HomeMy WebLinkAboutONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEMSCANNED
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Sb STATE OFFLORIDAt. Lucie County PERMIT NO PAID.,
b
DEPARTMENTT OFF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: S-,U
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ X ] New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: GREGORY CHILDRESS (Vfg 6--i1,6 `
AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE: 1-772-340-7700
MAILING ADDRESS: 619 SW BILTMORE ST, 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.
PROPERTY INFORMATION
DATE
LOT: BLOCK:
PROPERTY ID #
341070200020007
PROPERTY SIZE 1.42 ACRES [Sgft/43560]
PLATTED:
[Parcel No.] ZONING:
PROPERTY WATER SUPPLY: [-] PRIVATE [X] PUBLIC
PROPERTY STREET ADDRESS: 6310 OLEANDER AVENUE
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION [ X ] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sgft Table 1, Chapter 64E-6, FAC
1 Residential 4+ 5255
2
3
4
[ X ] Garbage Grinders/Disposals [ ] Spas / Hot Tubs [ ] Floor/Equipment Drains
[ ] Ultra -low Volume Flush Toilets ( ] Other (_ecify)
APPLICANT'S SIGNATURE: *z '
DH 4015, 10/97 (Previous Editions May Be Used)
DATE: 12-08-10
Page 1 of 3
AJP JOB#: 10-0849
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: Greaory Childress
PROPERTY ADDRESS:
LOT:
PROPERTY ID #:
rP310! et0 anderlAWM Fort Pierce, FL 34981
BLOCK:
SUBDIVISION:
PERMIT 0:56-SF-1294295
APPLICATION #:AP989134
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR837339
341070200020007 [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
T [ 1,500 ] GALLONS / GPD Seotic CAPACITY
A I ] GALLONS / GPD N/A CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 8[ ]DOSES PER 24 HRS #Pumps [
D [ 875 ] SQUARE FEET SYSTEM
R [ ] SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [XI MOUND
I CONFIGURATION: [XI TRENCH [ ] BED [ ]
F LOCATION OF BENCHMARK: ORANGE SPOT ON CONCRETE SLAB-E OF HOUSE
I ELEVATION OF PROPOSED'SYSTEM SITE [ 21.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 9.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
t]
0
T
H
E
R
FILL REQUIRED: LSU.UU] INCHES EXCAVATION REQUIRED: L J 1Nuaab
The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
s. 64E-6.013(3)(0, FAG. .
Must submit revised site plan when water meter and line installed.
SPECIFICATIONS BY: James C Duncan N TITLE: Environmental Specialist II
APPROVED BY: TITLE: Environmental Specialist II St. Lucie CHD
c aun
DATE ISSUED: 03/07e EXPIRATION DATE: 09/07/2012
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 M989134 SE838162
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
PERMIT #.
APPLICANT: GREGORY CHILDRESS AGENT: Alexander J. Piazza Inc.
LOT: BLOCK:
PROPERTY ID # 341070200020007
SUBDIVISION:
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:
TOTAL ESTIMATED SEWAGE FLOW: 1441
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE: 1923 +\-
[ X ]
YES [ ] NO NET USABLE AREA AVAILABLE: 1.42 ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1/OTHER-TABLE21
GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: 1923 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Iron rod and cap "TRAVERSE" SET IN CENTER OF WESTERLY PROP,
ELEVATION OF PROPOSED SYSTEM SITE IS 8 [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? [ ] YES [ X ] NO
WELLS: PUBLIC: 200 FT LIMITED USE: 100 FT PRIVATE: 75 FT NON -POTABLE: 50 FT
BUILDING FOUNDATIONS: 6 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 100 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ X ] NO 100 YEAR FLOODING? [ ] YES [X] NO
100 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:
SOIL PROFILE INFORMATION SITE 2
MUNSELL #/COLOR TEXTURE DEPTH
TO
TO
TO
TO
TO
TO
TO
TO
TO
USDA SOIL SERIES:
,OBSERVED WATER TABLE: 40+ 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
DRAINFIELD CONFIGURATION: ( ) TRENCH [ X ] BED [ ]-OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY
DH 4015, 10/96 (Replaces HRS-H Form 4015 [page 31 which may be used)
12-08-10
Bag. 3 of 3
AJP JOB#: 10-849
a
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Gregory Childress
CONTRACTOR / AGENT: Alexander Piazza
LOT:
BLOCK:
APPLICATION # AP989134
PERMIT # 56-SF-1294295
DOCUMENT # SE838162
SUBDIVISION: ID#: 341070200020007
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: 1.42 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 700 GALLONS PER DAY [ RESIDENCES -TABLET I / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 3549.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 1313.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: ORANGE SPOT ON CONCRETE SLAB-E OF HOUSE
ELEVATION OF PROPOSED SYSTEM SITE 21.00 [ INCHES / FT ] [ ABOVE / BELO]I BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: N/A FT DITCHES/SWALES: N/A FT NORMALLY NET: [ ]YES [X]NO
WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON -POTABLE: 75 FT
BUILDING FOUNDATIONS: 10 FT PROPERTY LINES: 10 FT POTABLE WATER LINES: 10 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:Wabasso sand
Munsell #/Color Texture
Depth
10YR 611
Fine Sand
0 To 6
10YR 7/1
Fine Sand
6 To 12
10YR M
CMN/DST RF
12 To 24
1 OYR 514
Sandy Loam
24 To 36
REFUSAL
Refusal
36 To 72
USDA SOIL SERIES:Wabasso sand
Munsell #/Color Texture
Depth
10YR 6/1
Fine Sand
0 To 10
10YR 7/1
Fine Sand
10 To 18
10YR 7/3
CMN/DST RF
18 To 30
10YR 8/1
Sandy Loam
30 To 42
REFUSAL
Refusal
42 To 72
OBSERVED WATER TABLE: 36.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: I PERCHED / APPARENT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 12 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [X]YES [ ]NO MOTTLING: [X]YES [ ]NO DEPTH: 12.00 INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Fine Sand/0.80 DEPTH OF EXCAVATION:
DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY)
r- REMARKS/ADDITIONAL CRITERIA
SITE EVALUATED BY:
Duncan, James (WIlwAff ronmental Specialist 11) (St Lucle County Environmental F
DH 4015, 08/09 (Obsoletes Previous editions which may not be used) Incorporated: 64E-6.001, E
INCHES
DATE: 02/14/2011
Page 3 of 4
AP989134 EID1294296 v 1.0.2