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Home My WebLink AboutSewage�CflE r o� STATE OF FLORIDA DEPARTMENT OF HEALTH PERMIT NO. DATE PAID: 3 ' ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: sir 4z*a2 SYSTEM RECEIPT n: APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [�] New System ( ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: SOS IC AGENT: _�iA J] D G-pLDTN TELEPHONE: MAILING ADDRESS: U(9< 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: BLOCK: SUBDIVISION: PLATTED: PROPERTY ID '#: i 31-j 131 ` 000 y- 000 -y0 ZONING: 1� 5-1_ I/M OR EQUIVALENT: [ Y/N ] /// PROPERTY SIZE: +�%I ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC PC ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /69 ) DISTANCE TO SEWER: FT �jp PROPERTY ADDRESS: 1 /CEO 0, P, exze- 3`�e15( DIRECTIONS TO PROPERTY: !U o vot-- 'Q-o P, BUILDING INFORMATION 'To W e7t 7-o I�Cj RESIDENTIAL [ ] COMMERCIAL Cg- Unit Type of No. of Building Commercial/Institutional System Design No Establishmennt,, Bedrooms ,000ms Area/Sgft Table 1, Chapter 64E-6,. FAC 1 S% A%� �'1'JJ�'� r I z- / T -1 2 3 4 [ ] Floc SIGNATURE: [ /] Other (Specify) DATE: DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: u:56-SF-2044288 BILL DOG #:56-BID-4564162 CONSTRUCTION APPLICATION#AP1471042 RECEIVED FROM: Dave Golden Homes AMOUNT PAID: $ 545.00 PAYMENT FORM: CHECK 27122 PAYMENT DATE: 03/03/2020 MAIL TO: Joseph Moore FACILITY NAME: PROPERTY LOCATION: 4920 Conley PI Fort Pierce, FL 34951 Lot: Block: Property ID: 1313-131-0009-000-0 EXPLANATION or DESCRIPTION: 128 - OSTDS Construction System Inspection Research Fee -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge -1'- OSTDS Construction Application and Plan Review,New 123 - OSTDS Construction Site Evaluation 126 - OSTDS Construction Permit (New or Mod, Amendment) 127 - OSTDS Construction System Inspection 133 - OSTDS Construction Reinspection QUANTITY FEE 1 $ 5.00 1 $ 45.00 1 $ 100.00 1 $ 100.00 1 $ 115.00 1 $ 55.00 1 $ 75.00 1 $ 50.00 RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-4303814 StTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: CONTRACTOR / AGENT: Moore Dave Golden Homes LOT: BLOCK: SUBDIVISION: ID#:1313-131-0009-000-0 APPLICATION # AP1471042 PERMIT # 56-SF-2044288 DOCUMENT # SE1268636 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: 0.51 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 1275.02 GALLONS PER DAY I 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Oranqe spot an fire hydrant pad N of system. ELEVATION OF PROPOSED SYSTEM SITE 5.00 I INCHES]/ FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [ ]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 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 [ MEL / NGVD ] SITE ELEVATION: FT I MSL / NGVD RnTT. RRnFTT.R TN RMATTON ATW.. T SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 4/1 Sand 0 To 7 10YR 5/2 Sand 7 To 21 1OYR 6/1 Sand 21 To 28 1 OYR 2M Spodic Material 28 To 34 1OYR 4/3 Fine Sand 34 To 40 1OYR 514 Fine Sand 40 To 45 1 OYR 6/3 Sand 45 To 60 1 OYR 413 Sand 60 To 72 USDA SOIL SERIES: Munsell #/Color Texture Depth 1 OYR 4/2 Sand 0 To 6 1 OYR 512 Sand 6 To 23 1 OYR 612 Sand 23 To 31 1OYR 2/2 , Spodic Material 31 To 37 7.5YR 4/3 Fine Sand 37 To 44 10YR 4/4 Fine Sand 44 To 51 1OYR 6/3 Fine Sand 51 To 72 OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW]] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 21 INCHES [ ABOVE / EELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES EX ]NO MOTTLING: [X]YES [ ]NO DEPTH: 21.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) r REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. 10YR6/1 stripping In a IOYR512 matrix>10% with diffuse boundaries starting at 21" in SB1. RR1 B" hnlnw RM_ SR21" hnlnw RM_ A SITE EVALUATED BY: Ingram, Brian (Titlenvironmentat Specialist II) (ENVIRONMENTAL HEALTH) DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC 37 INCHES DATE: 03/16/2020 Page 3 of 4 AP1471042 EID2044288 v 1.0.2 0 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: APPLICANT: JOSeoh Moore PROPERTY ADDRESS: 4920 C LOT: BLOCK: OSTDS New PI Fort Pierce. FL 34951 SUBDIVISION: PERMIT #:56-SF-2044288 APPLICATION #:AP1471042 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1319196 PROPERTY ID #: 1313-131-0009-000-0 [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 [ 900 ] GALLONS / GPD Seotic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D, [ 375 ] SQUARE FEET Drainfield new SYSTEM R[ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND I -CONFIGURATION: [X] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: Orange Spot On fire hydrant pad N Of system. I ELEVATION OF PROPOSED SYSTEM SITE [ 5.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 2.00 ][INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D E 0 T H E R k Wular:U: L L I.UUJ INCHES EXCAVATION REQUIRED: t JJ.UU J INUN b system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of gpd. SPECIFICATIONS BY: Brian J Ingram TIC' Environmental Specialist APPROVED BY:TITLE: Environmental Specialist II Brian J Inr DATE ISSUED: 03/20/2020 EXPIRATION DATE: DE 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC II St. Lucie CHD 09/20/2021 Page 1 of 3 v 1.1.4 A 1471042 SE1268636 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order.