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HomeMy WebLinkAboutBuxton health dept permitSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Timothy and Lacey Buxton PROPERTY ADDRESS: 470 WOodcrest Fort Pierce, FL 34945 LOT: BLOCK: SUBDIVISION: PROPERTY ID #: PERMIT 4:56-SF-2085739 APPLICATION #: AP1506109 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1376123 [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 SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic New CAPACITY A [ ] GALLONS / GPD NIA CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANI{:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 375 ] SQUARE FEET Drainfield New SYSTEM R [ ] SQUARE FEET NIA SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] MOUND [ ] I CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: top of IR SE property corner I ELEVATION OF PROPOSED SYSTEM SITE [ 3.00 ][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE f ux) ][ INCHES FT ][ ABOVE BELOW]BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [21.001 INCHES EXCAVATION REQUIRED: [ 15.001 INCHES r30he system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 00 gpd. T H E R SPECIFICATIONS BY: Brian J Ingram TITLE. Environmental Specialist TI APPROVED BY:TITLE: Envi . r . onmental Specialist I Hunter Co iier DATE ISSUED: 07/02/2020 EXPIRATION DATE: - DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 AP1.506105 SE1314933 St. Lucie CHD 01/02/2022 Page 1 of 3 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. St. Lucie County Health Department ri 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: #:56-SF-2085739 BILL Uoc#:56-BID-4704111 CONSTRUCTION APPL!CATION#:AP1506109 RECEIVED FROM: Trefelner Construcion Inc. AMOUNT PAID: $ 660.00 PAYMENT FORM: CHECK 2131 PAYMENT DATE: 05/26/2020 MAIL TO: Timothy and Lacey Buxton FACILITY NAME : PROPERTY LOCATION 470 Wooderest Fort Pierce, FL 34945 Lot: Block: Property ID: EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 1 $ 45.00 -1 - OSTDS New Permit Surcharge 1 $ 100.00 -1 - OSTDS Construction Application and Plan Review,New 1 $ 100.00 123 - OSTDS Construction Site Evaluation 1 $ 115.00 126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127 - OSTDS Construction System Inspection 1 $ 75.00 133 - OSTDS Construction Reinspection 1 $ 50.00 -1 - Well Construction 1 $ 115.00 RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-4416296 STATE OF FLORIDA PERMIT NO. � � � � DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: C N SYSTEM RECEIPT # : APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: New System [ ] Existing System [ ] Holding Tank [ ] Innovative I ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: Timothy and Lacey Buxton AGENT: James Trefelner TELEPHONE : 772-201-9833 MAILING ADDRESS. 1760 Copenhaver Rd Fort Pierce, F134945 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: 11 BLOCK: B SUBDIVISION: Orange Park PLATTED: PROPERTY ID # : 2308-501-0024-000-3 ZONING. AR-1 I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 1-04 ACRES WATER SUPPLY: [�/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 470 Woodcrest Dr DIRECTIONS TO PROPERTY: see attached map BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sgft Table I, Chapter 64E-6, FAC 1 guesthouse 3`� �. �- 2 3 4 [ ] Floor/Equipment Drains [ ,(] Other (Specify) Garbage grinders/Disposals w� SIGNATURE. / DATE: 5/25/2020 DH 4015, OS 9 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Timothy and Lacey Buxton CONTRACTOR / AGENT: Trefeiner Construcion Inc. LOT SUBDIVISION: ID# BLOCK: APPLICATION # QP1506109 PERMIT # 56-SF-2085739 DOCUMENT # SE1314833 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: [XIYES [ ]NO NET USABLE AREA AVAILABLE: ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES-TABLEI / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 1559.99 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 750.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: top of IR SF property Corner ELEVATION OF PROPOSED SYSTEM SITE 3.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 75 FT DITCHES/SWALES: 75 FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 29 FT POTABLE WATER LINES: 100+ FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: Ti+ T#TL+r1 tAATTnWT CTrPW i [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO) FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 312 Sandy Loam 0 To 7 1 OYR 413 Sandy Ciay Loam 7 To 15 10YR 412 Loamy Sand 15 To 36 10YR 5/2 Sand 21 To 49 10YR 5/1 Sandy Clay Loam 49 To 60 REFUSAL Refusal 60 To 72 r-�ia M�1TTllAI CT7177 •i USDA SOIL SERIES: Munsell #/Color Texture Depth 10YR 312 Sandy Loam 0 To B 10YR 4/2 Sandy Clay Loam 7 To 16 10YR 4/2 Loamy Sand 16 To 40 10YR 5/2 Sand 21 To 49 1OYR 511 Sandy Clay Loam 49 To 60 REFUSAL Refusal 60 To 72 OBSERVED WATER TABLE: 40.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: ESTIMATED WET SEASON WATER TABLE ELEVATION: 21 INCHES [ ABOVE / BSI.OW ] HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [X ] TRENCH [ — REMARKS/ADDITIONAL CRITERIA ] BED [ PERCHED / APPARENT ] EXISTING GRADE DEPTH: 21,00 INCHES Sand/0,80 DEPTH OF EXCAVATION: [ ] OTHER (SPECIFY) WSWT determined using USDA WSS and soil borings. 10YR 612 stripping in 10YR 412 matrix > 10% with diffuse boundaries starting at 21" in SB1. SB1 3" above BM. SB2 3" above BM. SITE EVALUATED BY: �[ � A � +} Ingram, Brian (Tit e. Environmental Specialist II) (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (ohsoletes previous editions which may not be used) Incorporated: 64E-5.001, FAC AP'1506109 EID2086739 15 INCHES DATE: 06/25/2020 Page 3 of 4 v 1.0.2 'YC-5 STATE OF FLORIDA PERMi'TAPPLICATION To CONSTRUCT, Permit Na. F69-3D698 REPAIR, MODIFY, OR ABANDON A WELL Permi( Unique ID ! ❑ Southwest PLEASE RLL OVT AI_LAPPI (CABLE FIELDS D Northwest . CDenotes Required Fields Where AppliCWC) Permit Stipulations Required (See Attached) ❑ St. Johns River flrewaferyxiicontmaerisresponsible for completing 0 South Roddy Delineation No. ifils Torm and forwarding lies permit application to the 52-524 Quad No. ❑ Suwannee River appropriate dekogafed authority vrhefe ap9r-able. CUPPNUP Application N.0 D DEP Ei Delegated Authority (If Applicable) . • �. e . - a ! F - Pielr�e R 3 - ~State 'ZIP `'Telephone Number sWeli Location - Address, �o lName or l�lumt�er, i:tC� 11 '� Stock Unik 3. =Parcelll]Na_(PiN)orAlternateKey[CircleOne) �� L�LCt� �1(Q,yt Q, (�CJI� of Cheek if 62-624: J„ Yes 7� No 4. 'Section o ;Land Grartt Townhip "Range 'County� Subdivision y zq �� �t mw ili,ams W Uj a WlSouih e 5. 1-1'm VA t.tl+fi yr 1 _ _ License Number *Telephone Number E-mail Address L 3� b Water Nlell Contractor ltU5 lmm o kelee 116 • Fatter ?tc+rte State ZIP F, � rtw -- . 7, "Type of Work: �_ Construction Repair Modification �Abandanmen ,R,ason for Repair, ModificzWrl, or ec Date.Stamp I 8. 'Number of Proposed Wells --, ­ 9. `Specify intended Use(s) of Weil(s): ��„ , , _Landscape Irrigation AgrieulturaE lrngation Site Investigation {�I : L � �L,2fy point 5tic LivestockMonitoring �} W tl t Bottled Water Supply ,Recreation Area It —Nursery Irrigation Test Public Water Supply (Limited Use1DOH) Cammercisllindustrial Earth-Coup€ed Geo#hernial Public Water Supply (Community or Non-Commun'ttyfDEP) : Golf Course Irrigation ­HVAC Supply Ft OH in Se. Lucie COLM HVAC Return _Class t Injection Eli 1ROf� IOE iw1TAL. H&AL= Class V Injection: Recharge CommerctaVlndustrial Disposal ____Aquifer Storage and Recovery _Drainage Official Use Only Remediation: _Recovery Alr 5parge other (oescrlbr} Other (Desuibe) (Note: Net alltypesof wells are permitted by a g!van Fermining authority) 11_Facili Qescri tipn 1712.EstimatedStart Date i 1©'Distance from Septic System If s20U ft. Facility p Diamefer. sn. Open Hole: From To ft, 18." Estimated Well Depth ��•� ft_ 'Esfsmatod Casing Depth ft. =PrimCasing g 14. Estimated Screen Interval: From A a0 Ta 15."Primary Casing Material: Buck Steel Galvanized PVC Stainless Steel 3VotCa5ed Other: 16. Secondary Casing: Telescope Casing Liner surface Casing diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel / Other Sonic Au er Cable Toot Jetted ✓ Rotary 18 Method of Construction, Repair, or Abandonment: Eland Drigven (Well Point. Sand Paint) Hydraulic Po€nt (Direct Push) Combination (Two or More Methods) Horizontal DAlling Plugged by Approved Method Other (Describe? 19. Proposed Grouting Interval for the Primary, Secondary, and Additionai Casing: From To Sea! Material (._Bentonite Meat Cement Other From To Seat Material L—Bentonite Neat Cetrlent Other From To Seal Material [__-.:__Bentonite Neat Cement Other Frarrt To Seat Materlat t Sentonite - NeatCement Outer 2i7. Indicate total number of existing wells on site List number of existing unused Wells On 5jt0 21. "1s this well or any existing well orwater withdrawal. on the owner's contiguous property covered under a Consumptiveater useI�Use Per it (CUPMJUP) Districto. or CUPANUP Application? Yes K No If yes, complete. tits following: CUPJVVUP No. 22, Latitude Longitude WGS 84 GP5 INap Survey Datum: MAD27 NAD83 23. Data Obtained From: !cefiFihatlamhoaTera!thetaPetty.IIalMCFaro,11;opavdedic a:aaidthatIamawaraofmy { heraCy cest�iY that3 wHl wmp!Yui!Ft Ilia apPGm61e rugs oiTit!c 40. FW.KLaAdm54StF2bvb code. and thai3 wd:ar Flat rna"vseain Or bandan Etus waL; or, F de;dfy thif i a+a pea pearAof anr';W reWWga Po�'t. U naadcd,bas Gam or w,n be obt*--d priorW cammencem�i o(nvll tW aS nj to t eowne 1h2t thm'mlWmatnn Ptwi:'d is acC�aas. aa�d 4� 1 ,5y;jo M caned egthe ted A0S fl1V cansuaeaan. 1 FunhorceAery thataa!nrwrnalion �aNded in this apphcalph6abl eau S any 3tt5t l wi!i OhlEtl- deg h,-ties ax slated abeve_ Uv Wp-aisnnLs ifl a!butinq PCriOPnel aFltsawh rO or Oe!egated Aultwriy ncxsc nacas5a al Pr t allies iadgral, Bata. a g merzR daPPt:ca m I e5msm pdFcat3vwa 19 'O"" . .._ � eF¢!a mnsm:ction. repak, mod�F.cxt nn, ar !a Ilw we:f si!e dujal7 NecOnstrttgWR, run. or abandw,mud a�dtw,szed by Ilus porm-t, Approval Granted By Fee Received s Receipt No. Ctteok No. THIS TATIVE OF THE PERMIT SHALL SE.AVAILAR E AT THE ERMIT IS NOT VALO UNI-IL tlUELL SrrE DURING ALL CONSSTRUAUTHORIZCTIONOFF?REF REPAIR, MfODIFICCER OR ATION, OR NMENT CET DEP Form: 62-532.9017)(1) Incorporated in 62.5324DD{7). F-A,C. Effective Date: October 7, 2010 OUj i Hydrologist Approval ift:Um I D Page t of