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Home My WebLink AboutDOH PAPERWORKPJ STATE OF FLORIDA DEPARTMENT OF HEALTH `1* ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT PERMIT #: 56-SF-1 463104 APPLICATION #:AP1102097 DATE PAID: FEE PAID: RECEIPT #: -SCANNEOPocumENT #: PR902635 St. CONSTRUCTION PERMIT FOR: OSTDS New Lucie count/ APPLICANT: Patricia Ross PROPERTY ADDRESS: 7606 Fort Walton Ave Fort Pierce, FL 34950 LOT: 2 BLOCK: 67 SUBDIVISION: Lakewood Park PROPERTY ID #: 1301 $06-0201-000-6 [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 CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS" @I ]DOSES PER 24 HRS #Pumps I - + D L 334 1 SQUARE FEET SYSTEM _ .. R [ ] SQUARE FEET WA SYSTEM A TYPE SYSTEM: [ ] STANDARD [x] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: CIL ROAD CENTER OF PROPERTY " I ELEVATION OF PROPOSED SYSTEM SITE [ 14.0011 INCHES FT ][ ABOVE BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 8.00 ]I INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT L D E O T H E R ay.Yuaay.u. L 14.UUJ ncYuarou. L The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(% FAC. SPECIFICATIONS BY: Andrew R Gatewood TITLE: Environmental Specialist II APPROVED BY: TITLE: Environmental Specialist II St. Lucie CED Jemea W an - - DATE ISSUED: 04/09/20 EXPIRATION DATE: 10109/2014 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 . 110209i SE895140 0STATE OF FLORIDA AEPLxCATioN # AP1102097 ! <t, iil".. DEPARTMENT OF HEALTH PERMIT k 56-SF-1463104 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM UM DOCENT # SE895140 SITE EVALUATION AND SYSTEM SPECIFICATION s• APPLICANT: Patricia Ross CONTRACTOR / AGENT: Alexander J. Piazza PSM, Inc LOT: 2 BLOCK: 67 SUBDIVISION: Lakewood Park ID#: 1301-606-0201-000-6 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR PROVIDE REGISTRATION NUMBER AND SIGN AND SELL EACH PAGE OF SUBMITTAL. OTHER QUALIFIED PERSON. COMPLETE ALL ITEMS. ENGINEERS Musa PROPERTY SIZE CONFORMS TO SITE PLAN: EX ]YES [ ]NO NET USABLE AREA AVAILABLE: 0.23 ACRES TOTAL ESTIMATED SEWAGE FLOW: 200 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 345.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 500.00 SQFT UNOBSTRUCTED AREA REQUIRED: 500.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: CIL ROAD CENTER OF PRC ELEVATION OF PROPOSED SYSTEM SITE 14.00 [ INCHES / FT ] / BELOW ] BENCHMAAH/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: NIA FT DITCHES/SWALES: N/A FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: NIA FT LIMITED USE: N/A FT PRIVATE: 78 FT NON -POTABLE: NIA FT BUILDING FOUNDATIONS: 7 FT PROPERTY LINES: 10 £T POTABLE WATER LINES: N/A 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 I MSL / NGVD SOIL PROFILE INFORMATION SITE 1 � SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES:Malabar tine sand Munsell #/Color Texture Depth 10YR411 Fill - Sand 0TO 18 10YR 4/2 Sand 18 To 22 10YR 6/3 Loamy Sand 22 To 40 1OYR 713 Loamy Sand 40 To 50 10YR 512 Clay 50 To 72 USDA SOIL SERIES:Mfalsbar fine sand Munsell #/Color Texture Depth 10YR 411 FII - Sand 0TO 15 10YR4/2 Sand 15 To 24 10YR 6/2 Loamy Sand 24 To 42 I OYR 614 Loamy Sand 42 To 48 I OYR 6/4 Clay 48 To 72 OBSERVED WATER TABLE: 36.00 INCHES [ ABOVE /BELOW ] EXISTING GRADE TYPE: [ PERcxED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 30 INCHES [ ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [ ]NO DEPTH: INCHES SOIL TEXTURE/LOADING PATE FOR SYSTEM SIZING: Fine Sand/0.60 DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [ ] TRENCH [XI BED [ ] OTHER (SPECIFY) r REN.ARKS/ADDITIONAL CRITERIA @ 30" INCHES BITE EVALUATED BY: DATE: 04/04/2013 Gatewood, Andre*4?ltle:1EnvlronVr#a1 Specialist)]) (St. Lucie County Environmental Hea DE 4015, 08/09 (Ob.oletes Previous edition. which may naL 21a used) Incorporated: 64E-6.001, FAC Page 3 Of 4 AP1102097 EID1463104 v1.02 4. STATE OF FLORIDA PERMIT NO ..� F fi DEPARTMENT OF HEALTH DATE, PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [✓ ] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: Patricia Ross = E/'7Qo (l srNj AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE: 772-340-7770 MAILING ADDRESS: 619 SW Biltmore 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 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: 2 BLOCK: 67 SUBDIVISION: Lakewood Park Unit PLATTED: 1957 PROPERTY ID #: 1301-606-0201-000-6 ZONING: R I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 0.226 ACRES WATER SUPPLY: PRIVATE PUBLIC [ ]4C=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 7606 FORT WALTON AVENUE DIRECTIONS TO PROPERTY: SEE LOCATION MAP BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sgft Table 1, Chapter 64E-6, FAC I RESIDENTIAL 2 1199 2 3 4 [ ] Floor/Equipment Drains Other (Specify) GARBAGE GRINDERS/DISPOSALS SIGNATURE: L:1 i DATE: 3-19-13 DH 4015, 09/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT #. APPLICANT: Patricia Ross AGENT: Alexander I Piazza PSM, Inc. LOT: 2 BLOCK: 67 SUBDIVISION: Lakewood Park Unit PROPERTY ID # : 1301-606-0201-000-6 I Section/Township/Parcel No. or 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: I✓] YES [ ] NO NET USABLE AREA AVAILABLE: 0.226 ACRES TOTAL ESTIMATED SEWAGE FLOW: 333 GALLONS PER DAY [RESIDENCES -TABLE I/0THER-TABLE2 ] AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [15000PD/ACRE OR2500GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 500 SQFT UNOBSTRUCTED AREA REQUIRED: 500 SQFT BENCHMARK/REFERENCE POINT LOCATION: PAINTED "X" IN CENTER OF ROAD ELEV= 20.41 NAVD 1988 ELEVATION OF PROPOSED SYSTEM SITE IS34 (INCHES/FT ] [ABOVE I 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? [ ] 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 I✓j NO 10 YEAR FLOODING? [ ] YES [✓] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD ORc V �TEXTUREy` TO TO TO G4: USDA SOIL SERIES: USDA SOIL SERIES: �TEXTUREyL DEPTH TO Mn TO TO TO OBSERVED WATER TABLE: 40+ INCHES [BELOW T] EXISTING GRADE. TYPE:[ PERCHED /APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [.ABOVE/BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES I ] NO MOTTLING: [ j YES [ ] NO DEPTH: INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZ]:NGt:`-t' DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: I✓] TRENCH .,[,1`_'BEDI I ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: SITE EVALUATED BY: �i--:i',?�— DATE: 3-19-13 DH 4015, 12/11 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4