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AGREEMENT FOR THE CONSTRUCTION OF OFF-SITE UTILITIES
THIS AGREEMENT by and between INDIAN RIVER COUNTY, a political subdivision of the
State of Florida, the address of which is 1801 27th Street, Vero Beach, Florida 32960 (hereinafter the
COUNTY") and, JESSE ROLAND AND CATHERINE MICHELLE BARTON=ROLAND whose
address is 7760 92nd Court, Vero Beach, Florida 32967 and JONATHAN BLAKE GOWEN AND
DEBBIE SUE GOWEN whose address is 7805 92°d Court, Vero Beach, Florida 32967, (hereinafter
Roland and Gowen shall be referred to as the DEVELOPER) is effective upon execution by all parties.
WHEREAS the DEVELOPER is desirous of obtaining County drinking water at its residences: and
WHEREAS the county owns and maintains a water line that runs along 79th Street annroximately 800 feet
to the north of Developer' s residences: and
WHEREAS, the DEVELOPER, is willing, to construct the needed improvements necessary in order to bring
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County water service to its residences located at 7760 and 7805 92nd Court, Vero Beach, Florida, and in so
doing, will make County water service available to 10 other residences along 92°d Court, as more specifically
described inExhibit "A" incgMorated by reference herein, and
WHEREAS;•pdrsuant to Section 918 .05 , The Code of Indian River County (Ordinance 90- 16, as amended),
the COUNTY, requires the DEVELOPER to provide the utility improvements to serve the regional area up
front, and,,aees to reimburse the DEVELOPER, as provided herein, for the cost of providing these off-site
utilities,
NOW, THEREFORE, for and in consideration of the mutual promises set forth herein and other good and
valuable consideration, the COUNTY and DEVELOPER agree as - follows :
1 . DEVELOPER OBLIGATIONS FOR CONSTRUCTION OF OFF-SITE UTILITIES :
The DEVELOPER shalt construct the necessary off-site utilities described herein as directed by the Indian
River County Utilities Department as listed below:
A. 6" Water Main (Part of Master Plan) :
The DEVELOPER shall furnish and 4 install a 6" PVC Water Main along the Western Right of Way of
92nd Court from 79th Street to 78th Place (see Exhibit "B").
B . Assignability:
Either party may assign this Agreement. However, the rights granted herein shall run with the land
and are not the personal property of the DEVELOPER. Therefore, while the DEVELOPER has the
right under this Agreement to freely, transfer the rights and obligations granted by this Agreement,
the assignee shall not have the right to transfer these rights to another property unless this Agreement
is amended in writing by the assignee and the COUNTY .
LC
C Construction Plans Technical Specifications and Contract Documents :
The DEVELOPER agrees to complete a final set of construction drawings and make submission for a
Utilities Construction Permit to the Indian River County Utilities Department and Florida Department
t
F:\UTjImTMS\UTRM - ENGINEERINO\PROJECTS • UTILITY CONSTRUCTION POWTS\92ND COURT WATER MAIN EXTENSION - UCP# 3172\DEVELOPEWS AGREB&NT-APPROVED BY WXD.09-13-
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of Environmental Protection (FDEP). The DEVELOPER shall not commence construction until all
permits are approved and obtained.
D. DEVELOPER' s Obligations :
The DEVELOPER shall prepare at its own expense, plans, specifications, Agreement, advertisement,
general conditions, hereinafter referred to as the "contract documents", for the lines and facilities
necessary to deliver the water utilities from the COUNTY ' S facilities. All plans and specifications
shall be subject to the COUNTY ' s approval prior to the DEVELOPER' s application. The
DEVELOPER shall be responsible for all costs associated with the design, permitting and
construction of the offsite facilities (which includes but is not limited to transmission lines, valves,
fittings, hydrants, meters, and associated appurtenances) whether designed, permitted or constructed
by the DEVELOPER or the COUNTY.
The DEVELOPER shall be deemed in possession of the potable water on the DEVELOPER' s side of
the water meter, however the DEVELOPER shall not be deemed to own the water, and the transfer or
sale of water by the DEVELOPER is prohibited .
The DEVELOPER may not transfer or sell water capacity to any party for use off-site of the property.
E . Easements :
The DEVELOPER shall convey to the COUNTY a utility easement for the water utilities for the
COUNTY to install, maintain, operate and monitor the water and utilities, within the private right-of-
way including, but not limited to, water lines, services, meters, and related utility structures.
After the COUNTY ' S final inspection of the off-site water facilities for conformance with the
approved plans and specifications, the DEVELOPER shall convey all the off-site facilities together
with an interest in land, as may be required by the COUNTY, to the COUNTY . The conveyance shall
include any of the following documents as may be required by the COUNTY, in a form acceptable to
the COUNTY :
a) Bill of Sale
b) Grants of Easements
c) Maintenance Bond
d) Record Drawings (hard copy and electronic format — AutoCAD rel . 14 . 0 or higher)
F. Insurance and Indemnification:
The DEVELOPER hereby releases and holds harmless the COUNTY, and the COUNTY' s officers,
employees and agents, from and against any and all claims for damages, costs, third party claims,
judgments, and expense to persons or property that may arise out of, or be occasioned by, any work
contemplated by this agreement, or from any act or omission of any representative, agent, client,
and/or employee of DEVELOPER, and DEVELOPER shall indemnify the COUNTY against any such
claims and any judgments that may be entered in connection therewith, including attorney fees.
DEVELOPER shall indemnify the COUNTY against any claim for damage that any utility, whether
publicly or privately owned, may sustain or receive in connection with any work contemplated by this
agreement. DEVELOPER shall not make any claim of any kind or character whatsoever against the
COUNTY for damages that it may suffer by reason of the installation, construction, reconstruction,
operation, and/or maintenance of any public improvement, or utility, whether presently in place or
which may in the future be constructed or installed, including but not limited to, any water and/or
sanitary sewer mains and/or storm sewer facilities, and whether such damage is due to flooding,
infiltration, backflow, and/or seepage caused from the failure of any installation, natural causes, or
from any other cause of whatsoever kind or nature. It is the intention of this indemnification
F:\UTII.ITIES\UTIUTY • ENGINEERINGWROIECTS • UTILITY CONSTRUCTION PERMITS\92ND COURT WATER MAIN EXTENSION • UCPM 3172\DEVEI.OPER'S AOREEMENT-APPROVED BY WKD.09.13-
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agreement on the part of DEVELOPER, and a condition of this agreement, that it shall be full and
total indemnity against any kind or character of claim whatsoever that may be asserted against the
COUNTY. DEVELOPER hereby agrees to defend any and all suits, claims, and causes of action
brought against the COUNTY arising out of or in connection with any work contemplated by this
agreement, and DEVELOPER agrees to pay any judgment or judgments, including attorney fees, that
may be rendered against the COUNTY or against the COUNTY 's officers, employees or agents in
connection therewith.
G. Maintenance Bond:
The DEVELOPER agrees to convey all right, title, and interest in the aforementioned utility
improvements to INDIAN RIVER COUNTY and provide a Maintenance Bond, subject to the
COUNTY's approval, issued by a reputable surety company authorized to do business in the State of
Florida, for a period of one year after the COUNTY's acceptance of the improvements. The value of
the Maintenance Bond shall be 25 percent of the total construction value of the utility improvements.
At the COUNTY's sole discretion, the COUNTY may accept a Letter of Credit, drawn on a reputable
financial institution located within 200 miles of Vero Beach, Florida, in lieu of a surety bond.
H. Permits :
The DEVELOPER shall be responsible for obtaining all construction and operating permits required
for the construction, delivery, use and monitoring of the water distributed to and collected from the
subject property. If, through no fault of the parties involved, any federal, state or local government or
agency (excluding the COUNTY) fails to issue necessary permits, or fails to grant necessary
approvals, or requires a material change in the system, then to the extent necessary and if possible, the
parties agree to negotiate an amendment to the Agreement to reflect the change in condition. If the
COUNTY determines that it is impossible or impracticable to perform under the terms of this
Agreement because of the above, then this Agreement shall terminate and the parties shall have no
further obligations to each other.
The DEVELOPER shall comply with reasonable request by the COUNTY concerning on-site
operations and maintenance including but not limited to all FDEP regulations relating to
bacteriological and hydrostatic testing, cross connection control, monitoring, color-coding of water and
equipment.
2 . COUNTY OBLIGATIONS :
A . Reimbursement:
The COUNTY shall reimburse the DEVELOPER pursuant to the provisions of Section 20 1 . 11 , The
Code of Indian River County, for funds advanced by DEVELOPER to construct facilities in
accordance with the COUNTY ' S Master Plan, less the cost of the DEVELOPER' S front footage Line
Extension Fees, as set forth below. Compensation shall be in the form of a check from the COUNTY
and shall not exceed the amount of $ 17 ,454. 24 (see Exhibit "C").
The COUNTY shall reimburse the DEVELOPER based on an itemized invoice of the installed
material on a complete basis, less the DEVELOPER' S share of Line Extension Fees, after the above-
referenced facilities are dedicated to and accepted by the COUNTY. The DEVELOPER' S share for
this portion is tabulated below.
Frontage Total Fronta aCost per Front Footage $/ ft. Developer Cost
380 380 F $ 11 .25 $4275
F:UJTIUTIESIUITUTY - ENGWEERWGIPROJECTS - UTILITY CONSTRUCTION PERMITS192ND COURT WATER MAW EXTENSION - UCP# 317211)EVaOPER'S AGREEWENT-APPROVED BY WMv09.130
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3 . BIDDING AND AWARD :
The DEVELOPER shall cause the DEVELOPER' s consulting engineer to review the bids
and to make a written recommendation to the County' s Department of Utility Services for award of the bid
to a licensed and qualified utility contractor. The term "qualified" shall be as determined by the County.
The COUNTY' S reimbursement of construction costs to the DEVELOPER shall be conditioned upon the
approval of all project costs by the County ' s Department of Utility Services. Bid proposals and
engineering costs related to the work described herein shall be subject to prior approval by County ' s
Department of Utility Services. The DEVELOPER shall not commence work unless the County ' s
Department ofUtility Services provides written approval ofthe final construction cost and the final project
cost.
4 . MISCELLANEOUS :
A. Amendment:
This Agreement may be modified only by a written instrument executed by all parties to the
Agreement.
B . Authority:
Each party hereto represents and warrants to the other that the execution of this Agreement and any
other documents required or necessary to be executed pursuant to the provisions hereof are valid,
binding obligations and are enforceable in accordance with their terms.
C . Captions :
Captions, if included, in this Agreement are included for convenience only and are not to be
considered in any construction or interpretation of this Agreement or any of its provisions.
D. Definition
All pronouns shall be deemed to refer to the masculine, feminine, or neuter, singular or plural, as the
identity of the party or parties may require.
E. Entire Ag eement
This Agreement embodies the entire agreement between the parties relative to the subject matter
hereof, and there is no oral or written agreements between the parties, nor any representations made by
either party relative to the subject matter hereof, which are not expressly set forth herein.
F. Governing Law & Jurisdiction :
This Agreement shall be governed by the laws of the State of Florida and the laws of the United States
pertaining to transactions in such state, and all actions arising out of this Agreement shall be brought
in Indian River County, Florida, or, in the event of federal jurisdiction, the United States District Court
for the Southern District of Florida. All of the parties to this Agreement have participated freely in the
negotiation and preparation hereof. Accordingly, this Agreement shall not be more strictly construed
against any one of the parties hereto.
G. Multiple Counterparts :
This Agreement may be executed in a number of identical counterparts which, taken together, shall
constitute collectively one ( 1 ) Agreement; but in making proof of this Agreement, it shall not be
necessary to produce or account for more than one such counterpart executed by the party to be
charged.
F:\UTHXnES\UT1UTY - ENGQJEERING\PROIECTS - U71IZY CONSTRUCTION PERMITS\92ND COURT WATER MAIN EXTENSION - UCPN 3172\DEVELOPERS AGREEMENT-APPROVED BY WKD,0943-
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H. Recording of Aueement:
This Agreement may be recorded in the official records of Indian River County by the COUNTY . If
recorded, the obligations defined in this Agreement shall run with the land and shall bind subsequent
owners of the property for the term of this Agreement. The DEVELOPER shall pay for all recording
cost.
I. Severability / Invalid Provision :
If any provision of the Agreement is held to be illegal, invalid or unenforceable under present or future
laws, such provision shall be fully severable; this Agreement shall be construed and enforced as if
such illegal, invalid or unenforceable provision had never comprised a part of this Agreement, and the
remaining provisions of this Agreement shall remain in full force and effect and shall not be affected
by such illegal, invalid, or unenforceable provision or by its severance from this Agreement.
J. Term :
The term of this Agreement is five (5) years. Unless otherwise agreed to by the parties in writing, this
Agreement shall not be renewed automatically for successive terms. Notwithstanding the foregoing,
this Agreement shall be coterminous with FDEP Permit for construction and with the County' s Utility
Construction Permit, whichever provides a shorter time period, but shall be not more than five (5)
years from the date of issuance. The County may terminate this Agreement early in its sole discretion
if it determines that the development project intended to be served by the improvements is suspended
or discontinued.
K. Time of Essence :
Time is of the essence of this Agreement; however, if the final date. of any period which is set out in
any provision of this Agreement falls on a Saturday, Sunday or legal holiday under the laws of the
State of Florida, then, in such event, the time of such period shall be extended to the next day which is
not a Saturday, Sunday or legal holiday.
-THE REST OF THIS PAGE LEFT BLANK INTENTIONALLY-
F:\UTR]TMSIUTR.ITY • ENGAIEERING\PROJECTS - UTWY CONSTRUCTION MMTS192ND COURT WATER MAIN EXTENSION - UCP# 31721DEVELOPER'S AGREEMEM-APPROVED BY WKD,09-13-
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IN WITNESS WHEREOF, the COUNTY and the DEVELOPER have accepted, made, and executed this
Agreement as follows.
Sign By
Wi ess as to Both Jesse Roland
Printed name Y ► 5 �l f t
Sign B Vk/,00U vu
Witness as to Both Catherine Michelle Barton-Roland
Printed name : mmaefet.
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
The foregoing instrument was acknowledged before me this YOnday of September , 2012, by Jesse
Roland and Catherine Michelle Barton-Roland, who are personally known to me or who each has produced a
Florida Driver' s License As identification.
NOTARY PUBLIC Signt �X e
, U nn -
�E�� Aa Bethany L. Camm ted name tel, 4. an �. L . QkyyV �ncx ro+m
rte°' , k, v 'MISSIONKE041196
Stamped Seal & Commission = ' : '
PIZ , 2014
Expiration Date h a:'� v�,�,AA NONoV. 9ARymm
Sign .eJ-- By
Wi ia Jonathan BI a wen
Printed n -�� t- I aiC.lv"�
Sign Al By
Witness Debbie Sue Gowen
Printed name : Dt? rC_ v
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
The foregoing instrument was acknowledged before me this day of September , 2012, by
Jonathan Blake Gowen and Debbie Sue Gowen, who are personally known to me or who each has produced a
Florida Driver' s License as identification.
NOTARY PUBLIC µ ' ALVEFIDIACARWMI ign g�,g� n4. c1 n - Q lbi�c40
MY COIaMIMN t EE 159517
WThrUEXPIRES* 4 pv 9, row ted name.6 W ^QM7� [ Sf 6L ,� (�
Bonded Thru Nary PubYc UnderrrtlEere _r,
Stamped Seal & Co
Expiration Date - �(
F:IUTIUT1ES\UTILITY - ENOBgERINGWRO3ECTS • UTMITY CONSTRUCTION PERMITS\92ND COURT WATER MAIN EXTENSION - UCP# 3172\DEVELOPER'S AGREBENf-APPROVED BY WM09-13-
12JRR.DOC - 6 -
i
BOARD OF COUNTY COMMISSIONERS
INDIAN RIVER COUNTY, FLORIDA
Attest:
Jeffrey R. Smith, Clerk of the Circuit Court and Comptroller
ggaaaraaaasa
r'OMMISs��y�
By; �s' By: ate : 10/ 10/12
eputy Clerk •: Gary C neeler, Chairman
e` � • s
a s
a
BCC Approved : October 9 , 2012
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°°°Sn C0� .a° ° Approved by:
aaYaaatlaatlgga
Date :
?OsepfA. Baird, County Administrator
Approved as to Form and Legal Sufficiency:
Date . Z--
William . DeBraal, Dep County Attorney
-THE REST OF THIS PAGE LEFT BLANK INTENTIONALLY-
F.\LIMTTES\UTILITY - ENOINEERING\PRO3ECTS • UTILITY CONSTRUCTION PERMITS\92ND COURT WATER MAIN EXTENSION - UCP# 31720EVELOPER5 AGREEMENT-APPROVED BY WMD 0943-
12,JRR.DOC 7
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a
2
EXHIBIT " C"
Itemized List of Expenses
County Obligation ( Master Plan Water Main ) :
Engineering = $ 7, 604. 24
Permitting = $ 1, 150.00
Construction = $ 129975 . 00
Total = 21,729.24 *
Developer Obligations ( Line Extension Fees ) :
Gowen Front Footage = 150 LF
Roland Front Footage = 230 LF
Total Front Footage = 380 LF
Line Extension Fees = $ 11. 25 x 380'
County Obligation ($21,729. 24) — Developer Obligation ($4,275 ) = Reimbursement Amount 17,454.2
* Please refer to the following attachments for project invoices and fee schedules.
IF I F IF
Invoice Date -�� Sep 19 2012 �j
IMMBVIF I
ENGINEERING, INC. Invoice Num 12-0883
MOIA BOWLES VILLAMIZAR & ASSOCIATES -IF I IF IF . I
SSOCIATESI
1835 20th Street ■ Vero Beach, FL 32960 B1111ng TO �ep 912012
Phone: 772.569.0035 ■ Fax: 772.778.3617
Page 1 of 1
To: Mr. Jesse Roland
7760 92nd Court
Vero Beach FL 32967
INVOICE
For professional services rendered on the above referenced project for the period ending September 19 , 2012
Charges or payments made after closing date are not reflected in this invoice.
Please include invoice number with all payments. A service charge of 1 . 5 % per month will be billed for late payments .
Project ID Project Name Contract Amount % Complete Previously Billed Amount Due
12 - 192 : C0A 92nd Ct. Waterline Extension - $37550 .00 100 .00 $2 , 847 . 50 $702 . 50
CONST ADMIN
Reimbursable Expenses :
Description Units cost Amount
Delivery Charge 1 .00 $ 15 .00 $ 15 .00
Mileage 160 .00 $0 . 55 $ 88 .00
Prints 1 .00 $2 . 50 $2.50
UPS 1 .00 $ 16 .07 $ 16.07
Total Expenses: $121 .57
Sub-Total $824.07
Current Period Charges: $824.07
Past Invoices. $ 19914. 47
Total Amount Due Including This Invoice: $ 2 ,738.54
_ -- . _ _ _
To avoid late fees pay before Due Date : 1011912012
dcOF cot�rtt SumCnaryOIL-
,_. IF
. �
l5 FF-7
j Ser'ices BTD Expenses BTDII Billed To DIF,ale F�arct To Cta ; O IFI Late FeesFl�!, FIFO Owed Ballance Due
IF$ 3,650.00 $ 193 54 ;$` I k s4 $ 1�OOs dO . % '$NO
0 00 $ , 2y 38 54"
? ,
If you have reason to believe this billing is incorrect please notify us via a-mail ; billing@mbveng .com
Inv Num Inv Date Bill Amt Pay Date Retainer +/- Amt Paid Inv Balance Late Fee Late Fee Paid
12-0822 08/28/2012 $ 1 ,914 .47 $0 .00 $0 .00 $ 1 ,914.47 $0.00 $0 .00
12-0883 09/ 19/2012 $ 824 . 07 $0 .00 $0 .00 $824 . 07 $0. 00 $0 .00
$2,738.54 $0.00 $0.00 $29738.54 $0.00 $0. 00
92nd Ct. Waterline Extension - CONST ADMIN Project Balance: $ 2,738.54
- ' Invoice Date Sep 19, 2012
M BV
ENGINEERING, INC . invoice Num 12-ossa
MOIA BOWLES VILLAMIZAR & ASSOCIATES
1835 20th Street ■ Vero Beach, FL 32960 Billing To Sep 19, 2012
Phone: 772.569.0035 ■ Fax: 772.778.3617
Page 2 of 2
To: Mr. Jesse Roland
7760 92nd Court
Vero Beach FL 32967
Re : 12- 192 : COA-ADD
92nd Ct. Waterline Exten CONST ADMIN - ADD SERV
INVOICE
For professional services rendered on the above referenced project for the period ending September 19 , 2012
Charges or payments made after closing date are not reflected in this invoice .
Please include invoice number with all payments . A service charge of 1 .5 % per month will be billed for late payments .
Total Amount Due Including This Invoice: $ 1 ,014.70
To avoid late fees pay before Due Date : 10/19/2012
If you have reason to believe this billing is incorrect please notify us via e-mail ; billing@mbveng .com
rr
l � - DFS
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CATHERINE M BARTON-ROLAND 7103
7760 92ND CT ,
VERO BEACH FL 32967
63- 7790/ 2631
Date
Pay
to
of' �13 V AAf :WC—CtQI C� I $ �j
Y •Z 4
0 L( 5 /.� rJ / >�7"`� ' /c 0 � Dollars ago,
Beat.
SP Check 21 requires paper processing of this check
CREDIT UNION
S C
SCC U 0 C O M
For e« INL` XIA6 G
� : 2 6 3 17 790 311 : 6 160000S 190 1611' 7 L0 3
CW"
Invoice Date Jul 25, 2012Y
® - M BV
ENGINEERING, INC. (invoice Num _ 12-0716
�_ _.___
MOIA BOWLES VILLAMIZAR & ASSOCIATES
1835 20th Street ■ Vero Beach, FL 32960 L Billing To 1-un 29 , 2012 _
Phone: 772.569.0035 ■ Fax: 772.778.3617
Page 1 of 1
To: Mr. Jesse Roland
7760 92nd Court
Vero Beach FL 32967
INVOICE
For professional services rendered on the above referenced project for the period ending June 29 , 2012
Charges or payments made after closing date are not reflected in this invoice .
Please include invoice number with all payments . A service charge of 1 . 5% per month will be billed for late payments .
Project ID Project Name Contract Amount % Complete Previously Billed Amount Due
12- 192 : 92nd Ct. Waterline Ext - CIVIL $2 ,750 .00 100.00 $22750 .00 $0.00
DESIGN PERMITTING
Reimbursable Expenses :
r
Description Units Cost Amount
Copies 36 .00 $0 .25 $9 .00
Mileage 6 .00 . $0. 55 $3 .30
Postage 1 .00 $ 1 .70 $ 1 .70
Prints 20.00 $2 . 50 $50.00
Total Expenses : $64.00
Sub-Total: $64.00
` Current Period Charges. $64.00
IIIIIIIIIIIIIIIN
Total Amount Due Including This Invoice: $ 64.00
To avoid late fees pay before Due Date : 812412012
Accountummary
Services BTD Expenses BTD Billed To Date ' ",Par d id To DateI Late Fees Owed Balance Due
$ 21750 .00 _ $ 96.00 $ 21846.00 $ 21782 .00 $ 0 .00 $ 64. 00 _
If you have reason to believe this billing is incorrect please notify us via e-mail ; billing@inbveng .com
III NO - nce Late Fee Late Fee Paid
� Y
u<_ x`, r� r�eois 2 4 4 oo $0000 $0 .00
Michelle Garton-Roland f �=-
�Je��e Roland 1.00 $0.00 $0.00
>7760 92nd Court Dare ` $ 64.00
Vero Beach, FL 32967 }
Ar
6
To
The Order Of V Cr1 it ee r l y Q O ' '� l� � L
7W 'f roar 0 Dollars
SPACE COAST CREDIT UNION
(800) 447-7228
Q WWW.sccu.coM *1 " .Pot AA& I I 11� . 1
,
i
For �Vaat � ecrr ►1q C� t'iS
I : 26 3 0 79031 : 299000.. '190 1 Ell 1 244
�® Invoice Date Jun 21720'12
1 >. M BV64 1IF
ENGINEERING , INC .
Invoice Num 12-0590
MOIA BOWLES VILLAMIZAR & ASSOCIATESIF
1835 20th Street ■ Vero Beach, FL 32960 Billing To May 25, 2012
Phone: 772.569.0035 • Fax: 772.778.3617 ; ; : :,n.;:IF
: IF me VW
:.: .
Page 1 of I
To : Mr. Jesse Roland
7760 92nd Court
Sebastian FL 32958
INVOICE
For professional services rendered on the above referenced project for the period ending May 25 , 2012
Charges or payments made after closing date are not reflected in this invoice .
Please include invoice number with all payments . A service charge of 1 . 5% per month will be billed for late payments
.
Project ID Project Name Contract Amount % Complete Previously Billed Amount Due
12- 192 :COA 92nd Ct. Waterline Extension - $3 ,350 .00 30 .00 $0 . 00 $ 13005 .00
CONST ADMIN
Current Period Charges : $ 1 ,005.00
Total Amount Due Including This Invoice : $ 1 ,005 .00
To avoid late fees pay before Due Date: 7/21/2012
,yA , tiZ q , L'f stIF I
, IF I lee.
, � . .
f .A� ynt,$ utn a I ` IF
IF
I .:- _ in I IF Y .r l :• t, ` +tai +uL ' t#i< '�s1 Y Yy - �I IF , r e . .
' k ' Late Fees Qwed Balance IF IV
Services BTD Fell
EXpenses BTD B1 �ediTa�Qef ;, P� tc +TYo Date ,
��.�.:.._,...,..�:.� _ FIFIFF
% , t d 4. xl. i fZ 4s.F 1�'1�1:zt of ae v7 ar 2 : R '4' 1 E '` t ,. _ n , .
.:
' -" %* Y t#'Y7u. tY{fir° S , kf "lur •t45ft`"t %a. 1 r 1 G i T. y . is
-
II $ 1, 01)5 00 :It�. 0. 00 IF I�, IF
f _$ni! �:5sS�siQrJ�"} �7 `� ( : R4 SIrOt00 . _ . It
$ 1, 005 00
If you have reason to believe this billing is incorrect please notify us via e-mail; billing@mbveng .com
Inv Num Inv Date Bill Amt Pay Date Retainer +/- Amt Paid Inv Balance Late Fee Late Fee Paid
_ . _ . . _. . _ . ._ I. .
12-0590 I . 06/21 /2012 $ 1 ,005 .00 $0 .00 $0. 00 $ 12005 . 00 $0 .00 $0.00
$1 ,005.00 $0600 . $0000 1 $ 19005.00 $0000 $0006
92nd Ct. Waterline Extension - CONST ADMIN Project Balance: $ 1 ,005.00
IF
IF
'7 23
p nso-zsst' 1237
Michelle Barton-RolandIF I I IF
Je��e Roland C�
7760 62nd court DateVFW, ( �
III
Vero Beach, FL 32667III IF
Pay To M6U EsuG��,� � EiP�iVG 1 . 37 7. p
The Order Of S , , Q ?
-T�OuS�ty d EIG> / - SEi/ ay Dollar
5 8
SPACE COAST CREDIT UNION
(800) 447-7228
g Mm.sccu.coM
Fore-l �rN(T' w4vIGL% Y "''
1 : 2631779031 : 2990000S .1905611' 237
■ie l r l � �[ ` � � `
ENGINEERING, INC . Invoice Num 12 0589
MMA BOWLES VILLAMIZAR & ASSOCIATESAt
1835 ?.0th Street ■ Vero Beach, FL 32960 Billing To May 25, 2012
Phone: 772.569.0035 ■ Fax: 772.778.3617 ""'` ' '- `'°" '
Page 1 of l
To : Mr. Jesse Roland
7760 92nd Court
Sebastian FL 32958
INVOICE
For professional services rendered on the above referenced project for it. period ending May 25 , 2012
Charges or payments made after closing date are not reflected in this invoice .
Please include invoice number with all payments . A service charge of 1 . 5% per month will be billed for late payments .
Project ID Project Name Contract Amount % Complete Previously Billed Amount Due
12- 192 : 92nd Ct. Waterline Ext - CIVIL $2,750 . 00 100 . 00 $0 .00 $2,750 . 00
DESIGN PERMITTING
Reimbursable Expenses :
Description Units Cost Amount
Copies 8 .00 $0 .25 $2 . 00
Prints 12 . 00 $2 . 50 $30 .00
Total Expenses : $32. 00
Sub-Total• $21782.00
Current Period Charges : X22782 . 00
A.
'Total Amount Due Including This Invoice. $ 2 ,782 .00
To avoid late fees pay before Due Date: 7/21/2012
.. . . s-t;-lrsCi �"& ,`� YWNts+� I 'fxr { nTa ° I-Ed { 11+ Ed
I < :yYntlyell ,k' Oi'alll aEd
fryy/'+s'' , F r5;r11+ '�l a J' $s. ' 4, ,*;; Ed
-
ry � i n a . `:w Kc4 ( } lir rrr�u s rtC� /,,l}}a. s, tt a . .o ,. c11
r ] 4 .,ri'Ar44'Ld' , ' a •:a 9FA ? 'P;. _ i If ,s� b,'; s. "iCl�'n yes . j
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rvices BTD Expenses $TD ` }rd ' B U. SIS 'tee ` Rat � o Dfi " i ' 2 X Late Fee Owed � ' Balance bue
r !r > 1 - '�C 7kaEd 0 + rn'.r. >•4�Y,ns`[ 1.7: 1i7' xis sr.* Mrr'i I '
'
' 9y 1 } y } Y 34 F .. . t ..� s.I G1 .I- 5 (C� CfAM � {f. Timid. t ( 'i.
.$ : 2 d . A ,7'50 00 E.$ 32.�d y t$i£�2 S 0 r + a i~ G0 00� t'1 a � � + , � i FAY $ 1y $
2782� 00
x p n
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��-`�.t:+fY�.c•,a+
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If you have reason to . believe -this. billing is incorrectpleasenotifyus via e-mail; billing@mbveng .com
Inv Num Inv Date Bill Amt Pay Date Retainer +/- Amt Paid Inv Balance Late Fee Late Fee Paid
t 2-0589 06/21 /2012 $2,782 . 00 $0. 00 $0 . 00 $22782.00 $0.00 . $0. 00
MIMME
$22782. 00 $0.00 $0.00 $2 ;782. 00 $0.00 $0.00
mmmmp
92nd Ct. Waterline Ext - CIVIL DESIGN PERMITTING Protect Balance; $ 2,782.00
- .Y
E.
63.77942631Add
1237 231
Michelle eartovl-Rolavld
le5:5e Roland i
7760 62nd Court Date 2 = Zv/-Z
_ V4 •
Vero beach, FL 32667
The Order Of N1RIl E,uGi� � E EiC��iV(rAl► $Pay To
3787' DpEd
do�z `:
¢ Dollars 19 � s.d.
SPACE COAST CREDIT UNION Ep
(800) 447a228
www.sccu.coM
ForEd
S• . ✓ �1���"�/N�r 1A//E �IlI
t : 2631779031 : 2990000 S. L901611' L237
1 -
Invoice
Date Invoice #
(1F 1 4l201 `? 1361
TREASURE COAST CONSTRUCTION .
Generat CCtaxttrttetor/_1?ro eet Ma.tiltgemen,t
Bill To Ship To
kssc: Ro% land Water
761)" 92srd Catirr , 92nd C°ourt=.c� 75tth treet
crxi 13iach, t t. 3 ?J67 Wro ticttrl , F1 329.b7
Terris:, � D"ue Date. P. O. No. Project
9/ l oV2tl 12.
Description Rate Amount
3 . i5 tap l care and tapping va1 ' �v slvve
110
I
- tip,
wntef line DR1 ,8 G installed wlbetl restrins as needed
A . 2 nretcr bore
5 `t irieti4ttal bore
b. koail epiatr,nnd valve i;ap .
T2 I " service lines aprox 400 LF ea ipstalleti`
$; Service for 2 houses wisoddte, �orp and ,curb stops
ry
Payments/Credits V00 , ;
80Ience D,u, e % $ 12;975:( 1
P. Q:' Box 2851 • 'Vero Beach , FL 32% 1 "Phone {772} 569-7165 • Fax (772) 569=8901 • License No. CBC053386
�.
MA
FF - - I , , jrF4 I
IFFAN Barton Roland
Je:5f)e` lZotand
`7760 g2yld 760um Daze ' Q � 2o /L•
Vero Beach, FL )2867 '
Pay To
� . The Order Of �� (�„ rovi Im, 1
kLl ( � jL1 r � '� eD Dollars
aw SPACE COAST CREDIT UNION
(800) 447x228
o WWW.SCCu.COM
AAA
For �f �+ a � �r�m Lm
� 2631779;03ion 299000;0. 5190Gil ' 1231
�. ._ _ ..
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63-7760-2831
Mhe►►e Garton- olan� 1232
% Je��e Rolavid
7760 g2rld Court , F . - -. - Date Yo • Dl- 20 Z
Vero beach, FL 32g67
The Order Of 1 f� c - Pt Q
QI. Ob
t l 'TY YI � O JDollars
x
SPACE COAST CREDIT] UNION
5 (800) 44777228
Q WWW.SGCU COM
For . " ' O I T � 7dd-- em .
x : -26 29900:005190 G . 1 23 2
�icL `: Srrl. Nt�rpJ,ci. . 1 :1. 411) 9
;aednrr. day ;
aE" PE: L' Fii LGC1q i, Y' bel
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:C� tstl Transact: ions
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•i 4i i. St• NI'l{1 '.i. iiil Ei ci ldl'IC.c eveO . l� l!
t . R . C . UTILITIES
000012 12. : 39 : 38PM
1:, 13
bob
UIP CODE : c; 7Fi0cK
iia TN
MIAN RIVER COUNTY
RIGHT-OF -WAY REVIEW/PERMIT APPLICATION
DATE ROW PERMIT NO ,
APPLICANT Mr. Jesse Roland 772-633-9282
NAME PHONE
7760 92nd Court; Sebastian, FL 32958
ADDRESS
CONTRACTOR TBD
NAME EMERGENCY PHONE
ADDRESS OFFICE PHONE
LOCATION OF WORK 92nd Court
STREET ADDRESS
31 = 38-34-00008-0100-00005 .0 & 0020-00013 . 0
LOT BLOCK SUBDIVISION UNIT
DESCRIPTION OF WORK : Installation of approx. 315 LF of 6" water main & 500 LF
of ( 2) 11 / 2" water service lines in the 92nd Court westside ROW.
TYPE OF RIGHT-OF-WAY: (CIRCLE ONE) RESIDENTIAL COMMERCIAL
LAND DEVELOPMENT SITE PLAN UTILITY
JURISDICTION : (CIRCLE ONE) PUBLIC PRIVATE
TYPE C STORMWATER REVIEW: (CIRCLE ONE) YES NO
CONSTRUCTION TYPE
DRIVEWAY CABLE TV UNDERGROUND
STREET PAVING ELECTRICITY OVERHEAD
SIDEWALKS/CURBS TELEPHONE STORM DRAINAGE
X RIGHT-OF-WAY X WATER SYSTEMS CLEARING
SANITARY SEWER OTHER
WORK START DATE : July 2012 WORK FINISH DATE September 2012
NOTE : 1 . Detailed drawings shall be submitted with each application .
2 . The permit is issued subject to all conditions on reverse side of this application .
3. A signature by the contractor shall be construed as making the contract personally liable for all
permit conditions unless contractor attached written proof of authorization to act on behalf of the
applicant.
4 . All work is subject to final inspection by the Engineering Division . Call 772-770-5455 , "AIRS"
(automated inspection request system) schedule inspections for any permit issued after January
1 , 2003 .
Mr. Jesse Roland
A ANT/ ONTR CTOR SIG AT NAME ( PLEASE PRINT)
OFFICE USE ONLY
PERMIT FEE: NOTES :
ISSUING OFFICER
DATEISSUED
EXPIRATION DATE
DIGHT-OF-WAY CONDITIONS
1 . Applicant shall not begin construction of any kind in the County right-of-way prior to application
and issuance of a valid permit by the Department of Public Works.
2 . Any areas disturbed in the County right-of-way must be restored by applicant to a condition
equal to or better than existing just prior to construction , including but not limited to compaction ,
grading , paving , seed mulching and sodding , etc. , as the case may be. The quality of construction ,
materials , and workmanship shall be in accordance with County standards.
3 . *Applicant shall notify the Engineering Division at least 48 hours prior to the placement of
concrete, paving of asphalt, installation of culverts , or backfilling of trenches , so that the County
may inspect installations as necessary. Applicant shall further notify the County in writing of its
request for final inspection and approval at the completion of the permitted activity .
4 . The permit shall EXPIRE WITH THE ASSOCIATED LAND DEVELOPMENT OR SITE PLAN
PERMIT unless otherwise stated in writing on the face of this permit by an authorized
representative of the Engineering Division .
5 . The applicant shall assume the responsibility for all maintenance , replacement or removal of
any right-of-way improvement authorized by this permit; and applicant further agrees by
acceptance of this permit to indemnify and save harmless the County, its officers, employees , or
agents, from any damages, claims, causes of actions, or losses whether for personal injury, loss .
of life or property damage, arising from the actions or omissions of applicant, its officers , agents ,
or employees, associated with the placement, maintenance or removal of installations authorized
by the permit. The applicant agrees to use all reasonable care under the given circumstances to
assure that members of the traveling public or not unreasonably inconvenienced nor endangered
by the activities conducted hereunder, including the use of reflectorized barriers, warning signals,
flagmen or other prudent measures as described in the Manual on Uniform Traffic Control Devices
( MUTCD) 2000 Edition , published by US Department of Transportation , Federal Highway
6 . The validity of this permit is contingent upon applicant obtaining necessary permits from any
other agencies having jurisdiction . Issuance of this permit does not relieve applicant of liability for
trespass to private property.
7 . The permit shall be considered a license only, for the limited purpose of installation , placement
and maintenance of the improvements specified on the face hereof, and does not convey any
other right, title , or interest of the County in the subject right-of-way property.
8 . Applicant agrees to remove or alter such installation without objection or cost to the County as
the County may direct, at any time and within a reasonable time after receipt of directions by the
County Engineer or his authorized representative .
9. Applicant is cautioned that electrical , water and sewer, or other installations or utilities may be
located within the construction area , and applicant shall use diligent efforts to first detect and
locate all such installations, and shall coordinate construction with all lawful users of said right-of-
way. Applicant shall be liable in every manner for all damages proximately resulting form its
interference with or interruption of services provided by other lawful right-of-way users .
10 . * In cases where a concrete driveway is to extend to a paved road , that portion of the driveway
from property line to edge of the road pavement shall be a minimum thickness of four inches for
residential , local roads only, all others will be six inches, as specified in Chapter 312 . 19(26) of the
County Right-of-way Ordinance. If road is unpaved concrete/asphalt driveway shall not extend
beyond the property line.
a ,
INDIAN RIVER COUNTY RIGHT-OF -WAY INFORMATION & FEE SCHEDULE
PERMIT/REVIEW TYPE FEE
STORMWATER TYPE C $ 100
SINGLE FAMILY ROW & DRAINAGE REVIEW ( PRIVATE) $45
SINGLE FAMILY ROW & DRAINAGE REVIEW ( PUBLIC ) $75
UTILITY ROW PERMIT $350
LAND DEVELOPMENT ROW PERMIT $550
COMMERCIAL ROW PERMIT $300
ADDITIONAL FEES
RE-INSPECTION AFTER 2 SITE VISITS - CHARGED AT AN HOURLY RATE
PLAN REVIEW AFTER 3rd RESUBMITTAL - CHARGED AT AN HOURLY RATE
� NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF
FLoaA�tsA" WATER MAIN EXTENSIONS FOR PWSs
INSTRUCTIONS : This notice shall be completed and submitted by persons proposing to construct projects permitted under the
" General Permit for Construction of Water Main Extensions for Public Water Systems" in Rule 62-555 .405 , F.A. C . AT LEAST 30
DAYS BEFORE BEGINNING CONSTRUCTION OF A WATER MAIN EXTENSION PROJECT, complete and submit one copy of
this notice to the appropriate Department of Environmental Protection (DEP) District Office or Approved County Health Department
(ACRD) along with payment of the proper permit processing fee . (When completed, Part 11 of this notice serves as the preliminary
design report for a water main extension project, and thus, it is unnecessary to submit a separate preliminary design report or drawings,
specifications, and design data with this notice .) All information provided in this notice shall be typed or printed in ink . The
DEP
permit processing fee for projects requiring the services of a professional engineer during design is $650, and the DEP permit
processing fee for projects not requiring the services of a professional engineer during design is $500. * Some ACHDs charge a county
permit processing fee in addition to the DEP permit processing fee. Checks for permit processing fees shall be made payable to the
Department of Environmental Protection or the appropriate ACRD. NOTE THAT A SEPARATE NOTIFICATION AND A
SEPARATE PERMIT PROCESSING FEE ARE REQUIRED FOR EACH NON -CONTIGUOUS PROJECT.t
* Except as noted in paragraphs 62-555. 520(3) (a) and (b), F. A . C. , projects shall be designed under the responsible charge of one or
more professional engineers licensed in Florida.
t Non-contiguous projects are projects that are neither interconnected nor located nearby one another (i. e. , on the some site, on
adjacent streets, or in the same neighborhood).
1 . General Project Information
A . Name of Project: 92" Court Waterline Extension
B . Description of Project and Its Purpose : Installation of 315 LF of 6" PVC water main and 500 LF of PVC for (2) 1 1 /2
" water
services lines with two residential meters to support private, residential connections for (2) homes.
C . Location of Project
1 . County Where Project Located : Indian River
2 . Description of Project Location : 92"d Court; Sebastian Florida
D . Estimate of Cost to .Construct Project: $ 13 ,000 . 00
E . Estimate of Dates for Starting and Completing Construction of Project: Start: July 2012 Completion : September 2012
F. Permittee
PWS/Company Name: N/A PWS Identification No. : *
PWS Type: * Communi Non-Transient Non-Community Transient Non-Community Consecutive
Contact Person : Mr. Jesse Roland I Contact Person's Title : Owner
Contact Person's Mailing Address: 7760 92 " Court
City: Sebastian State : Florida Zip Code : 32958
Contact Person's Telephone Number: 772-633 -9282 Contact Person's Fax Number:
Contact Person's E-Mail Address : captainsurfer2003 (@,yahoo . com
* This information is required only if the permittee is a public water system (PWS).
G . Public Water System (PWS) Supplying Water to Project
PWS Name: Indian River County Water Distribution System PWS Identification No. : 3314052
PWS Type: Communi Non-Transient Non-Comrnunity D Transient Non-Community Consecutive
PWS Owner: Indian River County Utilities
Contact Person : Mr. Gordon Sparks Contact Person's Title : Plans Reviewer
Contact Person's Mailing Address: 180127' Street
City: Vero Beach State : Florida Zi Code : 32960
Contact Person's Telephone Number: 772-226- 1823 Contact Person's Fax Number: 772470-5143
Contact Person's E-Mail Address : gsparks@,ircgov.com
DEP Form 62-555.900(7)Attemsfe Page I
Effective August 28, 2003
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Pro ' ect Name : 92nd Court Waterline Extension Permittee : N/A
H . Public Water System (PWS) that Will Own Project After It Is Placed into Permanent Operation
PWS Name : Indian River County Water Distribution System PWS Identification No. : * 3314052
PWS Type : * 0 Community Non-Transient Non-Community Transient Non-Community Consecutive
PWS Owner: Indian River County Utilities
Contact Person : Mr. Gordon Sparks Contact Person's Title : Plans Reviewer
Contact Person's Mailing Address : 180127" Street
City : Vero Beach State : Florida Zip Code: 32960
Contact Person's Telephone Number: 772-226- 1823 Contact Person's Fax Number: 772470-5143
Contact Person's E-Mail Address : gsparks(@,ircgov . com
* This information is required only if the owner/operator is an existing PWS.
I . Professional Engineer(s) or Other Person(s) in Responsible Charge of Designing Project *
Company Name : Mbv Engineering, Inc .
Designer(s) : Mr. Aaron J . Bowles, P. E . Title(s) of Designer(s) : Vice President
Qualifications of Designer(s) :
® Professional Engineer(s) Licensed in Florida — License Number(s) : 55313
❑ Public Officer(s) Employed by State, County, Municipal, or Other Governmental Unit of State
❑ Plumbing Contractor(s) Licensed in Florida — License Number(s): ^
Mailing Address of Designer(s) : 1835 20'h Street
City : Vero Beach State : Florida Zip Code : 32960
Telephone Number of Designer(s): 772-569-0035 Fax Number of Designer(s) : 772-778-3617
E-Mail Address(es) of Designer(s) : mbveng@mbveng. com
* Except as noted in paragraphs 62-555. 520(3) (a) and (b), F. A . C. , projects shall be designed under the responsible charge of one
or more professional engineers licensed in Florida.
t Attach a detailed construction cost estimate showing that the cost to construct this project is $ 10, 000 or less.
A Attach documentation showing that this project will be installed by the plumbing contractors) designing this project,
documentation showing that this project involves a public water system serving a single property and fewer than 250 fixture
units, and a detailed construction cost estimate showing that the cost to construct this project is $50, 000 or less.
11 , Preliminary Desian Report for 11roJect ,
A . Service Area, Water Use, and Service Pressure Information
I . Design Type and Number of Service Connections, and Average Daily Water Demands and Maximum-Day Water Demands, in
the Entire Area to Be Served by the Water Mains Being Constructed Under this Project:
? j Ry }r
a y� r5�a � xZ;*�rr da��s + C '�` ' "'�, ♦- 1 �4 ;� � S�` r i c3; ', t�.� � �s� °u
� J , ?�� a' � k�, � �' zr i � d :
R+ r �� �s „ `��,� �.��'���:�> "�hx��t`bl,�' s ” � �� " ' a�� r� i ` s�� 1`i iltl � $�t 5 '��'R � ���` �°
: ? a7a�1 y �nI ►C1r3'��'
A�q
:{ f � � 3 :� .. � �iA.�.>. Q "x^w .iiSA!>r. a *�. .�. t ,'T +>v!n Mvw,:, . ..b.< e ✓�stV A
% b'�. * T:)/1�v%" k" . 4..>
Sinple-Family Home 2 250 500 2 000
Mobile Home 0
Apartment 0
Commercial , Institutional, or Industrial Facility' ,
. Nlx . 500 2-000
a. Description of Commercial , Institutional, or Industrial Facilities and Explanation of Method(s) Used to Estimate Average
Daily Water Demand for These Facilities : Per IRCUD ERU rates = 250 gpd x 2 = 500 gpd
b. Explanation of Peaking Factor(s) or Method(s) Used to Estimate Maximum-Day Water Demand : Peak Factor = 4 x ADD
Peak Factor = 4 x 500 gpd = 2000 gpd
i
DEP Form 62.555.900(7)Alternate Page 2
Effective August 28, 2003
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Pro' ect Name : 92nd Court Waterline Extension I Permittee : N/A
2 . Explanation of Peaking Factor(s) or Method(s) Used to Estimate Design Peak-Hour Water Demand and , for Small Water
Systems that Use Hydropneumatic Tanks or that Are Not Designed to Provide Fire Protection, Peak Instantaneous Water
Demand : PHD = ADD x 4 / 24 hour = (500 x 4)/24 = 83 gph
J . Design Fire-Flow, Rate and Duration : 750 GPM for 4 hours
4 . Design Service Pressure Range : 50-60 psi
B . Project Site Information
1 . ATTACH A SITE PLAN OR SKETCH SHOWING THE SIZE AND APPROXIMATE LOCATION OF NEW OR ALTERED
WATER MAINS, SHOWING THE APPROXIMATE LOCATION OF HYDRANTS, VALVES, METERS, AND BLOW-
OFFS IN SAID MAINS, AND SHOWING HOW SAID MAINS CONNECT TO THE PUBLIC WATER SYSTEM
SUPPLYING WATER FOR THE PROJECT.
2 . Description of Any Areas Where New or Altered Water Mains Will Cross Above or Under Surface Water or Be Located in
Soil that Is Known to Be Aggressive : No known aggressive soils.
C . Information About Compliance with Design and Construction Requirements
I . if this project is being designed to comply with the following requirements, initial m ink before the requirements. If any of the
following requirements do not apply to this project or if this project includes exceptions to any of the following requirements as
allowed by rule, mark "X" before the requirements and complete Part II .C .2 below. RSWW = Recommended Standards for
Watt Works as incorporated into Rule 62-555 .330, F.A .C .
,(j 7 a. This project is being designed to keep existing water mains and service lines in operation during construction
�I or to minimize interruption of water service during construction. [RSWW 1 .3 . a; exceptions allowed under FAC 62-
A1 _ 555 . 330]
b. All pipe, pipe fittings, pipe joint packing and jointing materials, valves, fire hydrants, and meters installed
�— under this project will conform to applicable American Water Works Association (AWWA) standards. [FAC
62-555 .320(2 ) )(b), RSWW 8.0, and AWWA standards as incorporated into FAC 62-555 .330; exceptions allowed under FAC 62-
555 .320(21 )(c)]
c . All public water system components, excluding fire hydrants, that will be installed under this project and that
will come into contact with drinking water will conform to NSF International Standard 61 as adopted in Rule
62-555 .3351 F.A.C., or other applicable standards, regulations, or requirements referenced in paragraph 62-
555 . 320(3 )(b), F.A .C . [FAC 62-555 . 320(3)(b); exceptions allowed under FAC 6M55 .320(3)(d))
d . All pipe and pipe fittings installed under this project will contain no more than 8 .0% lead, and any solder or
flux used in this project will contain no more than 0 .2% lead. [FAC 62-555 .322]
e . All pipe and pipe fittings installed under this project will be color coded or marked in accordance with
subparagraph 62-555 .320(21 )(b)3 , F .A.C . , using blue as a predominant color. (Underground plastic pipe will
be solid-wall blue pipe, will have a co-extruded blue external skin, or will be white or black pipe with blue
stripes incorporated into, or applied to, the pipe wall ; and underground metal or concrete pipe will have blue
stripes applied to the pipe wall . Pipe striped during manufacturing of the pipe will have continuous stripes that
run parallel to the axis of the pipe, that are located at no greater than 90-degree intervals around the pipe , and
that will remain intact during and after installation of the pipe. If tape or paint is used to stripe pipe during
installation of the pipe, the tape or paint will be applied in a continuous line that runs parallel to the axis of the
pipe and that is located along the top of the pipe; for pipe with an internal diameter of 24 inches or greater, tape
or paint will be applied in continuous lines along each side of the pipe as well as along the top of the pipe.
Aboveground pipe will be painted blue or will be color coded or marked like underground pipe .) [FAC 62-
All 555 .320(21 )(b)3]
f. All new or altered water mains included in this project are sized after a hydraulic analysis based on flow
demands and pressure requirements . ATTACH A HYDRAULIC ANALYSIS JUSTIFYING THE SIZE OF
ANY NEW OR ALTERED WATER MAINS WITH AN INSIDE DIAMETER OF LESS THAN THREE
INCHES . [FAC 62=555.320(21 )(b) and RSWW 8. 1 ]
DEP Form 62.555.900(7)Altemate Page 3
Effective August 28, 2003 .
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Proiect me : 92nd Court Waterline Extension T Permittee : N/A
g. The inside diameter of new or altered water mains that are included in this project and that are being designed
to provide fire protection and serve fire hydrants will be at least six inches. [FAC 62-555 .320(21 )(b) and RSWW 8. 1
. 2]
Isis New or altered water mains that are included in this project and that are not being designed to carry fire flows
do not have fire hydrants connected to them . [FAC 62-555. 320(21 )(b) and RSWW 8. 1 . 5]
i . This project is being designed to minimize dead-end water mains by making appropriate tie-ins where
practical . [FAC 62-555 . 320(21 )(b) and RSWW 8. 1 .6.a]
j . New or altered dead-end water mains included in this project will be provided with a fire or flushing hydrant
or
blow-off for flushing purposes. [FAC 62 -555 . 320(21 )(b) and RSWW 8. 1 . 6. b]
!t v/ k. Sufficient valves will be provided on new or altered water mains included in this project so that inconvenience
and sanitary hazards will be minimized during repairs. [FAC 62-555 .320(21 )(b) and RSWW 8. 2]
_ I . New or altered fire hydrant leads included in this project will have an inside diameter of at least six inches
and
will include an auxiliary valve. [ FAC 62-555 .320(21 )(b) and RSWW 8 .3 .3]
m . All fire hydrants that will be installed under this project and that will have unplugged, underground drains will
be located at least three feet from any existing or proposed storm sewer, stormwater force main , pipeline
conveying reclaimed water regulated under Part III of Chapter 62-610 , F . A. C., or vacuum-type sanitary sewer;
at least six feet from any existing or proposed gravity- or pressure-type sanitary sewer, wastewater force main ,
or pipeline conveying reclaimed water not regulated under Part III of Chapter 62- 10, F.A .C. ; and at least ten
feet from any existing or proposed "on-site sewage treatment and disposal system . " [FAC 62-555 . 314(4)]
Xn . At high points where air can accumulate in new or altered water mains included in this project, provisions will
be made to remove the air by means of air relief valves, and automatic air relief valves will not be used in
situations where flooding of the valve manhole or chamber may occur. [FAC 62-555 . 320(21 )(b) and RSWW 8 .4 . 1 ]
o. The open end of the air relief pipe from all automatic air relief valves installed under this project will be
extended to at least one foot above grade and will be provided with a screened, downward-facing elbow. [FAC
62-555 .320(21 )( b) and RSWW 8 .4 .2]
p . New or altered chambers, pits, or manholes that contain valves, blow-offs, meters, or other such water
distribution system appurtenances and that are included in this project will not be connected directly to any
sanitary or storm sewer, and blow-offs or air relief valves installed under this project will not be connected
directly to any sanitary or storm sewer. [FAC 62-555 . 320(21 )(b) and RSWW 8.4.3]
q . New or altered water mains included in this project will be installed in accordance with applicable AWWA
standards or in accordance with manufacturers' recommended procedures. [FAC 62-555 .320(21 )(b), RSWW 8. 5 . ► , and
" 1� AWWA standards as incorporated into FAC 62-555.330]
)7 7 r. A continuous and uniform bedding will be provided in trenches for underground pipe installed under this
project; backfill material will be tamped in layers around underground pipe installed under this project and to a
sufficient height above the pipe to adequately support and protect the pipe ; and unsuitably sized stones (as
described in applicable AWWA standards or manufacturers' recommended installation procedures) found in
trenches will be removed for a depth of at least six inches below the bottom of underground pipe installed
under this project. [FAC 62-555 .320(21 )(b), RSWW 8.5 .2]
s . All water main tees, bends, plugs, and hydrants installed under this project will be provided with thrust blocks
or restrained joints to prevent movement. [FAC 62-555 .320(21 )(b) and RSWW 8 .5.4]
t. New or altered water mains that are included in this project and that will be constructed of asbestos-cement or
polyvinyl chloride pipe will be pressure and leakage tested in accordance with AWWA Standard C603 or
C605, respectively, as incorporated into Rule 62-555 .330, F .A.C ., and all other new or altered water mains
included in this project will be pressure and leakage tested in accordance with AWWA Standard C600 as
incorporated into Rule 62-555 .330 . [FAC 62-555 .320(21 )(b) 1 and AWWA standards as incorporated into FAC 62-555 . 330]
u . New or altered water mains, including fire hydrant leads and including service lines that will be under the
control of a public water system and that have an inside diameter of three inches or greater, will be disinfected
and bacteriologically evaluated in accordance with Rule 62-555 .340, F .A. C . [FAC 62-555 .320(21 )(b)2 and FAC 62-
555 .340)
v. New or altered water mains that are included in this project and that will be installed in areas where there are
known aggressive soil conditions will be protected through use of corrosion-resistant water main materials,
through encasement of the water mains in polyethylene, or through provision of cathodic protection . [FAC 62-
555 .320(21 )(b) and RSWW 8. 5 . 7.d]
DEP Form 62-555.900(7)A1temato Page 4
Effective August 28, 2003
NOTfCE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Proiect Name : 92nd Court Waterline Extension I Permittee : N/A
w. New or relocated, underground water mains included in this project will be laid to provide a horizontal distance
of at least three feet between the outside of the water main and the outside of any existing or proposed vacuum-
type sanitary sewer, storm sewer, stormwater force main , or pipeline conveying reclaimed water regulated
under Part III of Chapter 62-610, F. A .C . ; a horizontal distance of at least six feet between the outside of the
water main and the outside of any existing or proposed gravity4ype sanitary sewer (or a horizontal distance of
at least three feet between the outside of the water main and the outside of any existing or proposed gravity- .
type sanitary sewer if the bottom of the water main will be laid at least six inches above the top of the sewer); a
horizontal distance of at least six feet between the outside of the water main and the outside of any existing or
proposed pressure-type sanitary sewer, wastewater force main, or pipeline conveying reclaimed water not
regulated under Part III of Chapter 62-610, F.A .C . ; and a horizontal distance of at least ten feet between the
outside of the water main and all parts of any existing or proposed " on-site sewage treatment and disposal
system . " [FAC 62-555 .314( 1 ); exceptions allowed under FAC 62-555 .314( 5 )]
x . New or relocated, underground water mains that are included in this project and that will cross any existing or
proposed gravity- or vacuum-type sanitary sewer or storm sewer will be laid so the outside of the water main is
at least six inches above the other pipeline or at least 12 inches below the other pipeline; and new or relocated ;
underground water mains that are included in this project and that will cross any existing or proposed pressure-
type sanitary sewer, wastewater or stormwater force main, or pipeline conveying reclaimed water will be laid
so the outside of the water main is at least 12 inches above or below the other pipeline. [FAC 62-555 .314(2);
exceptions allowed under FAC 62-555 .314(5)1
y . At the utility crossings described in Part II .C . 1 .w above, one full length of water main pipe will be centered
above or below the other pipeline so the water main joints will be as far as possible from the other pipeline or
the pipes will be arranged so that all water main joints are at least three feet from all joints in vacuum-type
sanitary sewers, storm sewers, stormwater force mains, or pipelines conveying reclaimed water regulated under
Part III of Chapter 62-610, F.A .C . , and at least six feet from all joints in gravity- or pressure-type sanitary
sewers, wastewater force mains, or pipelines conveying reclaimed water not regulated under Part Ill of Chapter
62-6105 F.A.C. [FAC 62-555.314(2); exceptions allowed under FAC 62-555 .314(5)]
z. New or altered water mains that are included in this project and that will cross above surface water will be
adequately supported and anchored, protected from damage and freezing, and accessible for repair or
replacement. [FAC 62-555 .320(21 )(b) and RSWW 8. 7. 11
aa. New or altered water mains that are included in this project and that will cross under surface water will have a
minimum cover of two feet. [FAC 62-555 .320(21 )(b) and RSWW 8.7.2]
A4 bb. New or altered water mains that are included in this project and that will cross under surface water courses
greater than 15 feet in width will have flexible or restrained, watertight pipe joints and will include valves at
both ends of the water crossing so the underwater main can be isolated for testing and repair; the
aforementioned isolation valves will be easily accessible and will not be subject to flooding; the isolation valve
closest to the water supply source will be in a manhole ; and permanent taps will be provided on each side of the
isolation valve within the manhole to allow for insertion of a small meter to determine leakage from the
underwater main and to allow for sampling of water from the underwater main . [FAC 62-555 .320(21 )(b) and RSWW
8.7 .2]
cc . This project is being designed to include proper backflow protection at those new or altered service
connections where backflow protection is required or recommended under Rule 62-555 .360, F.A.C. , or in
Recommended Practice for Backflow Prevention and Cross-Connection Control, AWWA Manual M 14, as
incorporated into Rule 62-555 . 330 , F.A .C. ; or the public water system that will own this project after it is
placed into operation has a cross-connection control program requiring water customers to install proper
backflow protection at those service connections where backflow protection is required or recommended under
Rule 62-555 . 360, F .A .C . , or in AWWA Manual M14 . [FAC 62-555 .360 and AWWA Manual M14 as incorporated into
FAC 62-555 .330]
dd. Neither steam condensate, cooling water from engine jackets, nor water used in conjunction with heat
exchangers will be returned to the new or altered water mains included in this project. [FAC 62-555 .320(21 )(b) and
RSWW 8. 8 .2]
DEP Form 62-555;900(7)Altemate Page 5
Effective August 28, 2003
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Proiect Name : 92nd Court Waterline Extension Permittee : N/A
2 . Explanation for Requirements Marked "X" in Part II . C . 1 Above, Including Justification, Documentation , Assurances, and/or
Alternatives as Required by Rule for Exceptions to Requirements in Part II .C . 1 : 1 & in : No fire hydrants to be installed .
ii-p : No air release valves : v : No known aggressive soils z: No stream crossings
as & bb : No underwater crossings . dd: No heat exchangers .
1 completed Part Il of this notice, and the information provided in Part 11 and on the attachment(s) to Part 11 is true and
accurate to the
best of my knowledge and belief.
Signature, Seal , and Date of Professional Engineer (PE) or Signature, Seal , and Date of Professional Engineer (PE) or
Signature and Date of Other Person in Responsible Charge of Signature and Date of Other Person in Responsible Charge of
Designing Project: * Designing Project: *
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Printed/Typed Name : Mr. Aaron J . Bowles, P.E . Printed/Typed Name :
License Number of PE or License Number or Title of Other License Number of PE or License Number or Title of Other
Person in Responsible Charge of Designing Project: * 55313 Person in Responsible Charge of Designing Project: *
Portion of Preliminary Design Report for Which Responsible: Portion of Preliminary Design Report for Which Responsible:
Entire Project
* Except as noted in paragraphs 62-555. 520(3) (a) and (b), F. A. C. , projects shall be designed under the responsible charge of one or
more PEs licensed in Florida. If this project is being designed under the responsible charge of one or more PEs licensed in
Florida, Part 11 of this notice shall be completed, signed, sealed, and dated by the PE(s) in responsible charge. If this project
is not
being designed under the responsible charge of one or more PEs licensed in Florida, Part II shall be completed, signed, and dated
by the person(s) in responsible charge of designing this project.
DEP Form 6M55.9D0(7)A1lemate Page 6
Effective August 28, 2003 _,
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Proiect Name : 92nd Court Waterline Extension Permittee: N/A
A . Certification by Permittee
I am duly authorized to sign this notice on behalf of the permittee identified in Part I . F of this notice. I certify that, to
the best of
my knowledge and belief, this project complies with Chapter 62-555 , F.A.C . 1 also certify that construction of this project has
not
begun yet and that, to the best of my knowledge and belief, this project does not include any of the following construction work :
• construction of water mains conveying raw or partially treated drinking water;
• construction of drinking water treatment, pumping, or storage facilities or conflict manholes ;
• construction of water mains in areas contaminated by low-molecular-weight petroleum products or organic solvents;
• construction of an interconnection between previously separate public water systems or construction of water mains that create
a " new system " as described under subsection 62 -555 . 525 ( 1 ), F . A .C . ; or
• construction of water mains that will remain dry following completion of construction .
(A specific construction permit is required for each project involving any of the above listed construction work. )
I understand that, if this project is designed under the responsible charge of one or more professional engineers ( PEs) licensed
in
Florida, the permittee must retain a Florida-licensed PE to take responsible charge of inspecting construction of this project for the
purpose of determining in general if the construction proceeds in compliance with the Department of Environmental Protection
construction permit, including the approved preliminary design report, for this project. I understand that the permittee must have
complete record drawings prepared for this project. I also understand that the permittee must submit a certification of construction
completion to the Department and obtain w tten approval , or clearance, from the Department before the permittee places this
project int eration for y p ose of than disinfection or testing for leaks .
XMr. Jesse Roland owner
Signa and Date Printed or Typed Name Title
B . Certification by PWS Supplying Water to Project
1 am duly authorized to sign this notice on behalf of the PWS identified in Part I .G of this notice . I certify that said
PWS will
supply the water necessary to meet the design water demands for this project. As indicated below, the water treatment plant(s) to
which this project will be connected has(have) the capacity necessary to meet the design water demands for this project, and I
certify that all other PWS components affected by this project also have the capacity necessary to meet the design water demands
for this project. I certify that said PWS is in compliance with applicable planning requirements in Rule 62-555 .348 , F.A . C.
;
applicable cross-connection control requirements in Rule 62-555 .360, F.A .C . ; and to the best of my knowledge and belief, all other
applicable rules in Chapters 62-550, 62-555 , and 62-699, F.A .C. ; furthermore, I certify that, to the best of my knowledge and
belief, said PWS's connection to this project will not cause said PWS to be in noncompliance with Chapter 62-550 or 62-555 ,
F .A .C . I also certify that said PWS has reviewed the preliminary design report for this project and that said PWS considers the
connection(s) between this project and said PWS acceptable as designed.
• Name(s) of Water Treatment Plant(s) to Which this Project Will Be Connected: Indian River County North/South Water
Treatment Facility
• Total Permitted Maximum Day Operating Capacity of Plant(s), gpd : ILI . 2
q MCd
• Tot I Maximum Day Flow at Plant(s) as Recorded on Monthly Operating Reports uring Past 12 Months, gpd : q m
� /,Mr. Gordon Sparks ENVIRONMENTAL ENGINEER
Si nature and Date Printed or Typed Name Title
C . Certification by PWS that Will Own Project After It Is Placed into Permanent Operation
I am duly authorized to sign this notice on behalf of the PWS identified in Part LH of this notice. I certify that said PWS
will own
this project after it is placed into permanent operation . I also certify that said PWS has reviewed the preliminary design report
for
this roject a that sai WS consi ers this ' ect acceptable as designed.
2— Mr. Gordons arks ENVIRONMENTAL ENGINEER
Signature and Date Printed or Typed Name Title
DEP Form 62-555.900(7)Atternate Page 7
Effective August 28, 2003
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Proiect Name : 92nd Court Waterline Extension Permittee : N/A
D. Certification by Professional Engineer(s) in Responsible Charge of Designing Project*
1 , the undersigned professional engineer licensed in Florida, am in responsible charge of designing this project. I certify that,
to the
best of my knowledge and belief, the design of this project complies with Chapter 62-555 , F.A.C . 1 also certify that, to the best
of
my knowledge and belief, this project is not being designed to include any of the following construction work:
• construction of water mains conveying raw or partially treated drinking water;
• construction of drinking water treatment, pumping, or storage facilities or conflict manholes;
• construction of water mains in areas contaminated by low-molecular-weight petroleum products or organic solvents ,
• construction of an interconnection between previously separate public water systems or construction of water mains that create
a "new system " as described under subsection 62-555 . 525 ( 1 ), F . A .C . ; or
• construction of water mains that will remain dry following completion of construction .
(A specific construction permit is required for each project involving any of the above listed construction work.)
Signature , Seal , and Date: Signature , Seal , and Date :
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NSF
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55313
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Printed/T ed Name: WIMM"IT 13owles, P.E. Printed/Typed Name:
License Number: 55313 - License Number:
Portion of Preliminary Design Report for Which Responsible: Portion of Preliminary Design Report for Which Responsible :
Entire Project
* Except as noted in paragraphs 62-555. 520(3) (a) and (b), F.A . C. , projects shall be designed under the responsible charge of one
or more professional engineers (PEs) licensed in Florida. If this project is being designed under the responsible charge of one
or more PEs licensed in Florida, Part IIID of this notice shall be completed by the PE(s) in responsible charge. If this project
is not being designed under the responsible charge of one or more PEs licensed in Florida, Part Ill. D does not have to be
completed.
DEP Form 62-555.900(7)AUternate Page 8
Effective August 28. 2003
INDIAN RIVER COUNTY
DEPARTMENT OF UTILITY SERVICES
MAJOR USER WASTEWATER AND/OR WATER
UTILITIES CONSTRUCTION PERMIT
APPLICATION FORM
A. APPLICANT
NAME Mr. Jesse Roland
ADDRESS 776092 nd Court
CITY Sebastian STATE FL ZIP 32958
TELEPHONE 772-633-9282
B . OWNER/AUTHORIZED REPRESENTATIVE ( IF DIFFERENT FROM APPLICANT)
NAME SAME AS APPLICANT
ADDRESS
CITY STATE ZIP
TELEPHONE
C . PROJECT
PROJECT NAME 92nd Court Waterline Extension
PARCEL ID 31 -38-34-00008-0100-00005.0 & 0020-00013 .0
LEGAL DESCRIPTION See plan for legal description
TYPE OF PROJECT Waterline extension
HOURS OF OPERATION NIA
ANTICIPATED CONSTRUCTION SCHEDULE START July 2012
COMPLETION September 2012
HAS PROJECT BEEN REVIEWED BY PLANNING BOARD , PRE-APPLICATION AND
TECHNICAL REVIEW COMMITTEES YES NO X
PRE-APPLICATION AND/OR PROJECT No. ASSIGNED BY PLANNING BOARD
NIA
ALL PROJECTS WILL REQUIRE AN ENGINEERING REPORT SUBMITTED WITH THE
UTILITY APPLICATION PERMIT DEFINING THE PROPOSED PROJECT' S I CT ON THE
INDIAN RIVER COUNTY DEPARTMENT OF UTILITY SERVICE SYSTEM II► (initial)
` 1
THE SCOPE OF THE ENGINEERING REPORT SHALL BE DEPENDENT ON THE
COMPLEXITY OF THE PROPOSED PROJECT FOLLOWING CUSTOMARY ENGINEERING
STANDARDS , GUIDELINES WILL BE MADE ILABLE AT THE INDIAN RIVER COUNTY
DEPARTMENT OF UTILITY SERVICESYL ( initial )
D . METHOD(S ) OF FLOW DERIVATION ( CHECK APPROPRIATE LINE( S ))
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( X ) EQUIVALENT RESIDENTIAL UNIT DETERMINATION TABLE
( ) SPECIFIC REQUIREMENTS FOR INDIVIDUAL USE
( ) EXISTING FACILITY/PREVIOUS RECORDS
1 . ERU DETERMINATION TABLE ( COPY ATTACHED)
TYPE OF ESTABLISHMENT Residential
SQUARE FEET. 2 homes
APPLICABLE " UNITS" 2
WATER :
PROJECTED FLOW:2X X 250 GALLONS/DAY = 500 GPD (ADF)
( ERUs)
WASTEWATER :
PROJECTED FLOW: NIA X 250 GALLONS/DAY = 0 GPD (ADF)
( ERUs)
2 . SPECIFIC INDUSTRIAL USE:
TYPE(S) OF USE NIA
WATER
PROJECT FLOW:
WASTEWATER :
PROJECT FLOW:
3 . EXISTING FACILITY / PREVIOUS RECORDS :
THE INDIAN RIVER COUNTY UTILITIES DEPARTMENT MAY CONSIDER PAST RECORDS IF
AN EXISTING OPERATIONAL FACILITY FOR DETERMINING PROPOSED FLOW
REQUIREMENTS FOR A NEW DEVELOPMENT , PROVIDED THE APPLICANT SUBMITS
SUFFICIENT INFORMATION TO ALLOW THE DEPARTMENT TO DETERMINE ANTICIPATED
FLOW. THIS INFORMATION SHALL INCLUDE , BUT NOT BE LIMITED TO TWENTY-FOUR
MONTHS OF PREVIOUS WATER BILLS AND A COMPLETE LISTING OF THE DIFFERENCES
IN THE EXISTING AND PROPOSED FACILITY SUCH AS SIZE, HOURS OF OPERATION ,
TYPE OF USES , NUMBER OF EMPLOYEES, ETC .
2
E . GENERAL
ADDITIONAL WATER FLOW ANTICIPATED FOR PROJECT PHASING , BUT NOT REQUESTED
( ESTIMATED) NIA
ADDITIONAL WASTEWATER FLOW ANTICIPATED FOR PROJECT PHASING , BUT NOT
REQUESTED
( ESTIMATED) NIA
HIGH STRENGTH WASTE - YES" NO X
IF YES , COMPLETE AN INDUSTRIAL WASTE PERMIT APPLICATION
B O D ( BIOCHEMICAL OXYGEN DEMAND)
SS ( SUSPENDED SOLIDS )
PHOSPHORUS
F. OTHER REQUIREMENTS
1 , WILL THE DEVELOPMENT UTILIZE THE FOLLOWING?
RETROFIT EXISTING PLUMBING FIXTURES WITHWATER SAVING
DEVICES YES X NO
IRRIGATION REUSE SYSTEMS YES X NO
IF YES, PLEASE ATTACH A STATEMENT CERTIFIED BY A PROFESSIONAL ENGINEER
REGISTERED IN THE STATE OF FLORIDA INDICATING THE EXTENT OF SAVINGS, TO
INCLUDE SUPPORTING THE DOCUMENTED HISTORICAL DATA.
PLEASE NOTE. MANUFACTURER'S LITERATURE IS NOT ADEQUATE.
1 ZONING
EXISTING ZONING ON PROPERTY TO BE DEVELOPED RS4
IS EXISTING ZONING APPROPRIATE FOR PROPOSED DEVELOPMENT?
X YES NO
3 . PLATTING
IS THE PROPERTY PLATTED APPROPRIATELY TO SUPPORT THE PROPOSED
DEVELOPMENT YES NO
IF YES , PLEASE INDICATE PLAT BOOK AND PAGE NUMBER
PLAT BOOK PAGE
4 . FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
IS WATER OR SEWER EXTENSION REQUIRED? XYES NO
IF YES , THE APPLICANT MUST OBTAIN THE REQUIRED FDEP PERMIT PRIOR TO
THE ISSUANCE OF A COUNTY PERMIT
3
5 . SITE PLAN
YOU ARE REQUIRED TO SUBMIT A SITE PLAN INCLUDING ANY ON OR OFF-SITE
SANITARY SEWER OR POTABLE WATER LINE CONSTRUCTION AND THE POINT
OF CONNECTION TO THE COUNTY' S EXISTING SANITARY WATER OR SEWER
SYSTEM .
6 . ITEMS SUBMITTED WITH CHECKLIST
X PROPERTY APPRAISER' S MAP/EQUIVALENT ( FOR LOCATION )
X SITE PLAN ( REQUIRED)
X BUILDING PLANS
X FDEP PERMIT APPLICATION WITH ; CONSTRUCTION PLANS AND
SPECIFICATIONS
7 . SEE ATTACHED PROJECT CHECKLIST OF ITEMS REQUIRED FOR FINAL PROJECT C .O.
SIGNED DATE !
PRINT OR TYPE Mr. Jesse Roland , owner
APPLICANT: NAME AND TITLE
4