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®PY PERMIT q: 56-SF-2031320
STATE OF FLORIDA e APPLICATION s:AP1462612
.DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM
RECEIPT ]t:
DOCUMENT q: PR1301520
CONSTRUCTION PERMIT FOR: OSTDS New
APPLICANT: George & Helen Stefanakis
PROPERTY ADDRESS: TBD S Indian River Dr Fort Pierce, FL 34981
LOT: BLOCK: SUBDIVISION:
PROPERTY ID Q: 2436324-0003-000-1 [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 SeDtIc New CAPACITY
A [ ] GALLONS / GPD N/A CAPACITY
11 [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS 0[ ]DOSES PER 24 BRS #Pumps [
D [ 375 ] SQUARE FEET Dralnfield New SYSTEM
R [ ] SQUARE FEET N/A SYSTEM*
A TYPE SYSTEM: [x] STANDARD [ ] FILLED [] MOUND
I CONFIGURATION; [XI TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: Orange paint spot on NE corner of south neigt
I
DW atroad (house addressed
I ELEVATION OF PROPOSED SYSTEM SITE [ 15.00 1 [1 INCHES FT 111 ABOVE BELOW] BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 15,00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED: [ 0.00] INCHES _EXCAVATION REQUIRED: [ ] INCHES
The system Is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of
0 300 gpd.
T
E [Bottom of drainfield is not to exceed 30" below existing grade.
E
R
SPECIFICATIONS BY: Hunter A Collier TIT Environmental Specialist I
APPROVED BY: _Vy'\\A1_`I�J� �► aYX LTITLE: Environmental Specialist I St. Lucie CAD
am r A Cell ®r
DATE ISSUED: 02/04/2020 EXPIRATION DATE: 08/04/2021
ON 4016, 08/09 (Obsolete& all previous editions which may not be used)
Incorporated: 64E-6.003, PAC Page 1 of 3
v 1.1.4 AP1462612 SE1250963 2>w —%
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.
" .. SEE --A40 '61c-sF-ab_�13$
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2.' - 8 Indian River Nvid.Felt pief l FL'
%Nell Location -:Address, Road Name or Number; City -
3,2438'324.0003.0o0-1 -
'Pa1ceIIDNo. (PIN)'orAlternate Key (CirdeOne) - Lot, - Block Unit
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. 3; 772-490.0117 grAtt®ddlling�lbeliaeui0.[Iln
ater Well Contractor - 'License 4umber . •Telephone Nurn6eF - E-mall'Aedress
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` 7. 'Type of Work. '.0. C4r*hucgcn t3 Repair d Mod ration] Abandohnienl „
8. 'Number of Proposed Wells - •aeusP�s>ncs�* No'
9. 'Specify Intended Use(s) of Well(s):
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15'Pdmary Casing Material Block Steen Gid n@lopad .P11C- Stainless Steel•' '
_ Not Cased Other
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18,'Mathod of Construction, Repair. or Abandonment: I tiger Cable Tool. "- Jetted,, f=Rotiry ` Sortic ^
'Combination fTwo or More Methods) , Hant Driven,(Well Point, Send Paint) ^ Hydr`eullc'Polrn (Direct Push)
:Horizontal Drilling Plugged by Approved Me hod 'Other iocsze ,
19. Proposed Grouling Interval for the Primary. Secondary. an I Additiondicasing: '
From d ..To'. 1100 Seal Material( Bentonit sF-Ndat Cement Other
' From. To —. - . Seal Material( 'B"tonite Neat'Cernenr Other '....
From `•: To - Sea]Material(: Beritoa ' Neal Cement Other
From 'To - Seal:Motedal ( Bentonfici Neat Cement Other
" 20. Indicate total number of existing wells on site - - ".List number of existing unused wells on=sAdI
2VISt sA�ll'oren )dsanwellorwater.%NMdrawalomUe •merscontiguousproperty covered,undera�ConsumptivelWaler'Use Pennit(CUPANUP)
M, pliYes '✓ No, If yes complete the following: C IWUP No; - District WeS ID:No, -
22.Latitude '_ _: , _ -. Longitude) .Y." ... _ -. -
23. Date.Obtairted From: - GPS ' Map Surve -., - ° .Daturim; __NAD 27=MAD:83, ___WGS 84 _
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Fee Received 5. ..:: - Receipt Na - Cheek No
THIS PERMIT ISNOT VALID, UNTIL PROPERLY SIGNED BY ANA DRRED OFFICER OR,REPRESENTATiVE OFTHE WMD OR DELEGATED AUTHORITY. THE
PER'IIT SHALL 6EAVAILABLE AT THE WELL SITE DURING ALL NSTRUCYION.REPAIRSMOOiFICATION.'ORA9ANDDNMENTACTmYI8S. - -
DEP Fenn 62.5a2.Baa(1) Inmrporffieo.In e2-5a2.100(1). F,AC. Ea rm Qele OUaberT ?a1e., - Fuga l d7
*r .
4iK" St. Lucie Count Health Department
cn Y P
MOM 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: n 56 SF 2031320 BILL ooca•56-BID-4527560 CONSTRUCTION APPLICATION R: AP1462612
RECEIVED FROM: George & Helen Stefanakis AMOUNT PAID: $ 660.00
PAYMENT FORM: CHECK 7320 PAYMENT DATE: 01/17/2020
MAIL TO: George & Helen Stefanakis
FACILITY NAME:
PROPERTY LOCATION:
TBD S Indian River or
Fort Pierce, FL 34981
Lot: Block:
Property ID: 2436-324-0003.000-1
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-4267473
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STATE OF FLORIDA APPLICATION N AP1462612
DEPARTMENT OF HEALTH PERMIT # 5"F-2031320
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE1250963
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: George & Helen Stefenakis
CONTRACTOR / AGENT:
LOT:
BLOCK:
SUBDIVISION: ID#: 2436-324-0003-000-1
To BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MOST PROVIDE
REGISTRATION NUMBER AND SIGN AND SEAS EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.65 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 975.00 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 750.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
BENC@91RK/REFERENCE POINT LOCATION:
of south
ELEVATION OF PROPOSED SYSTEM SITE 15.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENC@IIARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: 100+ FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 90 FT NON -POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 13 FT POTABLE WATER LINES: 75 FT
SITE SUBJECT TO FREQUENT FLOODING?
10 YEAR FLOOD ELEVATION FOR SITE:
a zrctlm T.T' r Qlr v 1
[ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO]
FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
rUSDA SOIL SERIES:Paola sand
Munsell #/Color Texture
Depth
1 CYR 511
Sand
0 To 20
1 OYR 6/1
Sand
20 To 71
1 OYR 3/3
Sand
71 To 72
arms 7
-USDA SOIL SERIES:Paolo sand
Munsell #/Color Texture
Depth
10YR 4/1
Sand
0 To 12
10YR 5/1
Sand
12 To 28
10YR 6/1
Sand
28 To 72
OBSERVED WATER TABLE: INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE:
ESTIMATED WET SEASON WATER TABLE ELEVATION: 72 INCHES [ ABOVE / BELOW ]
HIGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]NO
[ PERCHED / APPAR= ]
EXISTING GRADE
DEPTH: 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
WSWr evaluated using USDA WSS and scll borings. No indicators observed throughout SB1 or SB2. SB1 15' above SM. S132 33"
above BM.
INCHES
SITE EVALUATED BY: li ``.., A A DATE: 01/31/2020
Collier, Hunter (TIUm Envlronmantal Specialist 1) (Florida Department of Health In St. L
DH 4015, 08/09 (obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1462612 EID2031320 v 1.0.2
APPLICANT'S NAME: C7Co Gli'!Ci /7G I" +/�cr
a/i�(�sn i
LEGAL DESCRIPTION: FoFreCe /Z� 24,q4
I certify that there are no potable private wells within 75 feet of the available area for the
proposed septic system, that there are no non -potable wells within 50 feet of the available area
for the proposed septic system, that there are no wells within 25 feet of a pesticide -treated
building foundation, that there are no public wells that serve less than 25 people or less than
15 homes or businesses within 100 feet of the proposed septic system, that there are no public
wells that serve more than 25 people or more than 15 homes or businesses within 200 feet of
the proposed septic system, that the water line from the water meter or well to the structure is
at least 10 feet from the available area for the proposed septic system unless the plans show
the line to be double sleeved, that there is not a gravity sewer line, low pressure sewer line or
vacuum sewage line in a public easement or right-of-way that abuts the property, that there
are no lakes, streams, wetlands, or surface water within 75 feet of the available area for the
proposed septic system unless the property was created prior to 1972, that the septic system is
proposed on the side of the lot farthest from surface water, that all private wells, septic
systems and surface water on adjacent or contiguous land within 75 feet of the applicant's lot
are shown on the site plan, that all public wells within 200 feet of the applicant's lot are
shown on the site plan, and that the location of building or residences, swimming pools,
recorded easements, paved areas or driveways, sidewalks, the general slope of the property,
filled areas, drainage features, and surface waters such as lakes, ponds, streams, canals, or
wetlands are shown on the applicants lot.
The natural grade elevation in the area of the proposed septic system and the benchmark must
be shown on the site plan. Please locate the benchmark within 200 feet of the proposed septic
system.
NOTE: MUST BE CERTIFIED BY A FLORIDA
REGISTERED SURVEYOR OR ENGINEER.
dnu-fiimtc'snptic45cpticAPPPPaec07
CL•RTIFIED BY:
FLORIDA P OFESSIONAL NO.:
DATE: JOB NO.: