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Home My WebLink AboutDOH PAPPERSSCANNED BY STATE OF FLORIDA St. Lucie 00110, DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION PERMIT # e / 2u771 CONTRACTOR/AGENT All 120[U'I4 2PIL, 4 I"IU.nLbi 2a LOT: Lj BLOCK: SUBDIV: Luc;.. CcsrdenS ID#: 3-gL(SO( ffW z30 f 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 WHY THE TANKS CANNOT BE CERTIFIED. EXISTING TANK INFORMATION'.) L I GALLONS SEPTIC TANK /GPI) ATU Ll LEGEND: A)/IA- MATERIAL:n-�av),hfz_ BAFFLED: 1yol C ] GALLONS SEPTICTANKIGPD ATU LEGEND: MATERIAL: BAFFLED:IY ] [ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: [ ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:[ r ] I CERTIFY THAT THE LISTED TANKS WERE PUMPED ON a / Gj / I (� BY 1� [I CdJ rI: .� se- f kojmmd , HAVE THE VOLUMES SPECIFIED AS DETERMINED BY L DIMENSIONS IFILLING/LEGEND ], ARE FREE OF OBSERVABLE DEEF�FjEj�CCTS,//OR AKS, AND HAVE A [ SOLIDS DEFLECTION DEVICE/ OUTLET FILTER DEVICE I INSTALLED_ SIGNATURE F LICENSED CONTRACTOR BUSINESSDATE EXISTING DRAINFIELD INFOPMATION [ JQrl ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES C ] DIMENSIONS: J_X j Cj [ ] SQUARE FEET SYSTEM NJO. OF TRENCHES [ ] DIMENSIONS: X TYPE OF SYSTEM: [ ] STANDARD [ ) FILLED [ [lI MOUND [ ] CONFIGURATION: [ ] TRENCB [ Y] BED [ 7 DESIGN: [ ] HEADER [ 0-D-BOX [ ] GRAVITY SYSTEM I , DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE INCHES [ABOVEi BELOW 7 SYSTEM FAILURE AND REPAIR INFORMATION [ l�ISl' 7 ] SYSTEM INSTALLATION DATE TYPE OF WASTE [ ] DOMESTIC Ce"I CON.MERCLAL u [ ] GPD ESTIMATED SEWAGE FLOW BASED ON [./METERED WATER [ ] TABLE 1, 64E-6, PAC SITE C I DRAINAGE STRUCTURES [ ] POOL CONDITMONS: [ ] SMOPTNG PROPERTY I/r NATURE OF I ] HYDRAULIC OVERLOAD FAILURE: [ j DRAINAGE / RUN OFF FAILURE [ 1 SEWAGE ON GROUND SYMPTOM: C 1 PLUMBING BACKUP REWYM/ADDITIONAL [ ] SOILS [ ] ROOTS [ ] PATIO / DECK [ ] MAINTENANCE I ] WATER TABLE AmpE$efgi.�e] [ ] SYSTEM DAMAGE I/1 is✓L [ ] TANK [ ] D BOX/HEADER [ ] DRAINFIELD SUIMITTED BY:� TITTB/LICENSE Py,s , �Cfr-q DATE:a-q 7ffo DH 4015, 08/D9 (Obsole Previous editions which may not be used) Incorporated 64E-6.001, PAC �ZIIE yLn/ _) r••�z''R, STATE OF FLORIDA PERMIT NO.S(-� DEPARTMENT OF HEALTH DATE PAID: -p ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: I ] New System [ ] Existing System I ] Holding [ ] Repair [ ] Abandonment [ ] Temporary [ �/ ] PLAN REVIEW APPLICANT: SOVRAN ACQUISITION LTD PARTNERSHIP AGENT: N/A TELEPHONE: (716)650-6008 MAILING ADDRESS: 6467 MAIN STREET, WILLIAMSVILLE, NY 14221 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: 4,5,6 BLOCK: 3 sUBDIvisiDN: ST. LUCIE GARDENS PLATTED • PB 1 PG 35 PROPERTY ID #: 3414-501-1904-2303 , ZONING: CG I/M OR EQUIVALENT: [ Y/N ] PROPERTY SIZE: 5.015 ACRES WATER SUPPLY: I ]] PRIVATE PUBLIC [V<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ y,(]V) ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 8531 S. US HIGHWAY 1, PORT ST. LUCIE, FL 34952 DIRECTIONS TO PROPERTY: NORTH ON US 1 TO 8531 S. US HIGHWAY 1 BUILDING INFORMATION [ ] RESIDENTIAL [,,of COMMERCIAL Unit Type of No Establishment 1 MIN -WAREHOUSE 2 3 4 No. of Building Commercial/Institutional System Design Bedrooms Area Sg£t Table 1, Chapter 64E-6, FAC N/A 89,380 MINI -WAREHOUSE W/ 750 SF OFFICE W/ ONE BATHROOM [ ] Floor/Equipment Drains I ] Other (Specify) SIGNATURE: DATE: 11/11/16 DH 4015, OB/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 oF. STATE OF FLORIDA `t DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION Jr�W wrin�. APPLICANT: PERMIT # 20-71 CONTRAC'ORIAGENT : jail CO��/TipIE. 4 Pluackt2y LOT: , BLOCK: �_ SUBDIV: 51. Lvc.Ia (.lerde.n5 ID#:' lq&.0 t�bN 430 Y TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ASS SUBMITTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED. EXISTING TANK INFORMATION `.t I GALLONS SEPTIC TANK /GFD ATU tl LEGEND: M&TERIALT: ('Gy4et?P/ BAFFLED: [Y I)] ( ] GALLONS SEPTICTANK/GPD ATU LEGEND: MATERIAL: BAFFLen:Iy/N I ( 7 GALLONS GREASE 32MRCEPTOR LEGEND: MATERIAL: ( ] GALLONS DOSING TANK LEGEND: MATERIAL: # PCHPS:I ] I CERTIFY THAT THE LISTED TANKS WERE POGIPED ON a/ Gj/ [6 BY All CAN.1l'(`�:x/JFiL F.Y'(7nh16, HAVE THE VOLUMES SPECIFIED AS pzTERMINED Hy ( DIMENSIONS/FILLING/LEGEND ], ARE ME OF OBSERVABLE DEFECTS OR LEAKS, AND HAVE A [ SOLIDS DEFLECTION DEVICE IOUTLET FILTER DEVICE ] INSTAr.+nn _ SIGNATURE F LICENSED CONTRACTOR BUSINESSdr DATE EXISTING DRAINFIDLD _MFORMATION . ( )C.a ] SQUARE FEET_ PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ a ] DIMENSIONS: �X ILi [ ]} SQUARE FEET SYSTEM NO. OF TRENCHES [ I DIMENSIONS: X TYPE OF SYSTEM: [ ] STANDARD I ] FILLED [ PI MOum [ ] CONFIGURATION: ( ] TRENCH ( Y] BED [ ] DESIGN: [ ] HEADER [ O-D-BOX [ I GRAVITY SYSTEM [ DOSED SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE INCHES [ABOVE;BELOW] SYSTEM FAILURE AND REPAIR IXMDRMA ION [ (C{,97 I SYSTEM INSTALLATION DATE TYPE OF WASTE [ ] DOMESTIC I�Al COMMERCIAL u [ ] GPD ESTIMATED SEWAGE FLOW BASED ON [.4 METERED WATER [ ] TABLE 1, 64E-6, PAC SITS [ I DRAINAGE. STRUCTURES [ ] POOL [ I PATIO / DECK [ I PARKING COND2TIONS: [ ] SLOPING PROPERTY Ili Cdr� NATURE OF [ 1 HYDRAULIC OVERLOAD FAILURE: [ } DRAINAGE / RUN OFF FAILURE [ ] SEWAGE ON GROUND SYMPTOM: C I PLUMBING BACKUP REMARKS/ADDITIONAL I I SOILS I I MAINTENANCE [ ] SYSTEM DAMAGE I ] ROOTS I 7 WATER TABLE [ fl l O JE [ ] TANK [ j D BOX/READER [ ] DRAINFIELD SjiB UTTED BY: TITLE/LICENSE DH 4015, 08/D9 j0bsol&i.A previous editions which may not be used) Incorporated 64E-6.001, PAC arm STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: PERMIT NO. DATE PAID: FEE PAID: /[f� RECEIPT #: [ ] New System I,(] Existing System I ] HoldingTank [ ] Repair [ ] Abandonment a L ] Innovative. [ ] Temporary [ �/ ] PLAN REVIEW APPLICANT: SOVRAN ACQUISITION LTD PARTNERSHIP AGENT: N/A TELEPHONE: (716)650-6008 MAILING ADDRESS: 6467 MAIN STREET, WILLIAMSVILLE, NY 14221 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: 4,5,6 BLOCK: 3 SUBDIVISION: ST. LUCIE GARDENS =.ammnn. PB 1. PG 35 PROPERTY ID #: 3414-501-1904-2303 ZONING: CG I/M OR EQUIVALENT: [ YIN I PROPERTY SIZE: 5.015 ACRES WATER SUPPLY: [] PRIVATE PUBLIC 11% <=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ YAlvl ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 8531 S. US HIGHWAY 1, PORT ST. LUCIE, FL 34952 DIRECTIONS TO PROPERTY: NORTH ON US 1 TO 8531 S. US HIGHWAY 1 BUILDING INFORMATION [ ] RESIDENTIAL 14 COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 1 MIN -WAREHOUSE N/A 89,380 MINI -WAREHOUSE W/ 750 SF OFFICE W/ OM BATHI�OOM 3 4 I ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC 11/11/16 DATE: Page 1 of 4