HomeMy WebLinkAboutHealth Department Septic Approval (2) PERMIT #:56-SF-1738905
APPLICATION #:AP1275226
STATE OF FLORIDA
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DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
...... ..... SYSTEM RECEIPT #:
DOCUMENT #:PRI 060633
CONSTRUCTION PERMIT FOR: OSTDS New File COPY
APPLICANT: Donald Glancy
PROPERTY ADDRESS: TBD Spring Hill Dr Jensen Beach,FL 34957
LOT: 5 Part of 6 BLOCK: 1 SUBDIVISION: Spring Hill
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID #: 4504-604-0012-000-0 [OR !kAX, 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 [ 1,050 ] GALLONS J GPD Septic new CAPACITY
A E I GALLONS J GPD N/A CAPACITY
N C I GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY ]GALLONS @E ]DOSES PER 24 HRS #Pumps E I
D E 500 1 SQUARE FEET Drainfield new SYSTEM
R E I SQUARE FEET N/A SYSTEM
A TYPE SYSTEM: [X] STANDARD FILLED E ] MOUND E I
I CONFIGURATION: EX3 TRENCH BED I I
N
F LOCATION.OF BENCHMARK: Site 13M painted X CL of rd center of property
I ELEVATION OF PROPOSED SYSTEM SITE E 24.00 ] [ INCHES FT ] E ABOVE BELOW]BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE .6.00 1 [� FT ] E ABOVE/ BELOW BENCHMARK/REFERENCE POINT
L
D FILL REQUIRED 1 0.00] INCHES EXCAVATION REQUIRED: INCHES
The system is sized for 4 bedrooms with a maximum occupancy of 8 persons(2 per bedroom),'for a total estimated flow of
0 400 gpd.
T T,he licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
H S.64E-6.013(3)(D,FAC.
MAX 30"DRAINFIELD COVER.
E
R I
.SPECIFICATIONS BY: Brian J Ingram TITLE: Environmental Specialist 11
APPROVED BY: 1-1—�- -—1� 3:TLE: Environmental Specialist 11 St. Lucie CED
Brian J TKram
2DATE ISSUED: 02/22/2017 EXPIRATION DATE: 08/22/2018
DH 4016, 08/09 (Obsoletes all previous editions which may not be used)
Incorporated: 64E-6.003, FAC Page 1 of 3
v 1.1.4 AP1275226 SE1024063
• STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, t 7 �•�•
REPAIR,MODIFY,OR ABANDON A WELL Permit No
_-.-
i-,,Southwest
'da Unlat$11)Flr
PLEASE FfL1,Otr ALL hPPLtCAB.
a Northwest (`Denotes Required Fietds Where Applicable) Permit Stipulations Required(See Attached)
I.Johns River
; South Florida rr sfom•�:dforntratt q the'e{mmi:aDo a;tion t vhe
ih.:skrm:.nr:,a:Far.Sn�r7re�etrz!,trxr�tstiattarht 82.524Quad Ncr Delineation No
USulmannee River apprur rcr.r�•fegateCc 34,�rfiy.=:t:e,rokscob e.
.3 DEP CUP1WtJP Avpu_tien No
Delegated Authority(If Applicable)
. .-
Donald Glancy 3832 N SW Bimini Circle Palin City, FI 34990
'Owner.Legal Name if Corporation 'Address -City 'State Zip Telephone Number
2.Spring Hill Drive Jensen Beach. FI 34957
'Well Location-Address,Road Name or Number,City
3,4504-604-0012-000-0 5&6
'Parcei ID No,(PIN)or Alternate Key(Circle One) Lot Block Unit
4,04 37S 41 E St Lucie Check if 62-524:[ Yes Rf No
'Section or Land Grant 'Township 'Range County Subdivision
5.James Paul Tyson 11352 954-818-4269 downthehole@att.net
'Water Well Contractor -License Number 'Telephone Number E-mail Address
6,PO BOX 861496 Port St. Lucie FI 34988
`Water Well Contractors Address City State ZIP
7. "Type of Work: 0 Construction f7 Repair I-] Nlodification[D Abandonment
8 'Number of Proposed Wells„ I ,__,__ finac tlerRa� rlatratv:c R^Lt��Mrttzni
9 'Specify Intended Use(s)of Well(s): atastMD
o
Domestic Landscape Irrigation Agricultural Irrigation Site investigations pp mo le
M
Bottled Water Supply Recreation Area irrigation P Livestock Monitoring
Public Water Supply(Limited Use/DOH) Nursery irrigation t Test FEB
�y Ari
Public Water Supply{Community or Non-Communityl(DEP) CornmercialtIndustrial Earth-Coupled Geothermal C o 2 G 2��a
Class I Injection I Golf Course Irrigation HVAC Supply
r-i HVAC Return
Class V Injection:t....l Recharge M Commerciatlindustrial Disposal Aquifer Storage and Recovery[J Drainage
Remediation:M Recovery[3 Air Sparge Q Other 'Ors—) Domn-st�>tt6>%CoU ty
Other mesaa s& , E � L F1
T
10,"Distance from Septic System if t 200 fL -r)' 11,Facili, Description r-o ose est encs 12.Estimated Start Date
`� .
13.'Esianated Well Depth ft., }'Estimated Casing Depth"�ft_ . Primary Casing Diameter in, Open Note: From To— ft,
14.Estimated Screen Interval.Fro m'f To
15."Primary Casing Material. Black Steel Galvanized � .P Stainless Steel
Not Cased Other: _
16 Secondary Casing: Telescope Casing Liner Surface Casing Diameter in.
17.Secondary Casing Material: Back Steel Galvanized PVC Stainless Steel Other
18.*Method of Construction.Repair,or Abandonment Auger Cable Tool Jetted Rotary,, Sonic
Combination{Two or More Methods} Nand Driven en{bYeli Point.Sand Point) Hy au IFoint(Direct Push)
Horizontal Drilling Plugged by Approved Method Other iDawnbq)
133.PrapOseQ G:outi{ig;nla I for the Primary.Secondary.and Adq�ii naf Gigging:
From To r Beal Material( Bentonite iert Other )
From To Seel Material( Bentonite Neat Cement Other I
From To Seal Material{ Bentonite Neat Cement Other }
From To Seal Material{ Bentonite Neat Cement Other )
20.Indicate total number of existing wells on site_ -0 _ List number of existing unused wells on site
21 'Is this well or any existinwell or water withdra cn the owner's contiguous property�covered under a Consumptive/Water Use Permit(CUPMfUP)
or CUPh"UUP Application. Yes L No If yes,complete the following:CUPIWUP No. District Well ID No.
22.Latitude Longitude
23,Data Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84
+rveuy cX,ay"Ua wa l -py aa:tr.aPpv +"_'a ra..,t,,,c+a,nz+ .+e:,�aeau.,�^.nn Cx:o,;w r:-u a.,xte� ea;�r,^.st a-t".;u va+uN:cr p^r PZTwrf rm ter.vN.atr r.+r Fzv.a.�!s accxmm.ma c.as r s sates cf my
nt GT--'+t v an[.erir+ecius9s Pe 't.d rsWt .res t"nr.4z tx.M;,-r.+.+t�.r_rtn, :,eS wr.7 :at7»>="_actas iasrtr Chzi-"-r 3:S Vk wa Las.:Rat::auram n ps�»=°y cdua.n;^.s wor m t c-toy s" —
, 60tk:J1G6 1 f•a^11er CC:4(RCi.c7 K:.brrffi1't p0lUCO to 4:¢6 i0iz'terlrl a t'.G,:a.@ tr;di R:3`.I N.14L".3:0 Pte'E}1^nl`rffi k"",4 Cr.-rxr,li»t iiC tl`'.M'r.^�'a�i.:fiJfS'S^C rtF 3R.+«w�a.i�.13hRi k 63Y�um*s:,Mi61.'^.!O,Y:Vtx Af a'zK
r�_y t,grm.r k"ane tulmal.are J;>-.rr jywtftlw Cs.a f+rre to pf4,,34 2,."4 rgyara;�z4a as iJ.:.ut ax+a.Cm'et cem stG!+i cbwc�;eenor.•+at a:::.t:1D er Da"egairo A.Erur,rr�.aYa
;sas�y:n ttGMfa�Se ik,t,w•n:.:x7 S6 Gsyb a".ert�rr:zcba eFC.¢G.tt3me,.'�,rc,i>mxr::,rr.»r.ar xt.^,ea s:�a .., Yes_ ••xexrc.xr r�.:•crt,ccr xs^a��-�^�-t a�hcrkraa Eri C,s�c�
anwfw:.ra�ev:�'cd py l<;es Pt^yl to tMt Dccrit ev+a1Un»n<f'rrar trc:r.rs,R
11 352
SIOnature of contractor 'Lioensa No. Signature of Uvmeror Agent 'Date
A.pprovai Granted fay 22 _.. ✓+ Issue Date fiG ,7 Expiration Date 1/,ZZ/11 Hydrologist Approval
ta1ta s
Fee Recowea 5 Rece,r:f No Cheek No
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTAnVE OF THE It=OR DELEGATED AUTHORITY THE
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DUPING ALL CONSTRUCTION,REPAIR.MODIFI(7,ATION,OR ABANDONMENT ACTIVITIES
nFP Frvrm Fa_sa)anni kt itunrrvntn!Ari'in AMZ3 .Anel I F A C. >^tjrrr;.ra rat;;-tlnnhur 7 2010 Pann i W-2
40 STATE OF FLORIDA PERMIT NO,5e f°7c�S`25
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT G o
APPLICATION FOR:
EX New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: e,5 r, I 1AAA 1A
AGENT: A46,4,c, L1.tM�� (�;I1S Jd- �lt. C . TELEPHONE:
MAILING ADDRESS:gZy t(�l F, ���7fb� .�t ���3 �etMn,� �'� • GeD+^Yl
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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.
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PROPERTY INFORMATION
LOT: a�n BLOCK: SUBDIVISION: sprilic, (-Jl L'/ PLATTED: `
PROPERTY ID #: 479(-)q- --OO)'1-000 "6 ZONING: I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: 0.3 ACRES WATER SUPPLY: [<] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /� DISTANCE TO SEWER: FT
PROPERTY ADDRESS:
DIRECTIONS TO PROPERTY: g12
BUILDING INFORMATION I ] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, 'FAC
1
2
3
4
I Floor/Equipment Drains [ ] Other (Specify)
SIGNATURE: DATE: Z
DH 4015, 08/09 (Ob lets previo s ditions which may not be used)
Incorporated 64E-6.0 AC Page 1 of 4
STATE OF FLORIDA PERMIT
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
WIL
'.� 0SITE. EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT:4��� ll.tQi�Ul�oQQ cS G�C -+ LI AGENT: �'f rcy��/�- L 1241clo
LOT:.5� PJ 10 BLOCK: SUBDIVISION: SR n i'l l;
,PROPERTY ID #: 45og � Wq-OD Z,,_000- b [Section/Township/Parcel No. or Tax ID Number]
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: 91 YES [ ] NO NET USABLE .AREA AVAILABLE: 0 1�3 ACRES
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES-TABLE 1/OTHER-TABLE23
AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE]
UNOBSTRUCTED AREA AVAILABLE: ,/ SOFT ] UNO`BSTRUCTED AREA REQUIRED: SOFT
BENCHMARK/REFERENCE POINT LOCATION:_ 4- 7,00 rI fL Kno a k4
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES/FT] [ABO /BELOW BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: )0 0 FT DITCHES/SWALES: )'b FT NORMALLY WET? [ ] YES [A NO
WELLS: PUBLIC:-L40 FT LIMITED USE: 100 FT PRIVATE: FT NON-POTABLE: -S-0 FT
SIIILDING FOUNDATIONS: i FT PROPERTY LINES: FT POTABLE WATER LINES: /06 FT
SITE SUBJECT TO FREQUENT FLOODING: I ] YES Eg NO 10 YEAR FLOODING? [ ] YES NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
MIINSELL #/COLOR TEXTURE DEPTH MUNSELL #/COLOR TEXTURE DEPTH
TO TO
TO TO
TO TO
TO TO
TO TO
TO TO
TO TO
TO TO
TO TO
USDA SOIL SERIES: USDA SOIL SERIES:
,OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ABOVE / BELOW] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES
-DRAINFIELD CONFIGURATION: [ ] TRENCH KI BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA:
SITE EVALUATED BY: DATE:
DH 4015, 08/09 (obeoietes previous editions which may not be used) Incorporated: 64E-6.001,FAC Page 3 of 4
STATE OF FLORIDA APPLICATION # AP1275226-
. pry. DEPARTMENT OF HEALTH PERMIT # 56-SF-1738905
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
DOCUMENT # SE1024063
SITE EVALUATION AND SYSTEM SPECIFICATION
APPLICANT: Donald Glancy
CONTRACTOR / AGENT: Atlantic Land Design
LOT: 5 Part of 6 BLOCK: 1
SUBDIVISION: Spring Hill ID#: 4504-604-0012-000-0
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: 0.33 ACRES
TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY [ RESIDENCES-TABLET / OTHER-TABLE 2 ]
AUTHORIZED SEWAGE FLOW: 495.01 GALLONS PER DAY [ 3.500 GPD/ACRE OR 2500 GPD/ACRE ]
UNOBSTRUCTED AREA AVAILABLE: 770.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT
BENCHMARK/REFERENCE POINT LOCATION: Site BM painted X CL Of rd center Of property
ELEVATION OF PROPOSED SYSTEM SITE 24.00 [ INCHES / FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES
SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO
WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON-POTABLE: FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 25 FT
SITE SUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]N0]
10 YEAR FLOOD ELEVATION FOR SITE: FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
USDA SOIL SERIES:St. Lucie sand USDA SOIL SERIES:St. Lucie sand
Munsell#/Color Texture Depth Munsell#/Color Texture Depth
10YR 5/1 Sand 0 To 11 1 OYR 5/1 Sand 0 To 16
10YR 7/1 Sand 11 To 72 1 OYR 8/1 Sand 16 To 72
•OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPANT ]
ESTIMATED WET SEASON WATER TABLE ELEVATION: 72 INCHES [ ABOVE / BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ]YES [X ]NO MOTTLING: [ ]YES [X]NO DEPTH: 72.00 INCHES
_SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [X] TRENCH [ ] BED [ ] OTHER (SPECIFY)
REMARKS/ADDITIONAL CRITERIA
WSWT determined using USDA WSS,soil borings,and local topographic knowledge.
No observed water table.No WSWT indicators.
SB1 19"above BM.SB2 24"above BM.
SITE EVALUATED BY: DATE: 02/15/2017
Ingram,BOA`(Title:Environmental Specialist II)(ENVIRONMENTAL HEALTH)
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4
AP1276226 EID1738906 v 1.0.2