HomeMy WebLinkAboutD.O.H. PAPPER WORKSTATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION
PERMIT #
SCANNED
BY
j� j� /��/ {� St. Lucie County ,
APPLIC4NT: �vS] \n (\ ayi 1
S]c
CONTRACTOR / AGENT: 111 Imo% j1 A11 I LI Lq ` [ [l l 61 j 1 I li • 2( t 7 �� /�
LOT: I_ BLOCK: I L[ SUBDIV: ID#: t.... I al _ :010
____________________________-____________
TO BE COMPLETED BY 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 WRY THE TANKS CANNOT BE CERTIFIED.
EXISTING TANK INFORMATION
[IO JV] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: ROCIL BAFFLED:[Y / N]
[ ] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: BAFFLED:[Y / N]
[ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL:
( ] GALLONS DOSING TANK LEGEND: MATERIAL:j1 # PUMPS:[ ]
I CERTIFY THAT THE LISTED TANKS WERE PUMPED O13Y1� L��YGI G: "' �SII •HAVE
THE VOLUMES SPECIFIED AS DETERMINED BY [ DIMENSIONS / FILLING / LEGEND ], ARE FREE OF OBSERVABLE
DE F OR s KS, AND HAVE A [ SOLIDS ff[fC ON„D_� O_UTl ,F�131TE �E� I IN � D.
S TURE OF LICENSED CONTRACTOR BUSINESS LNAME n �L/t� I DATE
-----------------------------
EXISTING DRAINFIELD INFORMATION
[ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ ] DIMENSIONS: X
[ ] SQUARE FEET SYSTEM NO. OF TRENCHES C 1 DIMENSIONS: li
TYPE OF SYSTEM: [ ] STANDARD [ ] FILLED ( ],MOUND [ ]
CONFIGURATION: ( ] TRENCH ( ] BED [ ]
DESIGN: I ] HEADER [ ] D-BOX [ ] GRAVITY SYSTEM [ ] DOSED SYSTEM
ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE INCHES [ ABOVE / BELOW]
SYSTEM FAILURE AND REPAIR INFORMATION
[ ] SYSTEM INSTALLATION DATE TYPE OF WASTE [ I DOMESTIC [ I COMMERCIAL
[ ] GPI) ESTIMATED SEWAGE FLOW BASED ON [ ] METERED WATER [ ] TABLE 1, 64E-6, FAC
SITE ( ] DRAINAGE STRUCTURES [ ] POOL
CONDITIONS: [ ] SLOPING PROPERTY [ ]
NATURE OF [ ] HYDRAULIC OVERLOAD [ ] SOILS
FAILURE: [ ] DRAINAGE / RUN OFF [ ] ROOTS
FAILURE [ ] SEWAGE ON GROUND [ ] TANK
SYMPTOM: [ j PLUMBING BACKUP L j
REMARKS/ADDITIONAL
SUBMITTED BY: _
DR 4015, 08/09 (O letes previous
s
Incorporated 64E- Ol, FAC
[ ] PATIO / DECK
[ ] MAINTENANCE
[ ] WATER TABLE
[ ] D BOX/HEADER
[ ] PARKING
[ ] SYSTEM DAMAGE
[ ] DRAINFIELD
;/LICENSE C_ `y-1 2 V D l
may not be used)
#lE c®p�'
DATE:
Page 4 of 4
ak n1e
? STATE OF FLORIDA
>. DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ ] New System [s/ ] Existing System [ ] Holding Tank
( } -Repair [ ] Abandonment [ ] Temporary
PERMIT NO. _%-SHCI 96O _Y✓
DATE PAID:
FEE PAID:
RECEIPT #:
[ ] Innovative
[ ]
APPLICANT: c)l``lgtkr)
AGENT: 1" C.Yl41U.. ��\(\� TELEPHONE: `M-?�Zl-)O97
MAILING ADDRESS: El c5US)h ((U 1�I( �(� `PIQ(c9. rL_ ,)tIC7JI
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT ASYSTEMS 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`7 BLOCK: I Zl SUBDIVISION: I.a�.LM.\�i 1C�t 111 �3U8'39E PLATTED:
PROPERTY ID #:
-bIZ"Cb7O-C a
-7 ZOONING: R�)-H I/M
OR EQUIVALENT:
[ Y/N ]
PROPERTY SIZE:
ACRES WATER SUPPLY:
[-I] PRIVATE PUBLIC [
]<=2000GPD [
1>2000GPD
IS SEWER AVAILABLE AS
PER 381.0065, FS?[
Y/6)] DISTANCE TO SEWER:
FT
PROPERTY ADDRESS:
�`) �gosac C7\c1-
\\
s-A Fc --\-)\QCC.Q.AFL-
3g95�
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
[V-4 RESIDENTIAL [
]
COMMERCIAL
Unit
Type of
No, of
Building Commercial/Institutional
System Design
No
Establishment
Bedrooms
Area Sqft Table
1,
Chapter 64E-6, FAC
1
!n ne—
�75
miffN130
2
3
4
[ ] Floor/Equipment Drains [ ] Other (Specify)
SIGNATURE:
DH 4015, 08/0g (Obscletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
DATE:
Page 1 of 4
me STATE OF FLORIDA PERMIT N0.51o'Sf-Iq$5830
DEPARTMENT OF HEALTH DATE PAID: $ l�
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ ] New System [ V] Existing System [ ] Holding Tank I ] Innovative
[ ] Repair 1 l�T[ ]p `Abandonment [ ] Temporary
c)l)[ 7
APPLICANT: \rl
AGENT: &UIL �TELEPHONE:-TIE-ELI-1097
MAILING ADDRESS:
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: 1-7 ' BLOCK:
I Zl SUBDIVISION:.
t att�r\f-
b1Ih,34E PLATTED: U6& I)
PROPERTY ID #: iM-617
-CQ70-o )-%
n�i
ZONING: 9�-"1
I/M OR EQUIVALENT: [ Y/N ]
[
1>2000GPD
PROPERTY SIZE: �a_ ACRES
WATER SUPPLY:
[/I PRIVATE
PUBLIC [ ]<=2000GPD
IS SEWER AVAILABLE AS PER 381.0065,
FS?-[
Y/6D]
DISTANCE TO SEWER:
FT
PROPERTY ADDRESS: ��0�
�p(� (`{�\�
�(� POUT
`�;e«e_,FL
3y95)
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
(V-4 RESIDENTIAL I
]
COMMERCIAL
Unit
Type'of
No. of
Building Commercial/Institutional
System Design
No
Establishment
Bedrooms
Area Sqft Table
1,
Chapter 64E-6, FAC
2
l^:I�2
3
4
[ ] Floor/Equipment Drains [_ ] Other (Specify)
SIGNATURE:
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
DATE:
Page 1 of 4
Property Identification
Site Address: 6505 PENSACOLA RD
Parcel ID: 1301612-0070-000.7
Account#: 2830
Sec/Town/Range: 01/34S/39E
Map ID: 13/01S
Zoning: RS4Use
Type: 0100
Jurisdiction: Saint Lucie County
Ownership
Justin Navin
5817 Sunberry CIR
Fort Pierre, FL 34951
Legal Description
LAKEWOOD PARK -UNIT 10-
BLK 121 LOT 17 (MAP 13101S)
(OR 3574-812)
Primary Building Information
Finished Area of this building: 1,430 SF
Gross Sketched Area: 3,489 SF
Exterior Data
Roof Cover: Fibrglss Shg
Roof Structure: Hip
Building T/ Te: HC
Year Built: 1997
Frame: Grade: C
Effective Year: 1997
Primary wall: CB Stucco
Story Height:1 Story
No. Units:I
Interior Dam
Bedrooms:3
FULL BATHS: 2
A/C %: 100%
Electric: MAXIMUM
Heated %: 100%
Heat Type: FrcdHotAlr
Avg Hgt/Floor- 0
Heat Fuel: ELEC
Primary Floor:: Carpet
Fan
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INSTALLATION OF NON BEARING INT. PARTITIONS
DONE IN SUCH A MANNER THAT GARAGE DOOR
REMAINED CLEAR OF ANY OBSTRUCTIONS,
COMPLETELY OPERABLE, AND STRUCTURALLY SOUND
WITHOUT ANY MODIFICATIONS LEAVING EXISTING
STRUCTURAL ENVELOPE INTACT AND UNMODIFIED
NEW 2X4 INTERIOR WALL STUDES ® 16" O,C. W/R-13 INSULATION
'2'GYP (2) SIDES
GARAGE DOOR OPERABLE
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FDOH in St. Lucie County
Environmental Health
Septic System Appears Adequate
For Proposed Construction_ g583a
This Approval Does Not Guarantee
Performance of the System
Reviewer: 24a. ,t.,�_
PROPOSE GARAGE CONVERSION PLAN M&E
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auto This Approval Does Not Gu
Performance of the Sys
Reviewer: 0, A a . -a_ /tfa•✓
t£x�1D=7mr: _
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DOKNDAR4( SKRV£y
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REVIEWED FOR
3. am-,A*oC �,.n. �n•
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CODE COMPLIANCE
5.7hieemuxy+.aanoVaWbL ItINYJA
,md/aeA3Yf����
ST. LUCIE COUNTY
met te4eWz=--d��
6. Mod Zone X
7yr mUEotlo•bmahwlYbabor. a.NQ malpaa
of had. ddbvad pmgaty by .bore. Nat .pa bihly n
IhhNty b.®ed q ruvefv favmarmvry ferns aiherpref� lodwiw but
not IOW kt aaaafn.rey fm vmrey.DNad4 rnJe of p%.V. a t..1 ad.
I hereby certify that the attached sketch of Davey of fho haws described
pmpeay 1. hue and were t W Iha beat of my Imawiedipa and hdid Y
rumored under my direction. I maher oclay roar INa saM mods x
McLaughlin Land Surveying, Inc.
minimum technical atcndat& for land mrveytog In the State of Flmlda
Maple Avenue
(chapter d1O176) paternal to wWon 471037, Florida dalrOM St NC4Io
I 34982
the rputiflodom mlad humg���J
�9
MICHAELP.MCLAUGHLIN
FAX f407) U
PROFESSIONAL LAND SURVEYOR
FLOMA REGIRRA11ON 140.196D
I
(.,ere• 4( Ad -IF.? I a( -.ALE: /-9' • I DWN. BY: .1ZA 110E NO.; 777 1