DAY 11500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: 1005 SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
BENCHMARK/REFERENCE POINT LOCATION: Found Nail and Tin Tab At Intersection os Southerly Lot Line with Center
Li a Seagrape at El 17.32 NAVD
ELEVATION OF PROPOSED SYSTEM SITE IS 0.57 [INCHES/FT] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 75' FT DITCHES/SWALES: 15' FT NORMALLY WET? [ ] YES [XI NO
WELLS: PUBLIC:N/A FT LIMITED USE: FT PRIVATE: 75+ FT NON -POTABLE: 50 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 10 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES ['4] NO 10 YEAR FLOODING? [ ] YES [�] NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
TEXTURE
USDA SOIL SERIES:
1
TO
TO
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE /
BELOW] 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
[ 7 NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED[] OTHER (SPECIFY)
3EMARKS/ADDITIONAL CRITERIA:__
"ITE EVALUATED BY:
DATE:8.6.2018
)H 4015, 10/96 (Replaces HAS-H Form 4015 [page 31 which may be used)
Page 3 of 4
PERMIT #:56SF-1903060 T
"'H' e�NFpAPPLICAT ION #:AP1383942
F 4n STATE OF FLORIDA 0 DATE -"PAID:
i#P• —DEPARTMENT—OF—HEALTH per, �Z
ONSITE SEWAGE TREATMENT AND DISPOSAL I�tbno DO 019 FEE PAID:
SYSTEM Suer@�4(b?Ot RECEIPT #:
DOCUMENT #: PR1194700
CONSTRUCTION PERMIT FOR: OSTDS New contractOf S C NNE®
APPLICANT: Gwendolyn Hutchinqs cop _ St. 1 I�cio f+......,t _
PROPERTY ADDRESS: TBD Seagrape Dr Fort Pierce, FL 34982
LOT: 42 BLOCK: 1 SUBDIVISION: Indian River Estates
PROPERTY ID #: 3402-608-0117-000-2 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAR 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 [ ] 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 [ 375 ] SQUARE FEET Drainfield new SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [X] FILLED [ ] MOUND [ ]
I CONFIGURATION: [X] TRENCH [ ] BED [ ]
J
F LOCATION OF BENCHMARK: Site BM
I ELEVATION OF PROPOSED SYSTEM SITE
E BOTTOM OF DRAINFIELD TO BE
L
D
O
T
H
E
R
CL of Seagrape, S property line extended W
[ 8.00 ][ INCHES FT ][ABOVE BELOW] BENCHMARK/REFERENCE POINT
[ 5.00 1 EFINCjjEST FT ][ABOVE BELOW] BENCHMARK/REFERENCE POINT
iL REQUIRED: L10.UU] INCHES EXCAVATION REQUIREu: [ 90.uur i u:nca
ie system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
10 gpd.
ie licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
64E-6.013(3)(0, FAC.
SPECIFICATIONS BY: gr�Lan J Ingram tom% TITLE: Environmental Specialist II
APPROVED BY: ecian J Ingr TITLE: Environmental Specialist II St. Lucie CHD
DATE ISSUED: 12/13/2018 EXPIRATION DATE: 06/13/2020
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 AP1383942 SE1143822
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.
5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: PERMIT #:56-SF-1903060 BILL Doc #:56-BID-4030169 CONSTRUCTION APPLICATION #: API 383942
RECEIVED FROM: Karner Surveying, Inc AMOUNT PAID: $ 515.00
PAYMENT FORM: CHECK 2150 PAYMENT DATE: 11/19/2018
MAIL TO: Gwendolyn Hutchings
FACILITY NAME:
PROPERTY LOCATION:
TBD Seagrape or
Fort Pierce, FL 34982
42
Lot:
Property ID: 3402-608-0117-000-2
EXPLANATION or DESCRIPTION:
Block:
128 - OSTDS Construction System Inspection Research Fee
-1 - Surcharge (All)
-1 - OSTDS New Permit Surcharge
-1 - OSTDS Construction Application and Plan Review,New
123 - OSTDS Construction Site Evaluation
126 - OSTDS Construction Permit (New or Mod, Amendment)
127 - OSTDS Construction System Inspection
133 - OSTDS Construction Reinspection
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
RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-3805406
SF ICIV '3t�f➢O—
STATE OF FLORIDA
PERMIT NO.
DEPARTMENT OF HEALTH
DATE PAID: ( q
'u
ONSITE SEWAGE TREATMENT AND
DISPOSAL
FEE PAID: 2�Lk6�ll) 5
SYSTEM
RECEIPT #: AO -Ln1
APPLICATION FOR CONSTRUCTION
PERMIT
APPLICATION FOR:
[� ] New System
[ ] Existing System
[ ] Holding Tank
[ ] Innovative
[ 7 Repair
[ ] Abandonment
[ ] Temporary
[ 7
APPLICANT: Gwen
AGENT: KARNER SURVEYING INC TELEPHONE(772) 288 7206
MAILING ADDRESS: 2740 SW MARTIN DOWNS BLVD #333, PALM CITY, FL. 34990
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.
PROPERTY INFORMATION
LOT: 1. BLOCK: 42 SUBDIVISION: Indian River Estates unit 7 PLATTED: May 2005
PROPERTY ID #: 3402-608-0117-000-2 ZONING: I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: 0.34 ACRES WATER SUPPLY: [] PRIVATE PUBLIC [� 3<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS:
Dr. $yc4IB2
DIRECTIONS TO PROPERTY: SEE ATTACHED
BUILDING INFORMATION [ J7 RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sgft Table 1 Chapter 64E-6, FAC
1
RESIDENCE 3 1632
2
3
4
[ 7 Floor/Equipment Drains [ 7 Other (Specify)
SIGNATURE:
DH 4015, 10/97 (Previous Editions May Be Used) ONLINE VERSION
DATE: 10-15-18
Page 1 of 4
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.
(Itl
STATE OF FLORIDA
,: „, DEPARTMENT OF HEALTH
—ONSITE—SEWAGE—TREATMENT—AND—DISPOSAS. SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Gwendolyn Hutchings
CONTRACTOR / AGENT: Kanner Surveying, Inc
LOT: 42 BLOCK: 1
SUBDIVISION: Indian River Estates ID#: 3402-508-0117-000-2
APPLICATION It AP1383942
56-SF-1903060 _
DOCUMENT # SE1143822
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: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0,34 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TAELEI / OTHER -TABLE 2 1
AUTHORIZED SEWAGE FLOW: 849.98 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 1005.00 SQFT UNOBSTRUCTED AREA REQUIRED: 563.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Site BM NID CL Of Seagrape, S property line extended W
ELEVATION OF PROPOSED SYSTEM SITE 8,00 [[INCHES / FT 1 [ ABOVE / BELOW 1 BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: 20 FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: 75 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 60 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD 1 SITE ELEVATION: FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE. 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:Waveland fine Sand
Munsell #/Color Texture
Depth
10YR 3/1
Sand
0 To 9
1 OYR 411
Sand
9 To 18
1 OYR 5/2
Sand
18 To 22
10YR 62
Sand
22 To 37
1 OYR 7/1
Sand
27 To 37
1 OYR 72
Sand
37 To 43
10YR 2/1
Spodic Material
43 To 48
1 OYR 32
Loamy Sand
48 To 52
1 OYR 414
Sand
52 To 72
USDA SOIL SERIES:Waveland
Munsell #/Color
fine sand
Texture
Depth
1 OYR 311
Sand
0 To 9
1 OYR 4/1
Sand
9 To 18
1 OYR 52
Sand
18 To 22
1 OYR 6/2
Sand
22 To 37
1 OYR 7/1
Sand
27 To 37
10YR 72
Sand
37 To 43
1 OYR 2/1
Spodic Material
43 To 48
1 OYR 32
Loamy Sand
48 To 52
10YR 4/4
Sand
52 To 72
OBSERVED WATER TABLE: 60.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 27 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 27.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: 48
DRAINFIELD CONFIGURATION: I X I TRENCH [ ] BED [ ] OTHER (SPECIFY)
7 REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS and soil borings.
10YR7/1 stripping in 10YR6/2 matrix> 10% with diffuse boundaries starting at 27" In SB1.
SB1 8" above BM. S132 6" above BM7 /%
SITE EVALUATED BY:
Ingram, Brian (Title: Enviro ntal Specialist II) (ENVIRONMENTAL HEALTH)
DH 4015, 08/09 (Obsolates previous editions which may no be used) Incorporated: 64E-6.001, FAC
AP1383942 EID1903060
INCHES
DATE: 12/07/2018
Page 3 of 4
v 1.0.2
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: Gwen M. Hutchin s AGENT: KARNER SURVEYING INC
LOT: N/A BLOCK: N/A SUBDIVISION: N/A
PROPERTY ID #:3402-608-0117-000-2 [Section/Township/Parcel No. or Tax ID Number]
TO BE COMPLETED BY ENGINEER, HEALTH DEPARTEMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINNEERS
MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [-4] YES [ ] NO NET USABLE AREA AVAILABLE:0.34 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 500 GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE21
AUTHORIZED SEWAGE FLOW: 500 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: 1005 SOFT UNOBSTRUCTED AREA REQUIRED: SOFT
BENCHMARK/REFERENCE POINT LOCATION: Found Nail and Tin Tab At Intersection os Southerly Lot Line with Center
Li a Seagrape at El. 17.32 NAVD
ELEVATION OF PROPOSED SYSTEM SITE IS 0.57 [INCHES/FT] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 75' FT
DITCHES/SWALES: 15' FT
NORMALLY WET? [ ] YES
[x] NO
WELLS: PUBLIC:N/A FT LIMITED USE:
FT PRIVATE: 75+ FT NON -POTABLE: 50 FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 10 FT
POTABLE WATER LINES:
10 FT
SITE SUBJECT TO FREQUENT FLOODING:
[ ] YES [-4] NO
10 YEAR FLOODING? [
] YES [J] NO
10 YEAR FLOOD ELEVATION FOR SITE:
FT MSL/NGVD
SITE ELEVATION:
FT MSL/NGVD
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
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET 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
JRAINFIELD CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
iEMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY:
:S.6.2018
)H 4015, 10/96 (Replaces HRS-H Form 4015 [page 31 which may be used) Page 3 of 4