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Home My WebLink AboutSewageSt, Lucie County: Health Department 51.50 NW Milner Dr Port Saint Lucie, FL. 3,4983 PAYING: ON: #:56-8,F2092719! BILL DOC #:56-BID-473694-3 CONSTRUCTION APPLI.CATIONt.AP1510.943 RECEIVED FROM: 434 21 st Street LLC AMOUNT PAID: $ 660.00,. PAYMENT ENT FORM: CHECK 1026 &162.7 PAYMENT DATE: 06/1912020 MAIL TO: (43421stStreet LI-C) FACILITY NAME 171 PROPERTY LOCATION: 5412 Deleon Ave Fod, Pierce, FL 94961 Lot: 13 160 Block: Property IQ: 1301.--6140 03*mOOG.4 EXPLANATION or.DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5100 -1 - Surcharge (All) 45.00 -1 - OSTDS Now Permit Surcharge 1 $ 100..00 -1 - OSTDS Construction Application and Plan ROVIeW,New 1 $ 100.00 123 - OSTDS Construction Site, Evaluation 1 $ 115.00 126 - OSTDS -Construction Permit (New or Mod, Amendment) $ 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: VanceMH AUDIT CONTROL NO. 56-PID-4.459581 STATE OF FLORIDA DEPARTMENT'OF REALTH ONSI.TE SEWAGE TREATMENT AND DISPOSAL 9TSTEM CONSTRUCTION PERMIT FOR: QSTD:S New APPLICANT (434 21at Street:LLC) PROPERTY ADDRESS: 5412 Deleon Ave Fort Pierce, FL 34951 LOT: 13 BLOCK., 16.0 SUBDIVISION: Lakewood Park PERMIT _# : WSF-209271.9 APPLICATION # AP1510943 DATE .PAID: FEE PAID: RECEIPT: DOCUMENT .#: PR1..3800.94 PROPERTY ID #: 1301-614-0103-Ot0-4 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] - [OR TAX ID NUMBER] AND .STANDARDS OF SEGTION SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE: WITH, SPECIFICATIONS 361.0065, F.S., AND CHAPTER 54E-6, F'A,C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERF0RMANC-9 FOR ANY SPECIFIC' PERIOD OF TIME, ANY CHANGE IN MATERIAL FACTS, ... .. FIHIGH 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 'WITit OTHER FEDERAL., STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT .OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 J GALLONS / GPD SeDtiC:new CAPACITY A [ ], GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR. CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ IGALLONS @[ ]DOSES PER 24 HAS #Pumps [ ] D [ 375 ] SQUARE FEET Drainfleld new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A..TYPE SYSTEM: [ ]. STANDARD [` ] FILMED [k] MOUND [ .] I CONFIGURATION: [X] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK.: Site BM. NID, CL of Rd, near -center of property I ELEVATION OF PROPOSED SYSTEM SITE [ 1.00 It I2iCHES FT I[ ABOVE BELOW]BENCHMARK/REFERENCE -POINT E BOTTOM OF..DRAINFIELD TO BE. ( 2.00 ][,INCHES FT ],[ABOVE .BELOW]BENCHMARK/REFERENCE POINT L D a T H E R REQUIRED: (19.Q01 INCHES EXCAVATION REQUIRED: [' 7 INCHES system is sized`for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 9pd.. SPECIFICATIONS BY: Brian ;Mram, TITLE: Environmental Specialist II APPROVED BY: TITLE: Environmental Specialist II St. Lucie CHD Brian J ngriam DATE ISSUED: 07/28/200 EXPIRATION DATE: 01/28/2022 DH 40161 08f09 (Obsoletes all previous editions which may not be used) Incorporated.: 64E-6.003', FAC Page 1 of 3 v 1.1.4 AP1510943 SE1338914 NOTICE OF RIGHTS A partywhosesubstantial interest is affected by this order .may petition for an i adm, nist 1 . , administrative hearing pursuant to sections 120.569 and -20,57, Florida . da Statutes. Such are governed by Rule 2 8-106i Florida, Administrative Code. A petition for administrative hearing must be lhwriting and Must be received by the. Agency Clerk for the Department, within. twenty-one (21): days from thereceipt :of this order; The address, of the Agency -Clorki,q.4052Bald Cypress Way, BIN: .A02,TE!Ildhasse.e,..F1'orida.32.399. The Agency Clerk's facsimile Medidtioh it'hot. available as an alternative, remedy. Your fcij!Ljrq to submit, a petit -ion: 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'.r Should this, order became a final order,, a, party who is adversely affected. by it is. entitled to judicial review pursuant to Section 120-69,, Florida Statutes- Review proceedings are governed'by'the Florida Rules of Appellate. Procedure Such proceedings � d, ngs may be commenced by filing one copy of a Notice of -Appeal with the Agency Clerk of the: Department of Health and a s . econd copy, accompanied by the filing fees required by law, with the Court of Appeal in the agpr6pfj8t0 District Court. The notice must be filed -wit - hin, 30 days of rendition of the final order. unty Health Department ElSt. Lucie Co rl" WE 5150 NW Milner Dr. Port Saint Lucie, FL 34983 HEALTH PAYING ON: #:.56r'SF-20927-19 BILL.Doc-#,56" . BID-4736943 60N$TRUCTION APPLICA.TION #: AP1 510943 RECEIVED FROM: 434 21st Streeit.1-LO: AMOUNT PAID:. $ 660=1. PAYMENT FORM: CHE:CK., 1:026 &1027 PAYMENT DATE: 061-1-9/2020 MAIL TO: (434 21.st Street LLC) FACILITY NAME -1710 OVI - G/ PROPERTY LOCATION: 5412 Deleon Ave. Fort Pierce, FL 349.51. 1-3 160 Lot: Block: Pro.perty fD- 1301-614-OfQ004 . M EXPLANATION or DESCRIPTION- QUANTITY FEE 128 - 08TIDS'ConstrUctibn System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 45.00 -1 - OSTDS: New Permit Surcharge 1 $ 100.00 -1 - OSTDS- Construction Application and Plan. Review,New 1 $ 100.0.0 123 - OSTDS Construction Site Evaluation 1 $ 115.00 1.26 - 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: VanceMH AUDIT CONTROL NO. 56-PID-4459581 w pS� -307 STATE OF FLORIDA PERMIT NO. �,- �-� - DEPARTMENT OF HEALTH DATE PAID-:..: ej; '? ONSITE SEWAGE TREATMENT AND 'DISPOSAL FEE PA115 LIU il.461 ,y SYSTEM: RECEIPT APPLICATION FOR CONSTRUCTION PERMIT G Oo"t'1 APPLICATION FOR., [.✓] New System ] Existing System [ ]. Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: 434 24 A Street LLC AGENT: TELEPHONE; 954-736-7418 MAILING ADDRESS:: 9111 E Bay ffarbor Dr 6f, Miami FL 33154 TO BE COMPLETED BY APPLICANT OR APPLICANT'$'AUTHORIZED AGENT: SYSTEMS MUST13E CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(at"") OR 4$9.552,.11ORIDA STATUTES IT I.S THE APPLICANT"S RESPONSIBILITY TO PROVIDE DOCU14ENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/M IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER .PROVISIONS. - PROPERTY INFORMATION LOT T3:. BLOCK: 160 sUBDivisioN`:- LAKEWOOD PARK -UNIT 12 PLATTED•: PROPERTY ID #: 13.0:1-614-0103-0004 ZONING: RS-4 I/M OR EQUIVALENT: [ Yes i PROPERTY SIZE: 0.27 ACRES WATER SUPPLY; [ ✓] PRIVATE . PUBLIC. [ 3<=2000GPD [. 1>2000GPD IS SEWER. AVAILABLE AS PER 381.0065,.FS? [ Yes ] DISTANCE TO SEWER: FT PROPERTY ADDRESS : .5412 Deleon Ave, Fort Pierce FL 349.51 DIRECTIONS TO PROPERTY. See attached 1ot location.. BUILDING INFORMATION Unit Type of No Establishment" 1 Single -Family. 2 3 [ ✓ ] RESIDENTIAL [ i COMMERCIAL No.. of Building Commercial/Institutional System Design Bedrooms Area Sq£.t Table 1, Chapter 64E-6,.FAC 3 N/A 4 ] Floor/Equipment_pay ins [ ] Other (Specify) SIGNATURE: DATE: 0610 2 1Zo?, DH.4015, 0 rObsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA APPLICATION # AP1510943 DEPARTMENT OF HEALTH PERMIT # 567SF-2092719 ONSITE SEWAGE TREATMENT AND DISPOSAL, SYSTEM DOCUMENT # SE13389.14.. SITE EVALUATION —AND SYSTEM SPECIFICATION APPLICANT, 4.34 21st Street LLC CONTRACTOR / AGENT: . 434 21;st :Street LLC LOT;: .1_3 BLOCK: 160' SUBDIVISION: Lakewood Park In#: 1301=614-0103-0004. TO BE COMPLETED BY ENGINEER,,. HEALTH DEPARTMENT 'EMPLOYEE.? OR. OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE RE623TRATION NUMBER_AND SIGN AND_$EAL EACH: PAGE OF: SUBMITTAL. COMPLETE. ALL ITEMS. PROPERTY SIZE CONFORMS TO :SITE PLAN. tX)=YE.S I ]NONET USABLE AREA AVAILABLE: '0,27 ACRES TOTAL MSTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES TAbLE1' /' OTHER TABLE 2, AUTHORIZED. SEWAGE FLOW: 4009 GALLONS PER DAY [ 1500, GPD/ACRE OR 2$00 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 100.0.00: SQFT UNOBSTRUCTED AREA REQUIRED: 750,00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site 8M. -NID,: CL of Rd, near.center of property ELEVATION OF -PROPOSED' SYSTEM SITE 1.:00 CINCHES. / FT ] [ABOVE /' BELOW ] SENCHMM/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN ME MAINTAINED FROM THE PROPOSED SYSTEM TO'THE FOLLOWING FEATURES SURFA= 'WATER e FT' DITCHES/SWALES: _.FT NORMALLY WET: [ - ]YES [.XINO WELLS: PUBLIC: FT LIMITED USE:, FT PRIVATE: 75 FT NON -POTABLE.: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINESt. 6ia FT SITE SUBJECT TO FREQUENT FLOODING? [ ]`YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NOj 10 YEAR FLOOD ELEVATION FOR. SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MS2./ NGVD SOIL PROFTLE INFORMATION SISE I SOIL PROFILE INFORMATION SITE 2 USDA SOIL -SERIES: Muns611#/Color Texture Depth 1 OYR V1 Sand 0 To 6 1 OYR 5/2 Sand . 6. fo 29 10YR 6/8 CMNORM.RF 23 Ta:29 10.YR 4/1 Sand. 29 To. 34 1 OYR 5/2 Sand 34 To: 5,1 10YR.5/4 .Sand. 51 T058' 10YR; 21z Spodip Material 58. Ta 62 REFUSAL Refusal 62 To 72 USDA SOIL SERIES: Murisell #/Color Texture Depth 10YR 5/2 Sand 0 To 9 10YR 4/1 Sand 9 Ta 3Q 1 OYR 5/2 Sand 23 To: 35. 10YR 42 Sand 35 To 55 10YR 5/3 Sand 6576 89 HOLE CAVING Refusal 59 To 72 OBSERVED WATER TABLE: 35.00 INCHES [ ABOVE / SELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER'TABLE ELEVATION; 23 INCHES [ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ]YES [ X ]NO MOTTLING: [ X ]'YES' [ ]NO DEPTH: 23.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80. DEPTH OF EXCAVATION: DRAINFIELD CONFIGURATION: [X ] TRENCH: [ .] BED [ ] OTHER (SPECIFY) r R$MARKS./ADDITIONAL. CRITERIA WSWT determined using USDA. W$S and soil borings.: 10YR5/2 stripping In 10Y.W. matrix>10% with diffuse boundaries starting at 23" in SB2. SB1 0" above BM. S1321" above-13M. SITE EVALUATED BY: Ingram, Br (Title: Envirojimental Specialist II) (ENVIRONMENTAL HEALTH) DH 4015, 00/09 (obsoletes previous editio 19 which may not be used) Incorporated: 64E-6.001; FAC AP1510943 EID2092719 INCHES DATE: 07/28/2020 Page 3 of 4 v 1.0.2